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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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Xiaohui QMD, Kun CMD, Gang CMDP, Liyun XMD, Guangwen CMD, Hong DMDP. Hepatic Reactive Lymphoid Hyperplasia and Primary Hepatic Lymphoma: Ultrasound Features and Differentiation Diagnosis. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2021. [DOI: 10.37015/audt.2021.200069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Avellana Moreno R, De la Serna Esteban S, García-Botella A. Hepatic reactive lymphoid hyperplasia: a difficult differential diagnosis with hepatocarcinoma. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 113:552. [PMID: 33256424 DOI: 10.17235/reed.2020.7462/2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Hepatic reactive lymphoid hyperplasia (HRLH) is an uncommon lesion. We present the case of a 58-year-old patient with a liver nodule incidentally found by abdominal ultrasonography (US). Liver function, tumor markers, viral serology and immunology were normal. Magnetic resonance imaging (MRI) showed a 16 mm nodule in segment VI-VII, with hypervascular enhancement in the arterial phase, wash-out in late phases, without contrast-retention in the hepatobiliary phase and restriction on diffusion-weighted imaging, suggestive of hepatocellular carcinoma (HCC).
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Tanaka T, Saito K, Yunaiyama D, Matsubayashi J, Nagakawa Y, Tanigawa M, Nagao T. Diffusion-weighted imaging might be useful for reactive lymphoid hyperplasia diagnosis of the liver: A case report. World J Clin Cases 2020; 8:5313-5319. [PMID: 33269264 PMCID: PMC7674723 DOI: 10.12998/wjcc.v8.i21.5313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/22/2020] [Accepted: 09/22/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Reactive lymphoid hyperplasia (RLH) of the liver is a rare liver lesion. It is considered difficult to differentiate radiologically from hepatocellular carcinoma, metastatic liver tumor and other pathologies.
CASE SUMMARY A 54-year-old woman presented to our hospital with RLH of the liver. The patient had a diagnosis of metastatic carcinoma of the liver from an unknown origin and subsequently underwent partial hepatectomy. However, histopathological analysis revealed RLH. The lesion showed perinodular enhancement in the arterial phase on contrast-enhanced computed tomography and magnetic resonance imaging. On diffusion-weighted imaging (DWI), we encountered linear hyperintensity along the portal tract consecutive to the liver lesion, which is a new characteristic radiologic finding. This finding corresponded to the lymphoid cell infiltration of the portal tract. Furthermore, there was strongly restricted diffusion on the apparent diffusion coefficient map. We used these characteristic radiologic findings to diagnose the lesion as a lymphoproliferative disease.
CONCLUSION The linear hyperintensity consecutive to the liver lesion on DWI provided additional valuable diagnostic information.
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Affiliation(s)
- Taro Tanaka
- Department of Radiology, Tokyo Medical University, Tokyo 1600023, Japan
| | - Kazuhiro Saito
- Department of Radiology, Tokyo Medical University, Tokyo 1600023, Japan
| | - Daisuke Yunaiyama
- Department of Radiology, Tokyo Medical University, Tokyo 1600023, Japan
| | - Jun Matsubayashi
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo 1600023, Japan
| | - Yuichi Nagakawa
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo 1600023, Japan
| | - Maki Tanigawa
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo 1600023, Japan
| | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo 1600023, Japan
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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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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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Bai Y, Liang W. Potential value of apparent diffusion coefficient in the evaluation of hepatic pseudolymphoma. Quant Imaging Med Surg 2019; 9:340-345. [PMID: 30976558 DOI: 10.21037/qims.2018.11.07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Yanjun Bai
- Department of Radiology, Beilun Branch Hospital of the First Affiliated Hospital, Zhejiang University School of Medicine, Ningbo 315800, China
| | - Wenjie Liang
- Department of Radiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
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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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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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