The liver in Hodgkin's disease--II. Histopathologic findings

PET-CT for Evaluation of Spleen and Liver 18F-FDG Diffuse Uptake Without Lymph Node Enlargement in Lymphoma

The aim of the study was to compare differences between lymphoma and inflammation as indicated by high diffuse uptake of F-fluorodeoxyglucose (F-FDG) in the spleen, liver, and bone marrow without increased F-FDG uptake in the lymph nodes and without enlarged peripheral lymph nodes.Eighteen lymphoma patients and 14 inflammation patients were examined with F-FDG positron emission tomography-computer tomography (PET-CT). All patients displayed high diffuse uptake of F-FDG in the spleen, liver, and bone marrow without increased F-FDG uptake in the lymph nodes and without enlarged peripheral lymph nodes. Our analyses compared the maximum standardized uptake values (SUVmax) of F-FDG uptake ratios between the spleen/liver, the spleen/bone marrow, and the liver/bone marrow and further compared spleen sizes between lymphoma and inflammation patients.Using Student t test, no significant differences were found in the SUVmax ratios of spleen/liver and liver/bone marrow between the lymphoma and inflammation patients (t = 0.853, P = 0.401 > 0.05; t = 1.622, P = 0.115 > 0.05). However, the SUVmax ratio of the spleen/bone marrow of the lymphoma patients was significantly different from that of the inflammation patients (t = 2.426, P = 0.021 < 0.05). The spleen size between the lymphoma and inflammation patients was also significantly different (t = 2.911, P = 0.007 < 0.05).As indicated by F-FDG PET-CT, our study demonstrated that lymphoma and inflammation patients displayed a few differences despite both having high diffuse uptake of F-FDG in the spleen, liver, and bone marrow without enlarged peripheral lymph nodes and without increased F-FDG uptake in lymph nodes.

Patterns of liver infiltration in lymphoproliferative disease

AIMS

Liver involvement is a common finding in patients suffering from lymphoproliferative disease, and histopathological patterns of infiltration vary according to lymphoma subtype. Data correlating the form of liver involvement with distinct lymphoma subtypes is, however, scarce. The aim was to review 89 liver biopsies diagnosed with lymphoma infiltration and evaluate the infiltration patterns.

METHODS AND RESULTS

In equivocal cases, additional immunohistochemical and molecular pathology analyses were performed to differentiate between neoplastic and reactive cell infiltrates and to classify the lymphoma subtypes. Diffuse large B-cell lymphoma (DLBCL), chronic lymphocytic leukaemia (CLL), Hodgkin's lymphoma (HL) and Burkitt lymphoma (BL) were the most prevalent subtypes in our series, which included 14 different lymphoma entities in total. Whereas DLBCL and BL predominantly demonstrated tumour nodules deranging the normal hepatic architecture, CLL and HL mostly showed infiltration of the portal fields. Interestingly, distinct lymphoma entities, particularly marginal zone B-cell lymphomas (MZL) and HL, commonly revealed lympho-epithelial lesions of bile ducts, which were observed in 10% of all investigated cases. Four cases, initially interpreted as T-cell lymphomas, proved to be reactive T-cell lesions.

CONCLUSIONS

Distinct lymphoma subtypes show characteristic patterns of liver infiltration. Additional molecular analyses can support diagnosis by verification of clonality or detection of characteristic genetic aberrations.

Hodgkin's disease presenting as cholestatic hepatitis with prominent ductal injury

In advanced stages of Hodgkin's disease, liver involvement is common. However, Hodgkin's disease mimicking cholestatic hepatitis at presentation is rare. We describe a patient with Hodgkin's disease who was initially considered to have acute cholestatic hepatitis. Liver biopsy demonstrated prominent bile duct injury associated with a florid inflammatory reaction. These changes may represent an early stage of ductal injury, subsequently leading to vanishing bile duct syndrome, a recently documented mechanism of cholestasis in Hodgkin's disease.

Positron emission tomography for detection and staging of malignant lymphoma

FDG-Positron emission tomography (FDG-PET) is an imaging modality using the physiological tracer glucose [modified as 18-fluorine-2-fluorodeoxyglucose (FDG)], whose uptake and metabolism is increased in malignant cells. While exact tumor staging in lymphomatous diseases is the basis for choosing the appropriate treatment strategy, the detection of nodal and extranodal manifestations are a key prerequisite. This study demonstrates that FDG-PET is an efficient, non-invasive method for the staging of primary untreated Hodgkin's lymphoma (HD) and non-Hodgkin's lymphoma (NHL). Clinical PET scanning is very useful in staging lymphoma patients and is more accurate than computed tomography (CT) in detecting lesions.

Hepatic involvement in Hodgkin's disease. Clues to histologic diagnosis

The hepatic histopathology was studied in 125 patients with Hodgkin's disease to determine whether there are any features other than Reed-Sternberg (RS) cells that might aid in the diagnosis of hepatic involvement by the neoplastic process. Liver biopsy specimens from 41 patients with Hodgkin's disease in the liver were compared with biopsy specimens from 84 patients without hepatic involvement. Patients with hepatic involvement by Hodgkin's disease are much more likely to have histologic evidence of portal infiltrates larger than 1 mm in diameter (78% versus 1%), acute cholangitis (85% versus 4%), portal edema (90% versus 8%), and portal infiltrates with a predominance of atypical lymphocytes (78% versus 12%) than patients with Hodgkin's disease who do not have hepatic involvement. When these features are observed alone or in combination in a liver biopsy specimen from a patient with proven or suspected Hodgkin's disease, a diligent search for RS cells is indicated, with serial sections and repeat biopsy if necessary.

The liver in Hodgkin's disease--I. Clinico-pathological relations

A retrospective analysis of staging results from 308 patients with Hodgkin's disease (HD) was performed in order to relate clinico-pathological findings with respect to the liver to other staging results and to prognosis. Thirty-four patients had clinically enlarged liver, 80 had increased serum-enzyme levels indicating possible liver damage, but only 10 patients had biopsy-proven histologic evidence of HD in the liver (7 primary biopsies, 3 re-biopsies). Among the prognostic correlations not only advanced stage and liver infiltrates were connected to poor prognosis, but also--even in early stages--elevated serum enzyme values (S-GOT and alkaline phosphate).