Diffuse large B-cell lymphoma of the gallbladder with hepatoduodenal invasion exhibiting a necrotic tendency.

IF 0.8 Q4 GASTROENTEROLOGY & HEPATOLOGY
Clinical Journal of Gastroenterology Pub Date : 2024-12-01 Epub Date: 2024-09-10 DOI:10.1007/s12328-024-02034-6
Hironao Matsumoto, Shunsuke Horitani, Yutaro Tokutomi, Masataka Kano, Masahiro Orino, Kanehiko Suwa, Masahiro Takeo, Toshiyuki Mitsuyama, Takeshi Yamashina, Masaaki Shimatani
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引用次数: 0

Abstract

We report a case of diffuse large B-cell lymphoma (DLBCL) of the gallbladder with extensive hepatoduodenal invasion, which was challenging to diagnose histologically due to a strong tendency to be necrotic. An 71 year-old man presented with upper abdominal pain and was referred to our hospital. Computed tomography revealed a distended gallbladder with air within the irregular gallbladder wall and an indistinct border with the hepatoduodenum, suggesting invasion. Esophagogastroduodenoscopy detected an ulceration in the duodenal bulb. However, histologic analysis failed to provide a definitive diagnosis due to the presence of necrotic tissue. Furthermore, direct biopsy from the gallbladder mucosa by endoscopic retrograde cholangiography revealed only necrotic tissue and no diagnosis. Contrast ultrasonography for the hepatic invasion revealed enhancement with blood flow, suggesting non-necrotic tissue. Subsequently, an ultrasound-guided core-needle biopsy was conducted to obtain tissue samples from the described lesion. The pathology showed atypical lymphocytes with irregular nuclei. Immunostaining indicated positive expression of CD10, CD20, Bcl-6, and C-Myc, consistent with a diagnosis of DLBCL. In our case, the lymphoma exhibited a strong tendency to be necrotic, making histologic diagnosis difficult. However, selective biopsy from the site of blood flow made the diagnosis possible and proved to be useful.

胆囊弥漫大 B 细胞淋巴瘤,伴有肝十二指肠侵犯,呈坏死倾向。
我们报告了一例胆囊弥漫大 B 细胞淋巴瘤(DLBCL)病例,该淋巴瘤伴有广泛的肝十二指肠侵犯,由于极易坏死,组织学诊断具有挑战性。一名 71 岁的男子因上腹疼痛而被转诊至我院。计算机断层扫描显示胆囊胀大,不规则的胆囊壁内有空气,与肝十二指肠的边界模糊不清,提示有侵犯。食管胃十二指肠镜检查发现十二指肠球部有溃疡。然而,由于存在坏死组织,组织学分析未能提供明确诊断。此外,通过内镜逆行胆管造影术从胆囊粘膜直接取活检,发现只有坏死组织,无法确诊。肝脏受侵部位的对比超声波检查显示有血流增强,提示非坏死组织。随后,在超声引导下进行了核心针穿刺活检,以获取所述病变的组织样本。病理结果显示淋巴细胞不典型,核不规则。免疫染色显示 CD10、CD20、Bcl-6 和 C-Myc 阳性表达,与 DLBCL 诊断一致。在我们的病例中,淋巴瘤有很强的坏死倾向,因此很难进行组织学诊断。然而,从血流部位进行选择性活检使诊断成为可能,并证明是有用的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Clinical Journal of Gastroenterology
Clinical Journal of Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
2.00
自引率
0.00%
发文量
182
期刊介绍: The journal publishes Case Reports and Clinical Reviews on all aspects of the digestive tract, liver, biliary tract, and pancreas. Critical Case Reports that show originality or have educational implications for diagnosis and treatment are especially encouraged for submission. Personal reviews of clinical gastroenterology are also welcomed. The journal aims for quick publication of such critical Case Reports and Clinical Reviews.
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