Ovarian Non-Hodgkin's Lymphoma presenting as obstructive jaundice - a case report

OBJECTIVE: To highlight the importance of considering abdominal Lymphoma as a differential diagnosis in the management of obstructive jaundice. PATIENT: A 51 year old female who presented with abdominal swelling associated with features of obstructive jaundice. Significant findings included jaundice on examination, with abdominal ascites. Laparotomy revealed three litres of icteric fluid. There was a huge left ovarian tumour measuring 14cm x 12cm. Massive peritoneal seedling involved the whole abdomen and pelvis was noted. Following surgery allowing for adequate wound healing, the patient was placed on appropriate chemotherapy. INVESTIGATION/DIAGNOSIS: Histology of excision biopsy revealed high grade Non-Hodgkins's Lymphoma. Screening for human deficiency virus (HIV) was negative. However the erythrocyte sedimentation rate (ESR) was raised at 92 mm Westergren in the first hour. The liver function tests were deranged with total bilirubin of 274 mmol/l and conjugated bilirubin of 204 mmol. serum Ast and Alt were also significantly raised. Total proteins, urea and electrolytes remained essentially within normal limits. The patient was placed on CHOP combination therapy. She attained remission after four cycles of chemotherapy and was discharged home. CONCLUSION: Abdominal Non-Hodgkin's Lymphoma should be a strong consideration in the management of obstructive jaundice.     

A rare case of Castleman disease presenting as pulmonary mass mimicking central pulmonary malignancy

Castleman disease is a rare disorder of the lymphoid system characterized by noncancerous growths that may develop in lymph node tissues throughout the body. Most often this occurs in the neck, mediastinum, and abdomen where lymph nodes aggregate. Here we describe a case of asymptomatic intrapulmonary Castleman disease adjacent to the left pulmonary hilum that mimicked central pulmonary malignancy in a 27-year-old man who underwent curative surgical removal of the mass.     

IgA multiple myeloma presenting as non-obstructive jaundice

Multiple myeloma can occasionally present with jaundice. The underlying process may be pancreatic head myeloma infiltration causing obstructive jaundice or hepatic amyloid deposition resulting in cholestatic jaundice. A rare case of myeloma presenting as jaundice due to hepatic myeloma infiltration is reported.     

表现为腹腔肿物的腹膜后单中心型Castleman病

目的报告1例罕见腹膜后单中心型Castleman病病例,提供诊疗经验,提高该病诊治水平。方法回顾性分析近期诊治并经病理学确诊的腹膜后单中心型Castleman病1例,并结合国内外文献对该病的流行病学特征、临床及病理分型、临床表现、诊断、治疗及预后进行讨论。结果女性,21岁,偶然查体发现腹腔肿物,无自觉症状及体征。CT检查发现8.0cm×7.0cm×7.7cm边界清楚富血供的上腹部肿块,无法明确来源。术中明确肿瘤来源于腹膜后,术后病理明确为Castleman病,透明血管型,结合临床所见确诊单中心型Castleman病,文献报告预后良好,仅予随访。结论Castleman病是一种罕见的淋巴增生性疾病,是腹腔占位的一种罕见原因。单中心型Castleman病手术完整切除后预后良好,可仅予随访观察。多中心型者预后较差,可选择化疗和免疫治疗。     

Hepatoma and obstructive jaundice

Three patients with hepatoma are described whose presenting feature was obstructive jaundice. Recognition of this rare manifestation of hepatoma can establish the diagnosis before surgery.     

CT对梗阻性黄疸的定性价值

本文通过对ＣＴ上仅仅表现为胆道扩张的良、恶性梗阻性黄痘对照分析，发现恶性病变肝内胆管为中、重度扩张（７３．１％）呈藤状（５７．７％），肝外胆管绝大多数在近段区域突然中断（９５．７％），良性病变的肝内胆管轻度扩张（６３．６％），多表现为竹节状（６８．２％），而肝外胆在远段逐渐变细（８４．２％），认为根据肝内胆管扩张程度与形态，以及肝外胆管扩张形态及梗阻部位改变，能够对梗阻的良、恶性作出诊断。     

Secondary syphilis presenting with jaundice

A patient with secondary syphilis presenting with jaundice is reported. Hepatic histology showed evidence of non-specific granuloma and active hepatitis but no cholestasis. This has been treated successfully with antisyphilitic therapy. The possibility of syphilitic pancreatitis and diabetes mellitus is discussed. The importance of serological tests for syphilis in jaundice of obscure origin is emphasized.     

Intrahepatic gallbladder and obstructive jaundice

A case of intrahepatic gallbladder--a rare anomaly of the biliary tree which predisposes towards the formation of calculi--is reported. The special difficulties which may be encountered in the management of the complications of cholelithiasis in these circumstances are described.     

阻塞性黄疸的CT诊断

目的：探讨阻塞性黄疸的ＣＴ诊断特点。方法：通过对肝、胆、胰ＣＴ表现的影像特征分析，探讨不同部位梗阻和不同性质病变时的影像特征差异。结果：肿瘤和结石是引起阻塞性黄疸的重要原因。肿瘤引起肝内胆管扩张的程度明显大于结石所引起的（Ｐ＜０．０５），二者对肝外胆管扩张程度的影响差异不显著（Ｐ＞０．０５），胆管炎可引起起间断性阻塞性黄疸，但肝内外胆管扩张程度常不显著。梗阻近端扩张，远端萎缩是普遍特征。胆总管未端形态和密度变化的分析对鉴别诊断尤为重要。结论：肿瘤和结石是引起阻塞性黄疸的重要原因。     

64排螺旋CT对梗阻性黄疸的诊断价值

目的探讨64排螺旋CT在梗阻性黄疸诊断中的应用价值。方法回顾性分析63例梗阻性黄疸病例,均行64排螺旋CT平扫和增强扫描,扫描图像传入工作站进行MPR、CPR处理,对胆管梗阻定位和定性诊断作出评价,并与手术病理、ERCP结果对照。结果 63例梗阻性黄疸中,CT定位均与手术、ERCP结果一致;良性病变38例,正确诊断35例;恶性病变25例,正确诊断23例。64排螺旋CT扫描对梗阻性黄疸定位和定性准确率分别为100%和92%。结论 64排螺旋CT具有强大的后处理功能,对梗阻性黄疸定位和定性准确率高,是一种有效的无创性检查方法。     

Celiac disease presenting as severe osteopenia

The authors describe a unique presentation of celiac disease as multiple non-traumatic fractures in a young male without gastrointestinal complaints. A 29-year-old man presented with back pain and was found to have a non-traumatic compression fracture of the lumbar and thoracic spine on plain X-ray. Dual-energy x-ray absorptiometry (DXA) confirmed osteoporosis at the L3/L4 vertebral bodies. Parathyroid hormone (PTH), calcium, and vitamin D levels were normal. He had no gastrointestinal complaints, but serologic studies were positive to include an elevated gliadin IgA Ab, gliadin IgG Ab, and an elevated tissue transglutaminase IgA Ab. He was treated with a gluten-free diet, calcium, and vitamin D supplementation as well as teriparatide. Follow up bone density showed improvement and has no further fractures to date. Primary care physicians, gastroenterologists, and endocrinologists must have a high index of clinical suspicion for celiac disease in any patient who presents with low bone density regardless of the serum 25-OH vitamin D levels or presence of gastrointestinal complaints.     

全身伽玛刀治疗癌性梗阻性黄疸临床疗效观察

目的观察全身伽玛刀治疗癌性梗阻性黄疸的临床疗效.方法收集32例癌性梗阻性黄疸病例,其中原发性肝癌8例,胰腺癌16例,胆管癌6例,胆囊癌术后转移2例.采用全身伽玛刀治疗,用50%～65%等剂量曲线包绕肿瘤边缘,治疗次数6～10次,单次剂量360～600 cGy,每日一次,观察临床症状、体征及实验室检查结果,按国际肿瘤疗效标准评价疗效.结果29例黄疸症状及胆红素检查均不同程度减轻.轻度减轻(SD)4例;中度减轻及明显减轻(PR)22例;黄疸完全消失(CR)3例.结论全身伽玛刀治疗癌性梗阻性黄疸疗效显著,副反应小,特别适合晚期无法手术的患者姑息治疗.     

梗阻性黄疸并发肾功能损害的实验研究

目的　研究梗阻性黄疸 (OJ)并发肾功能损害的模式及肠源性内毒素血症在其中的作用。方法　雄性Wistar大鼠 5 0只随机均分为假手术 (SO)、胆总管结扎术后 5d(CBDL5d)、10d(CBDL10d)、15d(CBDL15d)及胃饲脱氧胆酸钠治疗 (CBDL +DC)组 ,监测血浆内毒素 (ETX)水平和肾功能指标对氨基马尿酸清除率 (CPAH)、菊粉清除率 (CIN)及钠排泄分数 (FENa + )的变化。结果　CBDL大鼠血浆ETX水平随时间推移持续性升高 (P <0 0 5或P <0 0 1) ;CBDL5d组FENa + 较SO组显著升高 (P <0 0 1)、而CIN和CPAH无明显改变 ,术后 10d起肾功能指标进行性减低、CBDL15d组FENa + 已较SO组显著降低 (P <0 0 1) ;胃饲DC治疗可明显降低血浆ETX水平、改善肾功能指标 (P <0 0 5或P <0 0 1)。结论　肾小管水钠重吸收功能抑制是OJ并发肾损害的早期表现 ,随OJ时间延长 ,肾血流量和肾小球滤过率显著降低、肾小管水钠重吸收功能由抑制转向激活状态 ;肠源性内毒素血症在OJ并发肾功能损害中有重要作用