letter to the editor

Oman Medical Journal [2018], Vol. 33, No. 5:447 

How to Discriminate Between Primary Hepatic Lymphoma and Cholangiocarcinoma

Sora Yasri1* and Viroj Wiwanitkit2

1Medical Center Unit, KMT Primary Care Center, Bangkok, Thailand

2Department of Community Medicine, Dr DY Patil University, Pune, India

article info


Dear Editor,

We read the report on ‘Primary Hepatic Lymphoma Mimicking Cholangiocarcinoma’ published in the July 2017 issue of the Oman Medical Journal with great interest.1 In fact, both primary hepatic lymphoma and cholangiocarcinoma might result in highly similar clinical presentation and are sporadically mentioned in the literature.2–4 Here, we would like to discuss a possible way to differentiate between both disorders using serum alkaline phosphatase (ALP) isoenzyme electrophoresis, a simple laboratory test. Based on a previous report from Thailand, the significant elevation of specific fast liver isoenzyme of ALP can be observed in malignant tumors of the biliary tract.5 For primary hepatic lymphoma, additional atypical bone-like isoenzyme of ALP might be observed.6 Since the ALP isoenzyme test can be easily done and provide the result within a short time, it should be considered a tool to help confirm the diagnosis of cholangiocarcinoma.


  1. 1. Forghani F, Masoodi M, Kadivar M. Primary Hepatic Lymphoma Mimicking Cholangiocarcinoma. Oman Med J 2017 Jul;32(4):335-338.
  2. 2. Durham C, Jaiswal D, Wong L. Bile duct lymphoma disguised as cholangiocarcinoma. Proc (Bayl Univ Med Cent) 2017 Apr;30(2):190-191.
  3. 3. Hwang S, Song TJ, So S, Jeon MK, Oh EH, Kwon BS, et al. Primary Biliary Mucosa-associated Lymphoid Tissue Lymphoma Mimicking Hilar Cholangiocarcinoma. Korean J Gastroenterol 2016 Aug;68(2):114-118.
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