Diffuse Large B-Cell Lymphoma Mimicking Cholangiocarcinoma A Rare Cause of Obstructive Jaundice in a Young Patient

Introduction

Obstructive jaundice is commonly linked to bile duct cancers such as cholangiocarcinoma, but rare diseases can sometimes present with nearly identical symptoms and imaging findings. A fascinating case report recently highlighted how Diffuse Large B-Cell Lymphoma (DLBCL) closely mimicked cholangiocarcinoma in a young male patient, creating significant diagnostic challenges. Visit https://www.gastrohepatoljournal.com for more groundbreaking research in gastroenterology, hepatology, and clinical medicine.

Understanding the Rare Presentation of DLBCL

Diffuse Large B-Cell Lymphoma is one of the most common forms of non Hodgkin lymphoma, yet involvement of the bile duct remains extremely rare. In this unusual case, a 31-year-old man presented with symptoms typically associated with biliary tract cancer, including

• Progressive jaundice
• Dark urine
• Clay-colored stool
• Severe itching
• Epigastric pain
• Weight loss and low BMI

Initial CT imaging suggested cholangiocarcinoma due to a liver lesion causing biliary obstruction and portal vein involvement. However, further diagnostic evaluation revealed a completely different underlying disease.A detailed analysis can be found in the available at: https://doi.org/10.29328/journal.acgh.1001031

Diagnostic Challenges in Biliary Lymphoma

One of the most important lessons from this study is the difficulty in distinguishing biliary lymphoma from cholangiocarcinoma through imaging alone.

Key Diagnostic Findings

• CT scan showed a hypodense liver lesion with delayed enhancement
• ERCP demonstrated a tight mid-common bile duct stricture
• Endoscopic ultrasound-guided biopsy identified lymphoproliferative disorder
• Core needle biopsy ultimately confirmed DLBCL
• The case emphasizes the importance of tissue diagnosis before major surgical intervention.
• The American Cancer Society highlights that early and accurate diagnosis of lymphoma is essential because treatment strategies differ significantly from solid organ cancers.

Why This Case Matters Clinically

Although both diseases may present similarly, their management differs dramatically. In this patient, PET scan staging confirmed Ann Arbor Stage I lymphoma, and treatment with R-CHOP chemotherapy achieved complete remission with normalization of liver function tests.

The Role of Advanced Endoscopic Techniques

Modern gastroenterology increasingly relies on minimally invasive diagnostic approaches.

Important Diagnostic Tools

• Endoscopic Retrograde Cholangiopancreatography (ERCP)
• Endoscopic Ultrasound-Guided Fine Needle Biopsy (EUS-FNB)
• PET-CT staging
• Immunohistochemistry markers such as CD20 and CD79a

Imaging Clues That May Suggest Lymphoma

Radiologists should consider primary biliary lymphoma when imaging demonstrates:

• Smooth bile duct narrowing
• Diffuse duct wall thickening
• Lack of mucosal irregularity
• Discrepancies between CT/MRI and cholangiography findings

These subtle findings can help avoid unnecessary radical surgery. You can explore more clinical hepatology research at main journal article while staying updated on evolving diagnostic strategies.

Key Takeaways

• DLBCL can rarely mimic cholangiocarcinoma
• Obstructive jaundice is not always caused by bile duct cancer
• Histopathological confirmation is critical before surgery
• EUS-guided biopsy plays a major role in diagnosis
• Early chemotherapy can lead to complete remission

Study Reference

Read the full study at https://www.gastrohepatoljournal.com/acgh/issue/archive

Conclusion

This rare case highlights the importance of maintaining a broad differential diagnosis in patients presenting with obstructive jaundice. While cholangiocarcinoma is often suspected first, clinicians should remain aware that lymphomas such as DLBCL can closely imitate biliary malignancies. Early biopsy and multidisciplinary evaluation are essential for accurate diagnosis and optimal patient outcomes.

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