Simultaneous lymphoid hyperplasia of gallbladder and bile duct mimicking carcinoma: a case report

Abstract

Introduction: Lymphoid hyperplasia is a rare benign lymphoproliferative disorder. It can occur in various organs. However, lymphoid hyperplasia arising from extrahepatic bile duct and gallbladder simultaneously is extremely rare. Methods: A 72-year-old woman visited hospital with general weakness, dyspepsia and weight loss for 3 months. She had medical history of diabetes mellitus and depressive mood disorder and had been treated for liver abscess ten years ago. On physical examination, there was no icteric sclera and no tenderness in the upper abdomen. Viral hepatitis markers and all tumor markers were within normal limits. Magnetic resonance cholangiopancreatography (MRCP) showed 3cm length wall thickening and enhancement of suprapancreatic and intrapancreatic CBD, causing mild luminal narrowing and dilatation of upper biliary tract and also showed irregular wall thickening and enhancement of gallbladder body and fundus. Results: Under diagnosis of distal CBD cancer and gallbladder cancer, she underwent pylorus-preserving pancreaticoduodenectomy with routine lymph node dissection and s4b and S5 liver wedge resection. In operation finding, there were diffuse nodular sclerosing change from mid CBD to distal CBD and there were diffuse wall thickening of gallbladder body at liver bed side. Based on pathologic finding and immunohistochemical staining, lesion was diagnosed histologically as lymphoid hyperplasia. Conclusion: Lymphoid hyperaplasia of biliary system is a rare disease, and preoperative diagnosis is extremely difficult. Although it is benign condition, we should consider surgical excision for this lesion that cannot be excluded for malignancy.