High-Grade B-Cell Lymphoma in the Ampulla of Vater: A Rare Case Report

Abstract Introduction High-grade B-cell Lymphoma (HGBL) not otherwise specified (NOS) is a rare category for aggressive non-Hodgkin’s lymphomas (NHL), most commonly found in the gastrointestinal tract. This is a rare case of HGBL arising from the ampulla of Vater causing obstructive jaundice. Case Presentation A 73-year-old man presented with painless jaundice and generalized fatigue. Abdominal computed tomography (CT) showed postcholecystectomy changes with moderate intrahepatic and extrahepatic biliary dilation, with the common bile duct (CBD) dilated up to 1.7 cm. Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic ultrasonography (EUS) performed showed a large duodenal ulcer opening into a large D2 diverticulum. The CBD was dilated and measured 1.4 cm. A limited sphincterotomy away from the ulcer was performed with stent placement. CBD brushings and biopsies from the duodenal ulcer were obtained. Histological and immunohistochemical examination confirmed the diagnosis of HGBL. The patient was started on chemotherapy and has tolerated five cycles so far. Conclusion This case sheds light on the importance of considering lymphoma as a differential diagnosis in patients presenting with obstructive jaundice.