P0177 - B-Cell Lymphoma Disguised as Biliary Obstruction: A Rare Presentation

Sasha Singh, DO¹, Matthew Sutherland, DO², Ashish Shah, MD², Brandon Segrest, DO^2
1Riverside Medical Center, Bourbonnais, IL; ²Riverside Medical Center, Kankakee, IL

Introduction: Non-Hodgkin’s lymphoma (NHL) accounts for 1% - 2% of all cases of malignant biliary obstruction. Hepatobiliary involvement by malignant lymphoma is usually a secondary manifestation of systemic lymphoma and rarely presents as obstructive jaundice. A minute percentage of adults with NHL have been shown to have biliary obstruction due to their malignancy. Here we present a case of obstructive jaundice later diagnosed as Diffuse Large B-Cell lymphoma.

Case Description/Methods: A 64-year-old female with family history of pancreatic cancer in father diagnosed at age 55 presented to the emergency department for evaluation of nausea, postprandial abdominal pain,and jaundice for the past month. Right upper quadrant tenderness was noted on physical exam. Workup was notable for elevation in liver function tests and bilirubin. Ultrasound imaging showed a dilated common bile duct of 10 mm and gallbladder sludge without no definitive choledocholithiasis noted. CT was concerning for lymphadenopathy within the abdomen and pelvis involving multiple locations suggestive of lymphoma.Mild intrahepatic biliary ductal dilation with abrupt cut off adjacent to enlarged lymph nodes were noted as well as a 1 cm hypodense lesion in the tail of pancreas. Subsequent EUS showed a psueodocyst in the body of the pancreas as well as large peri-portal lymph node measuring 21 mm x 14 mm in maximal diameter which extrinsically compressed the common bile duct. the bile duct was dilated to 9 mm with evidence of a long mid to distal stricture with a soft tissue density at the level of the peri-portal lymph node which may have represented sludge vs mass within the duct. Subsequent ERCP completed for biliary stent placement. Fine needle aspiration from EUS resulted in pathology confirming diffuse large B cell lymphoma. The patient was started on chemotherapy therapy with hematology/oncology.

Discussion: Obstructive jaundice is a rare disease presentation of NHL. Despite rare occurrences, NHL needs to be considered in the differential diagnosis while taking care of patients with obstructive jaundice. Treatment of biliary obstruction due to lymphoma is controversial regarding chemotherapy alone versus biliary drainage preceded by chemotherapy. Biliary drainage is recommended in patients with infectious complications. With increasing evidence of NHL presenting as obstructive jaundice, better formulation of treatment guidelines is needed.



Disclosures:


Sasha Singh, DO¹, Matthew Sutherland, DO², Ashish Shah, MD², Brandon Segrest, DO². P0177 - B-Cell Lymphoma Disguised as Biliary Obstruction: A Rare Presentation, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.