Common Bile Duct Obstruction Due to Adrenal Lymphoma: A Case Report

سال انتشار: 1398
نوع سند: مقاله کنفرانسی
زبان: انگلیسی
مشاهده: 400

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شناسه ملی سند علمی:

CCRMED03_261

تاریخ نمایه سازی: 20 بهمن 1398

چکیده مقاله:

Lymphomas are cancers that arise from the white blood cells and have been divided into two large subtypes including Hodgkin and non-Hodgkin lymphoma. Lymphomas can potentially arise from any lymphoid tissue located in the body; however, primary adrenal non-Hodgkin lymphoma is extremely rare. We report an obstructive biliary duct due to primary adrenal lymphoma.Case presentation A 52-year-old man presented to our tertiary hospital with progressively increasing epigastric pain, nausea, and vomiting from four months ago. On examination, the patient had a left supra clavicular lymphadenopathy (4*5 cm), jaundice and icteric sclera. Past medical history and drug history were negative. Laboratory workup revealed the following results: amylase: 704 IU/L, lipase: 264 IU/L, white blood cells: 17800 /mm3, hemoglobin: 9.5 g/dL, platelets: 327000/mm3, gamma-glutamyltransferase: 191 IU/L, AST: 42 IU/L, ALT: 35 IU/L, total bilirubin: 8.5 mg/dL, direct bilirubin: 5.7 mg/dL, prothrombin time (PT): 14.4 second, partial thromboplastin time (PTT): 28 second, international normalized ratio (INR): 1.21, alkaline phosphatase: 1295 IU/L, creatinine: 1.71 mg/dL, blood urea: 99 mg/dL, sodium: 134 mEq/L, potassium: 4.5 mEq/L, calcium: 10.1 mg/dL and hepatitis screening tests were negative. Abdominal ultrasound done at the admission time and reveal a dilated common bile duct (CBD) (11 mm). Abdominal CT scan was reported pancreatitis, splenomegaly, abdominal lymphadenopathy and left adrenal mass that might relate to lymphoma (Figure1). The patient was initially treated with acute pancreatitis but the symptoms not improved and levels of liver function tests were increasing. Magnetic resonance cholangiopancreatography (MRCP) confirmed the CT scan findings and also obstruction on CBD due to external compression was reported. Finally, left supraclavicular lymph node biopsy showed lymphoma.Conclusion Primary adrenal lymphoma is rare but rapidly progressing disease that should be treated aggressively. It generally carries a poor prognosis, partly because an optimal treatment protocol has not yet been established.

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نویسندگان

Leila Alizadeh,

Assistant Professor of Gastroenterology and Hepatology, Liver and Gastrointestinal Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

Mahdieh Shakeri-Darzekonani

MD, Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

Masoud Nouri-Vaskeh,

MD, Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

Amirreza Khalaji,

Medical Student, Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran

Monireh Halimi,

Associate Professor of Pathology, Department of Pathology, Tabriz University of Medical Sciences, Tabriz, Iran