A case of malignant lymphoma of the gallbladder

Abstract

A 67-year-old man was found to have swollen cervical lymph nodes. Based on fine needle aspiration cytology a malignant lymphoma was suspected. However, the cervical lymph nodes became non-palpable ; no other lymph-nodes were palpable. On abdominal CT scan, no lymph-node was seen in the abdominal cavity. A papillary protrusion was detected in the fundus of the gallbladder. The patient underwent a laparotomy with a pre-operative diagnosis of carcinoma of the gallbladder. Operative findings included a 50×40 mm papillary tumor in the gallbladder and a 25×20 mm tumor in the jejunum. An extended cholecystectomy with partial resection of the common bile duct, partial resection of the jejunum, and choledochojejunostomy were performed. On histology, a malignant diffuse large B-cell lymphoma was diagnosed. Immunohistochemistry results included negative CD3and CD5 T-cell markers but positive CD10, CD20 and CD79a B-cell markers. The mitotic index was greater than 90%. The patient underwent 8 courses of combined therapy with anti-CD20 monoclonal antibody and CHOP chemotherapy. No recurrence has been noted during 4 years and 10 months of postoperative follow up. Malignant lymphoma of the gallbladder is rare ; it accounts for approximately 0.1% of malignant tumors of the gallbladder. Depending on the type of malignant lymphoma patients may require adjuvant chemotherapy.