Extra-hepatic biliary obstruction due to diffuse large B-cell lymphoma: an autopsy case report with unattended yet signi
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CASE REPORT
Extra‑hepatic biliary obstruction due to diffuse large B‑cell lymphoma: an autopsy case report with unattended yet significant pathologies Pulkit Rastogi1 · Harjeet Singh2 · Pankaj Gupta3 · Amanjit Bal1 · Usha Dutta4 · Nalini Gupta5 Received: 11 August 2020 / Accepted: 15 September 2020 © Japanese Society of Gastroenterology 2020
Abstract Autopsy practice has been an invaluable tool to understand the pathobiology of various disease processes. We herein have given the description of a case of malignant extra-hepatic biliary obstruction secondary to a diffuse large B-cell lymphoma. The patient disease could only be adequately characterized at autopsy in the form of exact origin and subtyping of lymphoma. The autopsy revealed certain unattended and exciting, yet significant pathological findings in the form of portal vein thrombosis, neurolymphomatosis, the exact track of the lymphomatous cells from abdominal to thoracic cavity, and the terminal events which led to the patient’s demise. The plausible clinical correlates of these pathological findings have been discussed. This can serve as a useful clue to the clinicians for managing such cases in the future. Keywords Autopsy · Extra-hepatic biliary obstruction · Diffuse large B-cell lymphoma
Introduction Malignant diseases of gastrointestinal tracts are heterogeneous with a variable clinical course. Though much has been known regarding the pathogenesis and natural course of these states, the concepts are still evolving. There are always certain pathologies which are missed antemortem. If these are given due attention during life, they could tilt the disease course in a favorable way. Autopsy pathology has been an invaluable tool since the inception of medical science to * Pulkit Rastogi [email protected] 1
Department of Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Room no. 503, Level 5, Research Block A, Chandigarh, India 160012
2
Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India 160012
3
Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India 160012
4
Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India 160012
5
Department of Cytology and Gynaecological Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India 160012
understand the basis of the various disease processes [1] and unraveling certain new concepts to those already known. The current description is of a case of malignant extrahepatic biliary obstruction (EHBO) caused by diffuse large B-cell lymphoma (DLBCL) affecting primarily the portal group of lymph nodes. It was diagnosed pre-terminally when the disease had already progressed to a widespread extent with sepsis. Autopsy findings of thoraco-abdominal organs have been described, which revealed the natural course of disease with many associated pathologies not susp
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