Jaundice caused by a clinically undetectable T-cell lymphoma infiltrating the sphincter of Oddi

Malignant lymphoma rarely presents with jaundice. We describe a patient who had a unique etiology for painless jaundice, dilated ducts, and a normal a mpulla of Vater. A Whipple's procedure was performed for the suspicion of p ancreatic cancer, and initial pathological review detected only mild focal chronic pancreatitis. Seven months later, the patient developed ascites, re troperitoneal mass, and splenomegaly caused by a T-cell lymphoma. Reevaluat ion of the Whipple's specimen revealed previously unrecognized microscopic infiltration and fibrosis of the sphincter of Oddi by atypical T-lymphocyte s. Obstructive jaundice caused by a clinically undetectable primary duodena l T-cell lymphoma has not been previously reported and is contrasted with o ther causes of jaundice associated with malignant lymphoma and ampullary le sions. (C) 2001 by Am. Coll. of Gastroenterology.