Subject(s)
Carcinoma, Hepatocellular/diagnosis , Liver Cirrhosis, Biliary/complications , Liver Neoplasms/diagnosis , Lymphoma, Non-Hodgkin/diagnosis , Neoplasms, Multiple Primary/diagnosis , Aged , Antineoplastic Agents/therapeutic use , Biopsy , Diagnosis, Differential , Diffusion Magnetic Resonance Imaging , Fatal Outcome , Female , Humans , Liver Cirrhosis, Biliary/diagnosis , Liver Neoplasms/complications , Liver Neoplasms/drug therapy , Lymphoma, Non-Hodgkin/complications , Lymphoma, Non-Hodgkin/drug therapy , Neoplasm Staging , Neoplasms, Multiple Primary/complications , Neoplasms, Multiple Primary/drug therapy , Predictive Value of Tests , Time Factors , Treatment FailureABSTRACT
Liver involvement in Hodgkin's lymphoma is common and is caused by hepatic infiltration, biliary obstruction by lymphoma, hepatitis, sepsis or complications of chemotherapeutic treatment. Jaundice caused by the vanishing bile duct syndrome related to Hodgkin's lymphoma is very rare. The mechanism is poorly understood but a paraneoplastic effect seems most likely as liver biopsy samples show cholestasis in the absence of lymphoma cells. Despite adequate treatment almost all reported patients died of liver failure or disease progression. Disease progression is explained partly by the difficulties encountered in the administration of potential hepatotoxic chemotherapy in severely cholestatic patients. We describe a 17-year-old man with vanishing bile duct syndrome and Hodgkin's lymphoma who was treated successfully with chemotherapy. The markedly elevated serum bilirubin levels completely normalized. Our case demonstrates that although dosing of chemotherapy in this situation can be very difficult, a good clinical outcome is possible, which makes the attempt at curative treatment worthwhile.
