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Mita J, Maeda T, Tsujita E, Yugawa K, Takaki S, Tsuji K, Hashimoto N, Fujikawa R, Ono Y, Sakai A, Tanaka S, Matono R, Ohmine T, Kometani T, Yamaguchi S, Konishi K, Hashimoto K. A case of difficult-to-diagnose hepatic reactive lymphoid hyperplasia finally diagnosed by using PCR analysis of IgH-gene rearrangements: a case report. Int Cancer Conf J 2024; 13:33-39. [PMID: 38187175 PMCID: PMC10764677 DOI: 10.1007/s13691-023-00632-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/14/2023] [Indexed: 01/09/2024] Open
Abstract
Reactive lymphoid hyperplasia (RLH) of the liver is extremely rare. Despite advancements in diagnostic imaging technology, it is still difficult to distinguish from hepatocellular carcinoma (HCC). Herein, we present a case of hepatic RLH mimicking HCC that was postoperatively diagnosed using several imaging modalities. A 78-year-old female was referred to our hospital with a positive hepatitis C virus antibody (HCV Ab) test. Ultrasonography revealed a 13 mm isoechoic lesion in segment 8 of the liver. Contrast-enhanced computed tomography (CE-CT) demonstrated arterial hyperintensity and washout during the later phase. On ethoxybenzyl magnetic resonance imaging (EOB-MRI), the lesion was hyperenhanced in the arterial phase and of low intensity in the hepatocyte phase. Although the tumor markers were all within normal limits, the pattern of contrast enhancement of the tumor on CT and MRI was consistent with that of HCC. We performed S8 segmentectomy of the liver. Histological examination of the resected specimen revealed dense lymphoid tissue of variable sizes and shapes with expanded germinal centers. Immunohistochemical examination was positive for CD3, CD10 (germinal center), and CD20, and negative for B-cell lymphoma 2 (bcl-2) (germinal center) and Epstein-Barr virus (EBV). A polymerase chain reaction (PCR) analysis of IgH-gene rearrangements revealed polyclonality. Based on these findings, hepatic RLH was diagnosed. The postoperative course was uneventful, and the patient was discharged on the 10th postoperative day. She had a good quality of life after surgery and no liver nodule recurrence was detected at the 4-month medical follow-up. Hepatic RLH is an extremely rare disease and preoperative diagnosis is difficult. This should be considered in the differential diagnosis of single small hepatic tumors. An echo-guided biopsy and careful observation of imaging may help diagnose hepatic RLH, and a PCR analysis of IgH-gene rearrangements would be necessary for the definitive diagnosis of hepatic RLH.
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Affiliation(s)
- Junya Mita
- Department of Surgery, Hiroshima Red Cross & Atomic-bomb Survivors’ Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima, Japan
| | - Takashi Maeda
- Department of Surgery, Hiroshima Red Cross & Atomic-bomb Survivors’ Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima, Japan
| | - Eiji Tsujita
- Department of Surgery, Hiroshima Red Cross & Atomic-bomb Survivors’ Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima, Japan
| | - Kyohei Yugawa
- Department of Surgery, Oita Red Cross Hospital, 3-2-37 Chiyomachi, Oita-shi, Oita, Japan
| | - Shintaro Takaki
- Department of Gastroenterology, Hiroshima Red Cross & Atomic-bomb Survivors’ Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima, Japan
| | - Keiji Tsuji
- Department of Surgery, Hiroshima Red Cross & Atomic-bomb Survivors’ Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima, Japan
| | - Naotaka Hashimoto
- Department of Surgery, Hiroshima Red Cross & Atomic-bomb Survivors’ Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima, Japan
| | - Ranma Fujikawa
- Department of Surgery, Hiroshima Red Cross & Atomic-bomb Survivors’ Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima, Japan
| | - Yuki Ono
- Department of Surgery, Hiroshima Red Cross & Atomic-bomb Survivors’ Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima, Japan
| | - Akihiro Sakai
- Department of Surgery, Hiroshima Red Cross & Atomic-bomb Survivors’ Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima, Japan
| | - Shinichi Tanaka
- Department of Surgery, Hiroshima Red Cross & Atomic-bomb Survivors’ Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima, Japan
| | - Rumi Matono
- Department of Surgery, Hiroshima Red Cross & Atomic-bomb Survivors’ Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima, Japan
| | - Takahiro Ohmine
- Department of Surgery, Hiroshima Red Cross & Atomic-bomb Survivors’ Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima, Japan
| | - Takuro Kometani
- Department of Surgery, Hiroshima Red Cross & Atomic-bomb Survivors’ Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima, Japan
| | - Shohei Yamaguchi
- Department of Surgery, Hiroshima Red Cross & Atomic-bomb Survivors’ Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima, Japan
| | - Kozo Konishi
- Department of Surgery, Hiroshima Red Cross & Atomic-bomb Survivors’ Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima, Japan
| | - Kenkichi Hashimoto
- Department of Surgery, Hiroshima Red Cross & Atomic-bomb Survivors’ Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima, Japan
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Matsuyama S, Fukuda A, Omatsu R, Nagao M, Okano A, Ueo T, Ohana M, Seno H. A case of hepatic reactive lymphoid hyperplasia: the review of 23 cases from the literatures. Clin J Gastroenterol 2023; 16:877-883. [PMID: 37610608 DOI: 10.1007/s12328-023-01844-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 08/07/2023] [Indexed: 08/24/2023]
Abstract
A 70-year-old woman was referred to our hospital because of slight elevation of soluble interleukin-2 receptor (sIL-2R) and accumulation of 18F-fluorodeoxyglucose (FDG) in S8 of the liver on positron emission tomography. The mass was strongly suspected to be malignant because of contrast enhancement and enlargement in size of the mass, and suspicion of portal vein invasion. Hepatic S8 subsegmentectomy was performed for diagnostic and therapeutic purposes. Hematoxylin and eosin staining of the resected specimen showed small lymphocytes with no atypia and no formation of lymphoid follicles. Immunostaining showed CD3-positive cells in the interfollicular region and CD20-positive cells in the lymphoid follicles. Both CD10 and BCL-2 were negative in the follicular germinal center. CD138-positive plasma cells were observed and there was no light chain restriction. Based on polyclonal growth pattern of lymphocytes in the lymphoid follicles and interfollicular region, she was diagnosed with hepatic reactive lymphoid hyperplasia (RLH).Review of the English literature of hepatic RLH which referred to imaging findings yielded 23 cases, including this case. As a result, we suggest that liver biopsy should be performed for definitive diagnosis, when hepatic RLH is suspected by imaging findings and backgrounds.
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Affiliation(s)
- Sho Matsuyama
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Akihisa Fukuda
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Risa Omatsu
- Department of Gastroenterology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, Japan
| | - Munemasa Nagao
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Akihiro Okano
- Department of Gastroenterology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, Japan
| | - Taro Ueo
- Department of Gastroenterology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, Japan
| | - Masaya Ohana
- Department of Gastroenterology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, Japan
| | - Hiroshi Seno
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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Jiang W, Wu D, Li Q, Liu CH, Zeng Q, Chen E, Lu C, Tang H. Clinical features, natural history and outcomes of pseudolymphoma of liver: A case-series and systematic review. Asian J Surg 2023; 46:841-849. [PMID: 36123208 DOI: 10.1016/j.asjsur.2022.08.113] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/05/2022] [Accepted: 08/30/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Pseudolymphoma is a rare, benign, nonspecific condition that forms a mass-like lesion characterized by the proliferation of non-neoplastic lymphocytes. Lacking of specific clinical symptoms, serological markers, and imaging features, the diagnosis is difficult. We reporte five cases of hepatic pseudolymphoma and provide a systematic review of existing literatures to improve our understanding of this rare liver disease. METHODS We followed-up five cases of hepatic pseudolymphoma in West China Hospital from January 2002 to January 2022. We also summarized the cases of hepatic pseudolymphoma from January 1981 to December 2021 through the PubMed database and comprehensively analyzed the characteristics of the cases. RESULTS The pathologic features of the five cases were characterized by benign lymphoid tissue hyperplasia, lymphoid follicle formation, and a polarized germinal center. Immunohistochemistry, in situ hybridization, and gene rearrangement revealed non-malignant lymphoma. Besides, a total of 116 cases have been reported in the PubMed database from 1981 to 2021. The incidence of hepatic pseudolymphoma is higher in middle-aged and elderly women and has been reported more frequently in Asia. All cases were pathologically diagnosed, among which 85.95% of the patients were treated by surgery. CONCLUSIONS Hepatic pseudolymphoma is an extremely rare benign disease, mainly in middle-aged and elderly women. Without distinctive clinical and imaging characteristics, pathological diagnosis is the highly reliable method at present. Thus, in the absence of risk factors for a primary liver tumor or metastatic tumor in middle-aged and elderly women, the possibility of pseudolymphoma should be considered to avoid extensive treatments.
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Affiliation(s)
- Wei Jiang
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China; Division of Infectious Diseases, State Key Laboratory of Biotherapy and Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Dongbo Wu
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China; Division of Infectious Diseases, State Key Laboratory of Biotherapy and Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Qin Li
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, China
| | - Chang-Hai Liu
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China; Division of Infectious Diseases, State Key Laboratory of Biotherapy and Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Qingmin Zeng
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China; Division of Infectious Diseases, State Key Laboratory of Biotherapy and Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Enqiang Chen
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China; Division of Infectious Diseases, State Key Laboratory of Biotherapy and Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Changli Lu
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, China.
| | - Hong Tang
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China; Division of Infectious Diseases, State Key Laboratory of Biotherapy and Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China.
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Vargo RJ, Robbins KJ, Stoeckel DC. An asymptomatic swelling of the hard palatal mucosa. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:420-424. [PMID: 35431175 DOI: 10.1016/j.oooo.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 02/02/2022] [Accepted: 02/07/2022] [Indexed: 10/19/2022]
Affiliation(s)
- Richard J Vargo
- Oral and Maxillofacial Pathology Specialty Care Unit, A.T. Still University-Missouri School of Dentistry & Oral Health, St. Louis, MO, USA; Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA; Department of Pathology, Anatomic Pathology, Saint Louis University School of Medicine, St. Louis, MO, USA.
| | - Katherine J Robbins
- Department of Pathology, Anatomic Pathology, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Daniel C Stoeckel
- Department of Pathology, Anatomic Pathology, Saint Louis University School of Medicine, St. Louis, MO, USA; Department of Pediatric Dentistry, Center for Advanced Dental Education, Saint Louis University, St. Louis, MO, USA
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Thienhiran A, Charoenpitakchai M, Hongjinda S, Fuengfoo P, Burasakarn P. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac048. [PMID: 35350223 PMCID: PMC8944704 DOI: 10.1093/jscr/rjac048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 02/06/2022] [Indexed: 11/13/2022] Open
Abstract
Reactive lymphoid hyperplasia (RLH) of the liver is an extremely rare benign lesion, which is often misdiagnosed as a malignant liver tumour. We present the case of a 69-year-old man with an incidental liver tumour revealed on the ultrasonography of the kidney-urinary bladder system for benign prostatic hyperplasia. Hepatocyte-specific contrast (gadoxetate disodium) magnetic resonance imaging revealed a round 6-mm lesion, which was hypointense on T1-weighted images, slightly hyperintense on T2-weighted images and highly intense on diffusion-weighted images. Other findings included arterial hyperintensity, venous and delayed hypointensity and a defect in liver segment 6. The patient was diagnosed with hepatocellular carcinoma; laparoscopic partial hepatectomy was performed. Intraoperatively, a 7-mm greyish white solid nodule was observed. In conclusion, it may be difficult to distinguish RLH from other malignant liver tumours. However, it should be considered as a differential diagnosis for small liver lesions in young, female patients without liver cirrhosis.
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Affiliation(s)
- Anuparp Thienhiran
- Division of HPB Surgery, Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand
| | | | - Sermsak Hongjinda
- Division of HPB Surgery, Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand
| | - Pusit Fuengfoo
- Division of HPB Surgery, Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand
| | - Pipit Burasakarn
- Correspondence address. Division of HPB Surgery, Department of Surgery, Phramongkutklao Hospital, Thung Phaya Thai, Ratchathewi, Bangkok 10400, Thailand. E-mail:
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Kanno H, Sakai H, Hisaka T, Kojima S, Midorikawa R, Fukutomi S, Nomura Y, Goto Y, Sato T, Yoshitomi M, Kawahara R, Okuda K. A case of reactive lymphoid hyperplasia of the liver in a patient with autoimmune hepatitis. Surg Case Rep 2020; 6:90. [PMID: 32367275 PMCID: PMC7198675 DOI: 10.1186/s40792-020-00856-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 04/24/2020] [Indexed: 11/26/2022] Open
Abstract
Background Reactive lymphoid hyperplasia (RLH) of the liver is a benign disorder. It is usually observed in the skin, orbit, thyroid, lung, breast, or gastrointestinal tract, but rarely in the liver. Since the first report of RLH of the liver in 1981, only 75 cases have been described in the past literature. Herein, we report a case of RLH of the liver in a patient with autoimmune hepatitis (AIH), which was misdiagnosed as hepatocellular carcinoma (HCC) preoperatively and resected laparoscopically. Case presentation A 43-year-old Japanese woman with autoimmune hepatitis was followed up for 5 years. During her medical checkup, a hypoechoic nodule in segment 6 of the liver was detected. The nodule had been gradually increasing in size for 4 years. Abdominal ultrasound (US) revealed a round, hypoechoic nodule, 12 mm in diameter. Contrast-enhanced computed tomography (CT) demonstrated that the nodule was slightly enhanced in the arterial dominant phase, followed by perinodular enhancement in the portal and late phases. A magnetic resonance imaging (MRI) scan showed low signal intensity on the T1-weighted image (T1WI) and slightly high signal intensity on the T2-weighted image (T2WI). The findings of the Gd-EOB-DTPA-enhanced MRI were similar to those of contrast-enhanced CT. Tumor markers were all within the normal range. The preoperative diagnosis was HCC and a laparoscopic right posterior sectionectomy was performed. Pathological examination revealed that the nodular lesion was infiltrated by small lymphocytes and plasma cells, and germinal centers were present. Immunohistochemistry was positive for B cell and T cell markers, indicating polyclonality. The final diagnosis was RLH of the liver. Conclusions The pathogenesis of RLH of the liver remains unknown, and a definitive diagnosis based on imaging findings is extremely difficult. If a small, solitary nodule is found in female patients with AIH, the possibility of RLH of the liver should be considered.
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Affiliation(s)
- Hiroki Kanno
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Japan.
| | - Hisamune Sakai
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Japan
| | - Toru Hisaka
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Japan
| | - Satoki Kojima
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Japan
| | - Ryuta Midorikawa
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Japan
| | - Shogo Fukutomi
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Japan
| | - Yoriko Nomura
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Japan
| | - Yuichi Goto
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Japan
| | - Toshihiro Sato
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Japan
| | - Munehiro Yoshitomi
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Japan
| | - Ryuichi Kawahara
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Japan
| | - Koji Okuda
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Japan
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Tom WJ, Xu X, Vahdat N, Cassidy F, Aganovic L. Follicular pancreatitis: A rare pancreatic inflammatory pseudotumor. Clin Imaging 2020; 59:39-44. [PMID: 31756593 PMCID: PMC6938461 DOI: 10.1016/j.clinimag.2019.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/16/2019] [Accepted: 08/21/2019] [Indexed: 02/07/2023]
Abstract
Inflammatory pseudotumors imitate neoplasms on imaging but actually represent focal inflammation. We report a case of follicular pancreatitis, which is a recently recognized distinct form of mass-forming focal chronic pancreatitis pathologically characterized by lymphoid infiltration with abundant reactive germinal centers. In our patient, follicular pancreatitis manifested as a pancreatic tail mass that was resected due to imaging findings, which were suggestive of pancreatic malignancy. We performed a literature review of this rare condition and present a summary of reported imaging findings. The most distinguishing feature from pancreatic adenocarcinoma is the enhancement pattern, as follicular pancreatitis enhances more than the surrounding pancreatic parenchyma on delayed post-contrast images which is unusual for pancreatic adenocarcinoma. If this benign diagnosis is suggested on imaging, unnecessary surgery and its potential complications may be avoided.
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Affiliation(s)
- W James Tom
- Department of Radiology, University of California San Diego, San Diego, CA, USA.
| | - Xiangdong Xu
- Department of Pathology, University of California San Diego, San Diego, CA, USA; Department of Pathology, VA San Diego Healthcare System, San Diego, CA, USA
| | - Noushin Vahdat
- Department of Radiology, University of California San Diego, San Diego, CA, USA; Department of Radiology, VA San Diego Healthcare System, San Diego, CA, USA
| | - Fiona Cassidy
- Department of Radiology, University of California San Diego, San Diego, CA, USA; Department of Radiology, VA San Diego Healthcare System, San Diego, CA, USA
| | - Lejla Aganovic
- Department of Radiology, University of California San Diego, San Diego, CA, USA; Department of Radiology, VA San Diego Healthcare System, San Diego, CA, USA
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Watanabe M, Enomoto A, Yoneyama Y, Kohno M, Hasegawa O, Kawase-Koga Y, Satomi T, Chikazu D. Follicular lymphoid hyperplasia of the posterior maxillary site presenting as uncommon entity: a case report and review of the literature. BMC Oral Health 2019; 19:243. [PMID: 31711493 PMCID: PMC6849200 DOI: 10.1186/s12903-019-0936-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 10/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Follicular lymphoid hyperplasia (FLH) is characterized by an increased number and size of lymphoid follicles. In some cases, the etiology of FLH is unclear. FLH in the oral and maxillofacial region is an uncommon benign entity which may resemble malignant lymphoma clinically and histologically. CASE PRESENTATION We report the case of a 51-year-old woman who presented with an asymptomatic firm mass in the left posterior maxillary site. Computed tomography scan of her head and neck showed a clear circumscribed solid mass measuring 28 × 23 mm in size. There was no evidence of bone involvement. Incisional biopsy demonstrated benign lymphoid tissue. The patient underwent complete surgical resection. Histologically, the resected specimen showed scattered lymphoid follicles with germinal centers and predominant small lymphocytes in the interfollicular areas. Immunohistochemically, the lymphoid follicles were positive for CD20, CD79a, CD10, CD21, and Bcl6. The germinal centers were negative for Bcl2. Based on these findings, a diagnosis of benign FLH was made. There was no recurrence at 1 year postoperatively. CONCLUSIONS We diagnosed an extremely rare case of FLH arising from an unusual site and whose onset of entity is unknown. Careful clinical and histopathological evaluations are essential in making a differential diagnosis from a neoplastic lymphoid proliferation with a nodular growth pattern.
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Affiliation(s)
- Masato Watanabe
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan.
| | - Ai Enomoto
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan
| | - Yuya Yoneyama
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan
| | - Michihide Kohno
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan
| | - On Hasegawa
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan
| | - Yoko Kawase-Koga
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan
| | - Takafumi Satomi
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan
| | - Daichi Chikazu
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan
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Dong CH, Lu Q, Wang WP, Ji ZB, Wang X. Contrast-Enhanced Ultrasound Features of Hepatic Reactive Lymphoid Hyperplasia: Correlation With Histopathologic Findings. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2379-2388. [PMID: 30666662 DOI: 10.1002/jum.14934] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/23/2018] [Accepted: 12/03/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To find certain specifics of hepatic reactive lymphoid hyperplasia (HRLH) on contrast-enhanced ultrasound (CEUS) imaging as diagnostic imaging clues by retrospectively analyzing its enhancement features. METHODS From June 2010 to June 2017, 18 histopathologically confirmed HRLH lesions in 18 patients were included in this retrospective study. The lesion's location, maximum diameter, shape, margin, echogenicity, and color flow signal on conventional ultrasound (US) imaging and enhancement pattern, presence of a feeding artery, and donutlike enhancement on CEUS imaging were observed and recorded. The lesion size on CEUS imaging at peak enhancement and that on conventional US imaging were compared and recorded. RESULTS All of the lesions showed homogeneous hypoechogenicity with a regular well-defined margin on conventional US imaging, with a mean diameter ± SD of 14.3 ± 4.6 mm (range, 8-24 mm). On CEUS imaging, all of the lesions showed "quick-wash-in and quick-wash-out," which showed complete homogeneous hyperenhancement in the arterial phase and wash-out in the second half of the arterial phase or first half of the portal phase. In 83.3% (15 of 18) of the lesions, the lesion size that was enhanced at peak was enlarged compared with the hypoechoic area on conventional US imaging, and transient donutlike enhancement appeared when the lesion showed wash-out. In 55.6% (10 of 18) of cases, the feeding artery was detected. CONCLUSIONS Enlarged complete homogeneous hyperenhancement in the arterial phase, consequently followed by quick wash-out of the lesion and the appearance of donutlike enhancement, may be the CEUS features of HRLH.
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Affiliation(s)
- Cai-Hong Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Qing Lu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Zheng-Biao Ji
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xi Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
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Intrahepatic Reactive Lymphoid Hyperplasia: A Case Report and Review of the Literature. Case Rep Surg 2018; 2018:9264251. [PMID: 30258664 PMCID: PMC6146636 DOI: 10.1155/2018/9264251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/29/2018] [Accepted: 08/12/2018] [Indexed: 12/27/2022] Open
Abstract
Introduction Reactive lymphoid hyperplasia (RLH) is a rare and benign lesion found in organs of the gastrointestinal tract, skin, lung, orbit, and more rarely in the liver. Due to its similar appearance on imaging, it is hard to differentiate from primary liver malignancies. The following is a case report of a patient presenting with a suspicious liver lesion found to be RLH associated with primary biliary cirrhosis (PBC), after surgical resection. Presentation of Case A 54-year-old woman presented with nonspecific abdominal pain, and her workup included axial imaging of the abdomen that showed a suspicious lesion in her liver. After an extensive workup, which included a percutaneous biopsy, failed to confirm a diagnosis, a laparoscopic surgical resection was recommended. Discussion RLH is a rare condition of the liver, presenting in a suspicious fashion and raising concerns for a primary liver malignancy. RLH should be considered in the differential diagnosis of small hepatic lesions in middle-age females in the absence of any significant risk factors for hepatocellular carcinoma (HCC). RLH tends to be associated with PBC of the liver. Conclusion RLH of the liver is a rare, hard to diagnose, benign lesion. When intrahepatic, it cannot be easily differentiated from primary liver tumors and frequently requires surgical resection for pathological diagnostic confirmation.
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Hepatic pseudolymphoma: imaging features on dynamic contrast-enhanced MRI and diffusion-weighted imaging. Abdom Radiol (NY) 2018; 43:2288-2294. [PMID: 29392361 DOI: 10.1007/s00261-018-1468-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To investigate dynamic contrast-enhanced (DCE) MR findings and diffusion-weighted imaging (DWI) characteristics of hepatic pseudolymphoma. MATERIALS AND METHODS The MR data of 20 lesions in 14 patients with histopathologically proven hepatic pseudolymphoma were retrospectively analyzed. All patients underwent dynamic gadopentetate dimeglumine-enhanced MR imaging and DWI. Morphologic characteristics and signal features on T1- and T2-weighted images (T1WI, T2WI), and DCE pattern were qualitatively evaluated. The quantitative analysis was performed for the size, the degree of enhancement on arterial phase, signal intensity (SI) of DWI, and apparent diffusion coefficient (ADC) values. The Wilcoxon signed ranks test was used for statistical analysis. RESULTS The contour of all lesions was round. The lesion size was 0.7-2.8 cm (mean 1.3 ± 0.5 cm). All lesions manifested as homogeneous hypointensity on T1WI and hyperintensity on T2WI. All lesions were shown as hypervascular with various enhancement patterns on DCE MR imaging. The presence of peripheral enhancement and pseudocapsule was observed in 7 and 4 lesions, respectively. SI of the hepatic pseudolymphoma was significantly lower than that of portal vein on arterial phase (P < 0.001) and the ADC was significantly lower than that of spleen (P = 0.012). CONCLUSION A homogeneous nodule with small size (<2 cm), manifestation of hypervascular with lower SI than that of portal vein on arterial phase and lower ADC values than that of spleen are the common MR features of hepatic pseudolymphoma.
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Kunimoto H, Morihara D, Nakane SI, Tanaka T, Yokoyama K, Anan A, Takeyama Y, Irie M, Shakado S, Noritomi T, Takeshita M, Yoshimitsu K, Sakisaka S. Hepatic Pseudolymphoma with an Occult Hepatitis B Virus Infection. Intern Med 2018; 57:223-230. [PMID: 29033422 PMCID: PMC5820041 DOI: 10.2169/internalmedicine.8981-17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
A 49-year-old woman who was asymptomatic was found to have a small liver tumor on abdominal ultrasonography (US) at her annual health checkup. US revealed a hypoechoic, solid, mass measuring 17-mm in size in segment 6. The tumor markers associated with liver malignancy were negative. An infectious disease screen was negative for hepatitis B surface antigen, but positive for antibody to hepatitis B core antigen. Imaging studies using computed tomography (CT), magnetic resonance imaging (MRI), and CT angiography suggested a malignant liver tumor, such as hepatocellular carcinoma. Partial hepatic resection of the posterior segment was performed. The pathological diagnosis was pseudolymphoma of the liver.
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Affiliation(s)
- Hideo Kunimoto
- Department of Gastroenterological, Faculty of Medicine, Fukuoka University, Japan
| | - Daisuke Morihara
- Department of Gastroenterological, Faculty of Medicine, Fukuoka University, Japan
| | | | - Takashi Tanaka
- Department of Gastroenterological, Faculty of Medicine, Fukuoka University, Japan
| | - Keiji Yokoyama
- Department of Gastroenterological, Faculty of Medicine, Fukuoka University, Japan
| | - Akira Anan
- Department of Gastroenterological, Faculty of Medicine, Fukuoka University, Japan
| | - Yasuaki Takeyama
- Department of Gastroenterological, Faculty of Medicine, Fukuoka University, Japan
| | - Makoto Irie
- Department of Gastroenterological, Faculty of Medicine, Fukuoka University, Japan
| | - Satoshi Shakado
- Department of Gastroenterological, Faculty of Medicine, Fukuoka University, Japan
| | - Tomoaki Noritomi
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Japan
| | | | - Kengo Yoshimitsu
- Department of Radiology, Faculty of Medicine, Fukuoka University, Japan
| | - Shotaro Sakisaka
- Department of Gastroenterological, Faculty of Medicine, Fukuoka University, Japan
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Kwon YK, Jha RC, Etesami K, Fishbein TM, Ozdemirli M, Desai CS. Pseudolymphoma (reactive lymphoid hyperplasia) of the liver: A clinical challenge. World J Hepatol 2015; 7:2696-2702. [PMID: 26609347 PMCID: PMC4651914 DOI: 10.4254/wjh.v7.i26.2696] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 09/05/2015] [Accepted: 10/27/2015] [Indexed: 02/06/2023] Open
Abstract
Reactive lymphoid hyperplasia (RLH), also known as pseudolymphoma or nodular lymphoid lesion of the liver is an extremely rare condition, and only 51 hepatic RLH cases have been described in the literature since the first case was described in 1981. The majority of these cases were asymptomatic and incidentally found through radiological imaging. The precise etiology of hepatic RLH is still unknown, but relative high prevalence of autoimmune disorder in these cases suggests an immune-based liver disorder. Imaging features of hepatic RLH often suggest malignant lesions such as hepatocellular carcinoma and cholangiocarcinoma. In this report, we discuss two cases of hepatic RLH in patients with autoimmune hepatitis. We also present pathologic and magnetic resonance imaging findings, including one case utilizing a hepatocellular contrast agent, Eovist. Definitive diagnosis of hepatic RLH often requires surgical excision.
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Pseudolymphoma of the liver: a case report and literature review. Surg Case Rep 2015; 1:107. [PMID: 26943431 PMCID: PMC4608947 DOI: 10.1186/s40792-015-0110-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 10/14/2015] [Indexed: 12/14/2022] Open
Abstract
Pseudolymphoma is a benign lymphocytic tumor-like lesion, and its occurrence in the liver is rare. Here, we report the case of a 78-year-old woman with pseudolymphoma of the liver. She had a history of tremors for several years. Therefore, she underwent computed tomography (CT) for screening, and liver tumors were incidentally identified. She did not have any history of liver disease. Liver function test results and tumor marker levels were all within normal limits, and viral markers for hepatitis were negative. Contrast-enhanced CT revealed four nodules measuring up to 13 mm in diameter with ring enhancement in both lobes of the liver. On magnetic resonance imaging, the lesions showed slightly high intensity on T2-weighted images and high intensity on diffusion-weighted images. Because of atypical imaging findings, the tumors could not be definitively diagnosed. Therefore, we performed laparoscopic limited resection of segments 2, 3, 4, and 8 of the liver. The final pathological diagnosis was pseudolymphoma of the liver. The patient has had no signs of recurrence for 6 months after the surgery. Although pseudolymphoma of the liver is rare, it is necessary to consider it in the differential diagnosis of a liver tumor.
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Affiliation(s)
- Ji Soo Song
- Department of Radiology; Chonbuk National University, Medical School; Research Institute of Clinical Medicine of Chonbuk National University Hospital; Research Institute for Endocrine Sciences; Jeonju Korea
| | - Hee Chul Yu
- Department of Surgery; Chonbuk National University, Medical School; Research Institute of Clinical Medicine of Chonbuk National University Hospital; Research Institute for Endocrine Sciences; Jeonju Korea
| | - Woo Sung Moon
- Department of Pathology; Chonbuk National University, Medical School; Research Institute of Clinical Medicine of Chonbuk National University Hospital; Research Institute for Endocrine Sciences; Jeonju Korea
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Yoshida K, Kobayashi S, Matsui O, Gabata T, Sanada J, Koda W, Minami T, Ryu Y, Kozaka K, Kitao A. Hepatic pseudolymphoma: imaging-pathologic correlation with special reference to hemodynamic analysis. ACTA ACUST UNITED AC 2014; 38:1277-85. [PMID: 23744440 DOI: 10.1007/s00261-013-0016-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To clarify radiological findings and hemodynamic characteristics of hepatic pseudolymphoma, as compared with the histopathological findings. METHODS Radiological findings of ten histopathologically confirmed hepatic pseudolymphomas in seven patients were examined using US, CT, and MRI. Six patients also underwent angiography-assisted CT, including CT during arterial portography (CTAP) and CT during hepatic arteriography (CTHA) to analyze hemodynamics. RESULTS The nodules were depicted as hypoechoic on US, hypodense on precontrast CT, hypointense on T1-weighted images, and hyperintense on T2-weighted images. On contrast-enhanced CT/MRI, they showed various degrees of enhancement, and sometimes, perinodular enhancement was observed at the arterial dominant and/or equilibrium phase. On CTAP, the nodules showed portal perfusion defects, including some in the perinodular liver parenchyma. On CTHA, irregular bordered enhancement was observed in perinodular liver parenchyma on early phase, and continued until delayed phase. Some nodules had preserved intra-tumoral portal tracts. Histopathologically, the nodules consisted of marked lymphoid cells. In perinodular liver parenchyma, stenosis or disappearance of portal venules, caused by lymphoid cell infiltration in the portal tracts, was observed. CONCLUSIONS Hepatic pseudolymphoma showed some characteristic radiological findings including hemodynamics on CT, MRI, and angiography-assisted CT. These findings are useful in the differentiation from hepatocellular carcinoma and other tumors.
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Affiliation(s)
- Kotaro Yoshida
- Department of Radiology, Kanazawa University School of Medicine, 13-1, Takara-Machi, Kanazawa, 920-8641, Japan,
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