Gastric outlet obstruction and obstructive jaundice as the first symptoms of primary duodenal lymphoma


Authors: H. Naeem
Authors‘ workplace: Gastroenterologické oddělení, Nemocnice Tábor, a.  s.
Published in: Gastroent Hepatol 2016; 70(4): 340-345
Category: Digestive Endoscopy: Case Report
doi: 10.14735/amgh2016340

Overview

Primary non-Hodgkin’s lymphoma of the duodenum is an uncommon primary tumor of the gastrointestinal tract. Diffuse large cell lymphoma of B-cell origin is currently recognized as the predominant histological type of primary extra-nodal lymphoma arising at a gastrointestinal site. There have been few reports of duodenal lymphoma presenting as gastric outlet obstruction and obstructive jaundice. Here, we report a case of a 59-year-old previously healthy male, who presented at our department with vomiting, anorexia, and obstructive jaundice. Primary lymphoma of the duodenum was found to be the cause of biliary obstruction and gastric outlet obstruction, which was confirmed by endoscopic biopsy. Histopathology also showed diffuse large B-cell lymphoma. This case demonstrates that gastric outlet obstruction with obstructive jaundice, although rare, can be a presenting symptom of duodenal lymphoma.

Key words:
duodenum – diffuse B cell lymphoma – gastric outlet obstruction – obstructive jaundice

The author declares he has no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

 Submitted:
19. 12. 2015

Accepted:
27. 2. 2016


Sources

1. Isaacson P, Wright DH. Malignant lymphoma of mucosa-associated lymphoid tissue. A distinctive type of B-cell lymphoma. Cancer 1983; 52(8): 1410– 1406.

2. Bozdag AD, Nazli O, Tansug T et al. Primary tumors of the small bowel: dia­gnosis, treatment and prognostic factors. Hepatogastroenterology 2003; 50 (Suppl 2): 216– 218.

3. Woo KH, Kim JH, Yoon SB et al. Duodenal mucosa as­sociated lymphoid tis­sue lymphoma: a case report. Korean J Intern Med 2007; 22(4): 296– 299.

4. Schottenfeld D, Beebe-Dim­mer JL, Vigneau FD. The epidemiology and pathogenesis of neoplasia in the small intestine. Ann Epidemiol 2009; 19(1): 58– 69. doi: 10.1016/ j.an­nepidem.2008.10.004.

5. Rosas Marcos E, Frisnacho Velarde O, Yábar Ber­rocal A. Malignant duodenal neoplasia: clinical-pathologic profile. Rev Gastroenterol Peru 2003; 23(2): 99– 106.

6. Jaffe ES, Harris NL, Stein H et al. Classification of lymphoid neoplasms: the microscope as a tool for disease discovery. Blood 2008; 112(12): 4384–4399. doi: 10.1182/blood-2008-07-077982.

7. Garrido A, Luque A, Vázquez A et al. Primary small bowel neoplasms as a complication of celiac disease. Gastroenterol Hepatol 2009; 32(9): 618– 621. doi: 10.1016/ j.gastrohep.2009.05.003.

8. Marsh MN. Studies of intestinal lymphoid tis­sue. XI –  The im­munopathology of cel­l-mediated reactions in gluten sensitivity and other enteropathies. Scan­n­ing Microsc 1988; 2(3): 1663– 1684.

9. Mundasad B, Hawe M. Lymphoma pre­sent­ing as a bleeding duodenal ulcer: a case report. The Internet Journal of Tropical Medicine 2005; 3(1): 1– 3.

10. Gumaste VV, Bhutani MS, Dunphy RC et al. Esophageal Lymphoma. [online]. Available from: http://emedicine.medscape.com/article/174662-overview.

11. Wang HH, Lin JT, Chiu CC et al. Endoscopic features of mucosa-as­sociated lymphoid tis­sue lymphoma of the duodenum. Gastrointest Endosc 1995; 41(3): 258– 261.

12. Isaacson P, Wright DH. Malignant lymphoma of mucosa-associated lymphoid tis­sue. A distinctive type of B-cell lymphoma. Cancer 1983; 52(8): 1410– 1406.

13. Nagashima R, Takeda H, Maeda K et al. Regression of duodenal mucosa-as­sociated lymphoid tis­sue lymphoma after eradication of Helicobacter pylori. Gastroenterology 1996; 111(6): 1674– 1678.

14. Tsuji K, Katanuma A, Mori M et al. Clin­ical study of MALT lymphomas and related diseases of the duodenum representing characteristic findings. Gastroenterol Endosc 1996; 38: 1931.

15. Yoshida T, Lesato Y, Yokomori T et al. A case of primary MALT lymphoma of the duodenum. Jpn J Gastroenterol Surg 1966; 29: 452.

16. Leone N, Brunel­lo F, Baronio M et al. High grade B-cell lymphoma aris­ing in mucosa-as­sociated lymphoid tis­sue of the duodenum. Eur J Gastroenterol Hepatol 2002; 14(8): 893– 896.

17. Rahman S, Reyes E, Mehta A et al. Primary duodenal lymphoma presenting as obstructive jaundice. Internet J Gastroenterol 2009; 7(2): 1– 4.

18. Bandyopadhyay SK, Moulick A, Dutta A.Primary duodenal lymphoma produc­ing obstructive jaundice. J As­soc Physicians India 2007; 55: 76– 77.

19. Peter U, Honegger H, Koelz HR. Obstructive jaundice caused by primary duodenal lymphoma case report and review of the literature. Digestion 2007; 75(2– 3): 124– 125. doi: 10.1159/ 000104828.

20. Hof­fart HE. Duodenal malignancies differential diagnosis and therapeutic aspects. Langenbecks Arch Chir 1985; 366: 539– 543.

21. Marsh MN. Studies of intestinal lymphoid tis­sue. XI –  The im­munopathology of cel­l-mediated reactions in gluten sensitivity and other enteropathies. Scanning Microsc 1988; 2(3): 1663– 1684.

22. Beaton C, Davies M, Beynon J. The management of primary small bowel and colon lymphoma –  a review. Int J Colorectal Dis 2012; 27(5): 555– 563. doi: 10.1007/ s00384-011-1309-2.

23. Tomíška M, Vášová I. Současná terapie primárního lymfomu gastrointestinálního traktu. Klin Farmakol Farm 2004; 18: 153– 159.

24. Ruskoné-Fourmestraux A, Aegerter P, Delmer A et al. Primary digestive tract lymphoma: a prospective multicentric study of 91 patients. Groupe d’Etude des Lymphomes Digestifs. Gastroenterology 1993; 105(6): 1662– 1671.

25. Dotan E, Aggarwal C, Smith MR. Impact of rituximab (rituxan) on the treatment of b-cell non-Hodgkin’s lymphoma. P T 2010; 35(3): 148– 157.

26. Kondo N, Furuya H, Yamamoto S et al. Dif­fuse large B-cell lymphoma in the ampul­la of vater caus­ing obstructive jaundice: report of a case. Surg Today 2008; 38(1): 76– 80.

27. Najem AZ, Porcaro JL, Rush BF Jr. Primary non-Hodgkin’s lymphoma of the duodenum. Case report and literature review. Cancer 1984; 54(5): 895– 898.

Labels
Paediatric gastroenterology Gastroenterology and hepatology Surgery

Article was published in

Gastroenterology and Hepatology

Issue 4

2016 Issue 4

Most read in this issue

This topic is also in:


Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account