CASE REPORTS   

Chirurgia 2013 February;26(1):37-9

Copyright © 2013 EDIZIONI MINERVA MEDICA

language: English

Atypical presentation of a large B-cell lymphoma: cholestatic jaundice associated with peritoneal carcinomatosis

Dioscoridi L., Maltinti G., Bechi P.

Second General and Emergency Surgery Unit, Careggi Hospital, Florence, Italy

The non-Hodgkin’s lymphomas, of which the large B-cell lymphoma (diffuse large cell lymphoma, DLCL) is the most common form, may present with many different clinical features. Its possible gastro-intestinal symptoms include abdominal pain, dyspepsia, changes in bowel habits, gastrointestinal bleeding, urinary symptoms and obstructive jaundice. In the present paper an observation of DLCL presenting with a cholestatic jaundice is reported. In our surgical unit due to the clinical picture, the common blood counts, a complete abdominal U.S. and an abdominal CT scan with contrast medium were performed. CT scan documented a localized hypodensity with the diameter of 2 cm at the level of the terminal portion of the common bile duct inseparable from the duodenum and the head of the pancreas, probably determined by the presence of a solid neoplasm of the pancreatic head or of the second duodenal portion. Associated with this finding, the CT scan showed multiple peritoneal nodularities suggestive for carcinomatosis. The biopsies performed during a following ERCP led to the diagnosis of large B-cell lymphoma with a high proliferation index of follicular origin. In order to complete the diagnostic and staging processes, a bone-marrow biopsy and a FDG-PET were performed.