title: Non-Hodgkin lymphoma as a cause of obstructive jaundice with simultaneous extrahepatic portal vein obstruction: a case report.
abstract: Non-Hodgkin lymphoma is a rare cause of biliary obstruction. To the best of our knowledge, non-Hodgkin lymphoma in the peripancreatic region causing obstructive jaundice with simultaneous portal vein (PV) invasion has not yet been reported. We present a 50-year-old patient with obstructive jaundice whose extrahepatic portal vein was obstructed by the invasion of a peripancreatic non-Hodgkin lymphoma. The patient denied any other symptoms such as recurrent fever, night sweat and loss of body weight. Computed tomography (CT) revealed a 10 cm mass in the retroperitoneal space behind the head of the pancreas causing obstruction of the distal bile duct and the PV. A pylorus-preserving pancreaticoduodenectomy combined with a PV resection was performed. The PV was reconstructed using an autologous right internal jugular vein graft. The resected specimen showed endoluminal invasion of both the bile duct and the PV. Histological examination showed the mass consisting of diffuse sheets of large malignant lymphoid cells. These cells were positive for CD20 and CD79a, partially positive for CD10, and negative for CD3, CD4, CD5, CD8 and CD30. The pathologic diagnosis was diffuse large B-cell type non-Hodgkin lymphoma and the patient was transferred to the Department of Hematology and Oncology for chemotherapy. He received four cycles of combined chemotherapy including cyclophosphamide, doxorubicin, vincristine and prednisone plus rituximab, and three cycles of intrathecal chemoprophylaxis including methotorexate, cytosine arbinoside and prednisone. The patient is alive with no evidence of the disease for 7 mo after operation and will receive additional courses of chemotherapy.
authors.affiliation: Department of Surgery, Tokyo Metropolitan Bokutoh General Hospital, 4-23-15 Kohtohbashi, Sumida-ku, Tokyo 130-8575, Japan. hashimom-tky@umin.ac.jp
authors.forename: Masao
authors.initials: M
authors.lastname: Hashimoto
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Umekita
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Noda
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols; D001652:Bile Ducts / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D007601:Jugular Veins / Q000637:transplantation; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D016577:Pancreaticoduodenectomy; D011169:Portal Vein / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome