J Korean Med Sci.  2009 Oct;24(5):956-959. 10.3346/jkms.2009.24.5.956.

Primary Biliary Lymphoma Mimicking Cholangiocarcinoma: A Characteristic Feature of Discrepant CT and Direct Cholangiography Findings

• Yoon MA
• Lee JM
• Kim SH
• Lee JY
• Han JK
• Choi BI
• Kim SW
• Jang JJ

• KMID: 1782022
• DOI: http://doi.org/10.3346/jkms.2009.24.5.956

Abstract

Primary non-Hodgkin's lymphoma arising from the bile duct is extremely rare and the reported imaging features do not differ from those of cholangiocarcinoma of the bile duct. We report a case of a patient with extranodal marginal zone B-cell lymphoma of mucosa associated lymphoid tissue (MALT), who presented with obstructive jaundice and describe the distinctive radiologic features that may suggest the correct preoperative diagnosis of primary lymphoma of the bile duct. Primary MALT lymphoma of the extrahepatic bile duct should be considered in the differential diagnosis when there is a mismatch in imaging findings on computed tomography or magnetic resonance imaging and cholangiography.

Keyword

Lymphoma; Bile Ducts, Extrahepatic; Magnetic Resonance Imaging; Tomography, Spiral Computed; Cholangiography

MeSH Terms

Bile Duct Neoplasms/complications/*diagnosis/radiography
*Bile Ducts, Extrahepatic
Cholangiocarcinoma/diagnosis
Cholangiography
Diagnosis, Differential
Humans
Jaundice, Obstructive/complications/diagnosis
Lymphoma, B-Cell, Marginal Zone/complications/*diagnosis/radiography
Magnetic Resonance Imaging
Male
Middle Aged
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Radiological images and gross finding of the primary mucosa-associated lymphoid tissue lymphoma of the extrahepatic bile duct. (A) Axial contrast-enhanced CT scan obtained during portal venous phase shows thickening of the left intrahepatic duct (arrow) and subtle thickening of the right anterior segmental intrahepatic duct (arrowhead) as well as dilatation of the intrahepatic bile duct. (B) Axial CT scan shows circumferential wall thickening of the proximal extrahepatic bile duct (arrow). Note the homogeneous enhancement of the thickened bile duct wall. (C) Axial CT scan at the level of distal extrapancreatic CBD shows marked thickening of the bile duct (arrow). Note that the bile duct lumen is not seen. (D) Cholangiography from the ERCP shows mild and smooth luminal narrowing of proximal (arrow) and distal (open arrow) extrahepatic bile duct and the proximal portion of the right posterior segmental intrahepatic bile duct (arrowhead) with upstream ductal dilation. Note. Black arrow=pancreatic duct. (E) Coronal gadolinium-enhanced T1-weighted MR image of the portal phase (acquired after ERBD tube insertion) shows long, segmental wall thickening (arrows) of the extrahepatic bile duct with homogeneous enhancement. (F) Gross specimen shows diffuse wall thickening of the extrahepatic bile duct (arrows) with smooth inner and outer surfaces.

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