Multiple Malignant Lymphomas of the Bile Duct Developing after Spontaneous Regression of an Autoimmune Pancreatitis-like Mass

Intern Med. 2021 Feb 1;60(3):409-415. doi: 10.2169/internalmedicine.5429-20. Epub 2020 Aug 29.

Abstract

We herein report a 67-year-old woman with malignant lymphomas of the bile duct that developed after regression of a pancreatic head mass. Computed tomography suggested the mass was pancreatic head cancer. Endoscopic ultrasonography showed a low-echoic mass with hyperechoic strands resembling autoimmune pancreatitis. Her serum IgG4 concentration was elevated to 674 mg/dL. After the pancreatic head mass spontaneously diminished, three masses were detected in the common bile duct. A biopsy of the major papilla revealed high-grade B-cell lymphoma with MYC, BCL2 and/or BCL6 rearrangement. Systemic chemotherapy with rituximab plus etoposide, prednisolone, vincristine, cyclophosphamide and doxorubicin resulted in complete remission.

Keywords: IgG4-related disease; automiine pancreatitis; bile duct; high-grade B-cell lymphoma; non-Hodgkin lymphoma; with MYC and BCL2 and/or BCL6 rearrangements.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Autoimmune Pancreatitis*
  • Bile Ducts
  • Female
  • Humans
  • Lymphoma, Large B-Cell, Diffuse* / drug therapy
  • Prednisone / therapeutic use
  • Proto-Oncogene Proteins c-bcl-2 / therapeutic use
  • Proto-Oncogene Proteins c-bcl-6

Substances

  • Proto-Oncogene Proteins c-bcl-2
  • Proto-Oncogene Proteins c-bcl-6
  • Prednisone