A Case of Diffuse Large B-cell Lymphoma of the Gallbladder B. Lugano classification Involvement of a single lymph node region or of a single extranoda

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1 Case Report The Korean Journal of Pancreas and Biliary Tract 2015;20: pissn eissn 담낭에단독으로재발한광범위큰 B 세포림프종 1 예 전주예수병원내과 신홍식ㆍ김상선ㆍ김병관ㆍ조아영ㆍ이성희ㆍ조미영ㆍ조진웅ㆍ김지웅 A Case of Solitary Relapsed Diffuse Large B-cell Lymphoma of the Gallbladder Hong Shik Shin, Sang Sun Kim, Byeong Gwan Kim, A Young Cho, Seong Hee Lee, Meyoung Cho, Jin Woong Cho, Ji Woong Kim Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea Secondary involvement of the gallbladder by systemic lymphoma is exceedingly rare and relapsed diffuse large B cell lymphoma of the gallbladder has not been reported. A 78-year-old man was admitted to the hospital due to epigastric pain and jaundice. His past medical history was remarkable for diagnosis with diffuse large B-cell lymphoma of the ileum 5 years ago. He underwent right hemicolectomy and three cycles of adjuvant chemotherapy and had complete remission. Abdominal computed tomography showed choledocholithiasis and focal thickening at fundus of the gallbladder. The patient underwent open cholecystectomy. Pathologic examination revealed diffuse large B-cell lymphoma. We report a case of solitary, relapsed diffuse large B- cell lymphoma of the gallbladder with literature review. Keywords: Non-Hodgkin lymphoma, Diffuse large B-cell lymphoma, Relapse, Gallbladder Received Mar. 20, 2015 Revised Apr. 3, 2015 Accepted Apr. 3, 2015 Corresponding author : Ji Woong Kim Department of Internal Medicine, Presbyterian Medical Center, 365 Seowon-ro, Wansan-gu, Jeonju , Korea Tel Fax ; afo30@hanmail.net This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright 2015 by The Korean Journal of Pancreas and Biliary Tract 서론 B 25%. 1 B. 5 B B 1. 증례 Copyright 2015 by Korean Pancreatobiliary Association 151

A Case of Diffuse Large B-cell Lymphoma of the Gallbladder B.

(R-CHOP). 5. 1. 7. 110/70 mmhg, 36.8 C, 18 /, 76 /,. 6,000/mm 3 ( 71.3%, 18.1%), 10.8 g/dl, 267,000/mm 3, 7.4 g/dl, 3.6 g/dl, 78 IU/L, 94 IU/L, 1,159 IU/L, 21.0 mg/dl, 13.

4 ng/ ml ( 0-5 ng/ml), carbohydrate antigen (CA) 19-9 >12,000.00 IU/mL ( 0-37 IU/mL). A B Fig. 1. (A) Abdominal computed tomography shows irregular wall thickening at fundus of the gallbladder.

2 A Case of Diffuse Large B-cell Lymphoma of the Gallbladder B. Lugano classification Involvement of a single lymph node region or of a single extranodal organ or site (IE) 3 rituximab, cyclophosphamide, adriamycin, vinctristine, prednisone (R-CHOP) /70 mmhg, 36.8 C, 18 /, 76 /,. 6,000/mm 3 ( 71.3%, 18.1%), 10.8 g/dl, 267,000/mm 3, 7.4 g/dl, 3.6 g/dl, 78 IU/L, 94 IU/L, 1,159 IU/L, 21.0 mg/dl, 13.6 mg/dl, 175 IU/L, 15 mg/ dl, 0.6 mg/dl, 12.4 (international normalized ration; INR 0.93), C mg/dl hepatitis B (HB)sAg, HBsAb, carcinoembryonic antigen (CEA) 3.4 ng/ ml ( 0-5 ng/ml), carbohydrate antigen (CA) 19-9 >12, IU/mL ( 0-37 IU/mL). A B Fig. 1. (A) Abdominal computed tomography shows irregular wall thickening at fundus of the gallbladder. (B) T1-weighted magnetic resonance imaging scan shows contrast enhancement in gallbladder fundus. Fig. 2. F-18 fluorodeoxyglucose positron emission tomography showed focal hypermetabolic lesion in the fundus of the gallbladder (standardized uptake value=6.9)

Hong Shik Shin, et al. 터단층촬영(Fig. 1A)과 자기공명췌담관조영술(Fig. 1B)에서 0.5 cm의 크기이며 점막 안쪽으로 괴사를 동반한 2.5 cm 원위 총담관에 7 mm의 결석이 있었고 담낭벽 저부(fundus) 2.

원위 총담관 범은 없었으며, 면역조직화학염색에서 cluster of differentiation 결석을 치료하기 위해 내시경역행담췌관촬영술을 시행하였 (CD) 20과 multiple myeoloma (MUM) 1, CD30 양성 보여 으나 원위

그 이후 환자는 고 내시경유두부괄약근절개술 및 담관스텐트삽입술만 시행하 령과 전신 쇠약, 당뇨를 이유로 항암화학요법을 거부하여 경 였다. 내시경역행담췌관촬영술을 시행한 이후 환자의 증상 과 관찰 중이다. 및 검사실 소견은 호전되었다.

9로 상승하여 담 낭암의 가능성이 높다고 판단하여 진단 및 치료 목적의 개복 담낭에서 발생한 암은 98%가 선암종이며 0.1-0.2%에서 담낭절제술을 시행하였다. 절제된 담낭조직은 3 cm 2.

3 Hong Shik Shin, et al. 터단층촬영(Fig. 1A)과 자기공명췌담관조영술(Fig. 1B)에서 0.5 cm의 크기이며 점막 안쪽으로 괴사를 동반한 2.5 cm 원위 총담관에 7 mm의 결석이 있었고 담낭벽 저부(fundus) 2.5 cm 크기의 결절이 있었다. 현미경 검사에서 결체조직을 에 불규칙적인 비후와 조영증강이 있으며, 복부 내 수술 부 침범한 림프종이 관찰 되었고 장막이나 혈관 침범, 임파선 침 위의 비후 및 주변 림프절 비대 소견은 없었다. 원위 총담관 범은 없었으며, 면역조직화학염색에서 cluster of differentiation 결석을 치료하기 위해 내시경역행담췌관촬영술을 시행하였 (CD) 20과 multiple myeoloma (MUM) 1, CD30 양성 보여 으나 원위 총담관의 심한 협착으로 내시경으로 담관결석을 역형성 변이형(anaplastic variant)을 동반한 재발성 광범위 제거하기 어렵고 수술적인 치료가 필요할 것으로 생각되어 큰 B세포 림프종으로 진단하였다(Fig. 3). 그 이후 환자는 고 내시경유두부괄약근절개술 및 담관스텐트삽입술만 시행하 령과 전신 쇠약, 당뇨를 이유로 항암화학요법을 거부하여 경 였다. 내시경역행담췌관촬영술을 시행한 이후 환자의 증상 과 관찰 중이다. 및 검사실 소견은 호전되었다. 그러나 악성 림프종 추적검사 를 위해 시행한 양전자방출단층촬영(Fig. 2)에서 담낭의 표 고 찰 준섭취계수(standardized uptake value)가 6.9로 상승하여 담 낭암의 가능성이 높다고 판단하여 진단 및 치료 목적의 개복 담낭에서 발생한 암은 98%가 선암종이며 %에서 담낭절제술을 시행하였다. 절제된 담낭조직은 3 cm 2.5 cm 악성 림프종을 보고하고 있는데2,3 대부분 원발성 담낭암이 A B C D Fig. 3. Patholgic findings of the resected gallbladder. (A) Large pleomorphic neoplastic lymphoid cells are seen (H&E, 200). The tumor cells stained strongly for (B) CD20 ( 200), (C) MUM1 ( 200) (D) CD30 ( 200). 153

4 A Case of Diffuse Large B-cell Lymphoma of the Gallbladder.. 4,5 Mani 6 14, B 14 3 (21.5%) 2. B 20% %, 9%, 7%, 2%. 8 B B. 9,. Ono 10,. Gardini 11.. Huang 12 42% Mani B 60. ifosfamide, carboplatin, etoposide (ICE), dexamethasone, high dose cystarabine, cisplatin (ESHAP), etoposide, methylprednisolone, cystarabine, cisplatin (DHAP). 14 rituximab B. B,. 요약 B, B. B. B B 1. 국문색인 : 비호지킨림프종, 광범위큰 B세포림프종, 재발, 담낭 Conflicts of Interest The author has no conflicts to disclose

5 Hong Shik Shin, et al. REFERENCES 1. Morton LM, Wang SS, Devesa SS, et al. Lymphoma incidence patterns by WHO subtype in the United States, Blood 2006;107: Willén R, Willén H. Primary Sarcoma of the gallbladder. A light and electronmicroscopical study. Virchows Arch A Pathol Anat Histol 1982;396: Yasuma T, Yanaka M. Primary sarcoma of the gallbladder: report of three cases. Acta Pathol Jpn 1971;21: Dasgupta T, Brasfield R. Metastatic melanoma. A clinicopatholgical study. Cancer 1964;17: Weiss L, Harlos JP, Torhorst J, et al. Metastatic patterns of renal carcinoma: an analysis of 687 necropsies. J Cancer Res Clin Oncol 1988;114: Mani H, Climent F, Colomo L, Pittalug S, Raffeld M, Jaffe ES. Gall Bladder and extrahepatic bile duct lymphomas: clinicopathological observations and biological implications. Am J Surg Pathol 2010;34: Ko YH, Kim CW, Park CS, et al. REAL classification of malignant lymphomas in the Republic of Korea: incidence of recently recognized entities and changes in clinicopathologic features. Hematolymphoreticular Study Group of the Korean Society of Pathologists. Revised European-American lymphoma. Cancer 1998;83: Papaxoins G, Papageorgiou S, Rontogianni D, et al. Primary gastrointestinal non-hodgkin s lymphoma: a clinicopatholgic study of 128 cases in Greece. A Hellenic Cooperative Oncology Group study (HeCOG). Leuk Lymphoma 2006;47: Yutaka T, Reiki O, Fumiyasu Y, et al. Non-Hodgkin s lymphoma: a case of testis lymphoma metastasized to the gallbladder. Open J Intern Med 2012;2: Ono A, Tanoue S, Yamada Y, et al. Primary malignant lymphoma of the gallbladder: a case report and literature review. Br J Radiol 2009;82:e15-e Gardini A, Saragoni L, Labarba G, Garcea D. Simultaneous occurrence of primary diffuse large B-cell lymphoma and extranodal marginal zone (MALT) B-cell lymphoma in the gallbladder: a case report. Pathologica 2009;101: Huang WT, Chuang SS, Huang CC, Lu CL, Eng HL. Primary diffuse large B-cell lymphoma of the gallbladder with cholelithiasis masquerading as acute cholecystitis: case report and literature review. N Z Med J 2007;120: Hiroyuki K, Tatsushi N, Yusuke I, Masato K, Minoru T, Shuji I. Primary non-hodgkin s lymphoma of the gallbladder diagnosed by laparoscopic cholecystectomy. J Hepatobiliary Pancreat Surg 2009;15: Raut LS, Chakrabarti PP. Management of relapsed-refractory diffuse large B cell lymphoma. South Asian J Cancer 2014;3: Kewalramani T, Zelenetz AD, Nimer SD, et al. Rituximab and ICE as second-line therapy before autologous stem cell transplantation for relapsed or primary refractory diffuse large B-cell lymphoma. Blood 2004;103:

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