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Idiopathic Intrahepatic Cholestasis as an Unusual Presentation of Hodgkin's Disease.

Atalay H, Boyuk B, Ates M, Celebi A, Ekizoglu I, Didik AA, Igdem AA - Case Rep Hematol (2015)

Bottom Line: Intrahepatic cholestasis in the form of paraneoplastic phenomena is an uncommon presentation of Hodgkin's lymphoma (HL).Herein we report the diagnosis of mixed type HL-related idiopathic intrahepatic cholestasis in a 73-year-old man presenting with jaundice, after the inguinal lymph node biopsy indicative of mixed cellular type HL and liver biopsy consistent with intrahepatic cholestasis, following several diagnostic interventions including surgery for suspected extrahepatic obstructive cholestasis.Our findings emphasize the value of early liver biopsy in the diagnostic algorithm along with consideration of HL-related idiopathic intrahepatic cholestasis as a diagnosis of exclusion in cholestatic jaundice of obscure origin.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Gaziosmanpasa Taksim Education and Research Hospital, 34240 Istanbul, Turkey.

ABSTRACT
Intrahepatic cholestasis in the form of paraneoplastic phenomena is an uncommon presentation of Hodgkin's lymphoma (HL). Herein we report the diagnosis of mixed type HL-related idiopathic intrahepatic cholestasis in a 73-year-old man presenting with jaundice, after the inguinal lymph node biopsy indicative of mixed cellular type HL and liver biopsy consistent with intrahepatic cholestasis, following several diagnostic interventions including surgery for suspected extrahepatic obstructive cholestasis. Our findings emphasize the value of early liver biopsy in the diagnostic algorithm along with consideration of HL-related idiopathic intrahepatic cholestasis as a diagnosis of exclusion in cholestatic jaundice of obscure origin.

No MeSH data available.


Related in: MedlinePlus

A portal tract showing prominent infiltration of mononuclear cells with sparse polymorphic leucocytes. Existence of extensive bile pigments in parenchyma and mild steatosis in portal tracts is striking (hematoxylin-eosin stain; original magnification ×10).
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fig1: A portal tract showing prominent infiltration of mononuclear cells with sparse polymorphic leucocytes. Existence of extensive bile pigments in parenchyma and mild steatosis in portal tracts is striking (hematoxylin-eosin stain; original magnification ×10).

Mentions: A 73-year-old man was admitted to our department with a 4-month history of pruritus and 2-month history of jaundice, alcoholic stools, dark urine associated with malaise, fatigue, and 8 kg weight loss. He had been admitted to the hospital for the complaint of pruritus in January 2012, while he was on routine follow-up for hypothyroidism but otherwise healthy. In March 2012, he had been hospitalized in general surgery department for further investigation upon findings of elevated liver enzymes and hyperbilirubinemia on laboratory tests (Table 1). No pancytopenia or bicytopenia was observed during the clinical course and ferritin levels were mildly elevated (not listed). Briefly, based on magnetic resonance cholangiogram findings suggestive of Klatskin tumor (Figure 1), following first percutaneous transhepatic cholangiography for drainage, he underwent cholecystectomy + T tube drainage + choleduct exploration, while no evidence of tumor was detected. Given that laboratory findings consistent with cholestasis persisted after surgery, an endoscopic retrograde cholangiopancreatography (ERCP) was performed, while revealing no bile duct obstruction or extrahepatic causes of cholestasis. Therefore, one month later the patient was referred to our department of internal medicine without any established diagnosis.


Idiopathic Intrahepatic Cholestasis as an Unusual Presentation of Hodgkin's Disease.

Atalay H, Boyuk B, Ates M, Celebi A, Ekizoglu I, Didik AA, Igdem AA - Case Rep Hematol (2015)

A portal tract showing prominent infiltration of mononuclear cells with sparse polymorphic leucocytes. Existence of extensive bile pigments in parenchyma and mild steatosis in portal tracts is striking (hematoxylin-eosin stain; original magnification ×10).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4488518&req=5

fig1: A portal tract showing prominent infiltration of mononuclear cells with sparse polymorphic leucocytes. Existence of extensive bile pigments in parenchyma and mild steatosis in portal tracts is striking (hematoxylin-eosin stain; original magnification ×10).
Mentions: A 73-year-old man was admitted to our department with a 4-month history of pruritus and 2-month history of jaundice, alcoholic stools, dark urine associated with malaise, fatigue, and 8 kg weight loss. He had been admitted to the hospital for the complaint of pruritus in January 2012, while he was on routine follow-up for hypothyroidism but otherwise healthy. In March 2012, he had been hospitalized in general surgery department for further investigation upon findings of elevated liver enzymes and hyperbilirubinemia on laboratory tests (Table 1). No pancytopenia or bicytopenia was observed during the clinical course and ferritin levels were mildly elevated (not listed). Briefly, based on magnetic resonance cholangiogram findings suggestive of Klatskin tumor (Figure 1), following first percutaneous transhepatic cholangiography for drainage, he underwent cholecystectomy + T tube drainage + choleduct exploration, while no evidence of tumor was detected. Given that laboratory findings consistent with cholestasis persisted after surgery, an endoscopic retrograde cholangiopancreatography (ERCP) was performed, while revealing no bile duct obstruction or extrahepatic causes of cholestasis. Therefore, one month later the patient was referred to our department of internal medicine without any established diagnosis.

Bottom Line: Intrahepatic cholestasis in the form of paraneoplastic phenomena is an uncommon presentation of Hodgkin's lymphoma (HL).Herein we report the diagnosis of mixed type HL-related idiopathic intrahepatic cholestasis in a 73-year-old man presenting with jaundice, after the inguinal lymph node biopsy indicative of mixed cellular type HL and liver biopsy consistent with intrahepatic cholestasis, following several diagnostic interventions including surgery for suspected extrahepatic obstructive cholestasis.Our findings emphasize the value of early liver biopsy in the diagnostic algorithm along with consideration of HL-related idiopathic intrahepatic cholestasis as a diagnosis of exclusion in cholestatic jaundice of obscure origin.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Gaziosmanpasa Taksim Education and Research Hospital, 34240 Istanbul, Turkey.

ABSTRACT
Intrahepatic cholestasis in the form of paraneoplastic phenomena is an uncommon presentation of Hodgkin's lymphoma (HL). Herein we report the diagnosis of mixed type HL-related idiopathic intrahepatic cholestasis in a 73-year-old man presenting with jaundice, after the inguinal lymph node biopsy indicative of mixed cellular type HL and liver biopsy consistent with intrahepatic cholestasis, following several diagnostic interventions including surgery for suspected extrahepatic obstructive cholestasis. Our findings emphasize the value of early liver biopsy in the diagnostic algorithm along with consideration of HL-related idiopathic intrahepatic cholestasis as a diagnosis of exclusion in cholestatic jaundice of obscure origin.

No MeSH data available.


Related in: MedlinePlus