-2 :: Topic - 7430 :: :: ::
Medical Image Database, Atlas, and Teaching File
All Topics are Peer Reviewed by an Editorial Panel

Tumor Name: Large B-cell Lymphoma

Cell of Origin: B lymphocytes

Special Stains: Strong membranous staining for CD45, CD20, bcl-2 and bcl-6. Negative for pancytokeratin and synaptophysin.

Radiology:
>> CT Liver: infiltrative mass in right lobe of liver, intrahepatic biliary dilatation, lymphadenopathy.

>> Ultrasound guided percutaneous biliary access with cholangiogram and external biliary drain placement: mildly dilated intrahepatic biliary ducts, mass effect displaces common hepatic duct.

>> Percutaneous cholangiogram and biliary stent placement: Gore Viabil covered metallic stent allows internal drainage.

Prognosis and Treatment:
>> 5 yr survival 26-73%. Lower in this case due to age >60, elevated serum LDH, and extra nodal involvement (liver mass).

>> Treatment for advanced disease usually includes chemotherapy (traditionally CHOP although this is evolving and has changed significantly over the last 30 years).

>> Other interventions are usually palliative, as in this case where percutaneous biliary stenting and eventual internal drainage was performed.


Key facts for biliary stenting of malignant obstructive jaundice:
>> It is palliative therapy.

>> Metal stents demonstrate longer patency than plastic (polyethylene) stents for malignant biliary obstruction (median expected patency: 250 and 110 days respectively).

>> This treatment provides significant palliation of patient symptoms due to biliary obstruction and is cost-effective in patients with longer than 6 months expected survival resulting in fewer hospital admissions.

>> Covered endobiliary stents like the Gore Viabil used in this case have good patency rates in malignant biliary obstruction and allow endobiliary drainage into the small bowel which is desirable for outpatient management of these patients.