A case report of primary non-hodgkin lymphoma of the bile duct

Primary biliary non-Hodgkin's lymphoma (PBNHL) is an extremely rare biliary malignancy often misdiagnosed as cholangiocarcinoma due to nonspecific imaging. Delayed recognition can result in unnecessary surgery and treatment delays, as chemotherapy is the primary therapy. We report an elderly male presenting with upper abdominal pain, initially suspected of cholangiocarcinoma, but diagnosed with B-cell non-Hodgkin's lymphoma (B-NHL) on histopathology. Due to poor baseline performance and multiple acute complications, he received only two days of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy and subsequently died from sepsis. We report a case of PBNHL, emphasizing its characteristic cholangiographic features and the potential contribution of immunosuppressive conditions, including Epstein-Barr virus (EBV) infection.