Published online Oct 27, 2021. doi: 10.4240/wjgs.v13.i10.1279
Peer-review started: April 20, 2021
First decision: June 24, 2021
Revised: June 24, 2021
Accepted: August 30, 2021
Article in press: August 30, 2021
Published online: October 27, 2021
There are several case reports of acute cholecystitis as the initial presentation of lymphoma of the gallbladder; all reports describe non-Hodgkin lymphoma or its subtypes on histopathology of the gallbladder tissue itself. Interestingly, there is no description in the literature of Hodgkin lymphoma causing hilar lymphadenopathy, inevitably presenting as ruptured cholecystitis with imaging mimicking gallbladder adenocarcinoma.
A 48-year-old man with a past medical history of diabetes mellitus presented with progressive abdominal pain, jaundice, night sweats, weakness, and unintended weight loss for one month. Work-up revealed a mass in the region of the porta hepatis causing obstructions of the cystic and common hepatic ducts, gallbladder rupture, as well as retroperitoneal lymphadenopathy. The clinical picture and imaging findings were suspicious for locally advanced gallbladder adenocarcinoma causing ruptured cholecystitis and cholangitis, with metastases to retroperitoneal lymph nodes. Minimally invasive techniques, including endoscopic duct brushings and percutaneous lymph node biopsy, were inade
This clinical scenario highlights the importance of histopathological assessment in diagnosing gallbladder malignancy in a patient with gallbladder perforation and a grossly positive positron emission tomography/computed tomography scan. For both gallbladder adenocarcinoma and Hodgkin lymphoma, medical and surgical therapies must be tailored to the specific disease entity in order to achieve optimal long-term survival rates.
Core Tip: Here we present a case of Hodgkin lymphoma masquerading as gallbladder adenocarcinoma. In our patient, Hodgkin lymphadenopathy in the region of the porta hepatitis led to obstructions of the cystic and common hepatic ducts, causing acute cholecystitis and subsequent gallbladder perforation with associated cholangitis. Our case highlights the importance of histopathological assessment in diagnosing gallbladder malignancy when a patient presents with gallbladder perforation and a grossly positive positron emission tomography/computed tomography scan. For either gallbladder adenocarcinoma or Hodgkin lymphoma, chemotherapy tailored to the disease (and appropriate surgical intervention) are essential to achieve the best chance of cure and long-term survival.