1
|
Hepatic Involvement of Diffuse Large B-Cell Lymphoma Mimicking Antinuclear Antibody-Negative Autoimmune Hepatitis Diagnosed by Liver Biopsy. MEDICINA (KAUNAS, LITHUANIA) 2022; 59:medicina59010077. [PMID: 36676701 PMCID: PMC9865022 DOI: 10.3390/medicina59010077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/16/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022]
Abstract
Non-Hodgkin's lymphoma (NHL) is the fifth most common hematologic disorder in the United States, and its prevalence has been rising in Western countries. Among the subtypes of NHL, diffuse large B-cell lymphoma (DLBCL) mostly involves the lymph nodes, stomach, and gastrointestinal tract, whereas hepatic involvement of DLBCL is rare. On serologic testing, elevated immunoglobulin G (IgG) levels can be observed in DLBCL; however, elevated IgG levels are mainly observed in autoimmune hepatitis. A targeted-lesion biopsy is required for the diagnosis of DLBCL. Based on a final diagnosis, the patient was treated with rituximab-based chemotherapy, including cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy (R-CHOP). Herein, we report a case of DLBCL mimicking antinuclear antibody-negative autoimmune hepatitis, which was finally diagnosed as DLBCL involving the liver, and was confirmed by liver biopsy.
Collapse
|
2
|
Bris PN, Gauchez P, Devillier R, Galicier L, Collignon A, Piana G, Poizat F, Faucher M, Hospital MA, Vey N, Gonzalez F, Servan L, Chow-Chine L, Sannini A, Mokart D, Saillard C, Bisbal M. Hepatic haemophagocytosis in haematology patients with hepatic dysfunction: prognostic impact and contribution of liver biopsy combined with the haemophagocytic syndrome diagnostic score (HScore). Br J Haematol 2022; 199:106-116. [PMID: 35968907 DOI: 10.1111/bjh.18382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 07/05/2022] [Accepted: 07/12/2022] [Indexed: 01/07/2023]
Abstract
Hepatic dysfunction (HD) is common in patients with haematological malignancies. Hepatic haemophagocytosis (HH) was detected in >50% of liver biopsies taken when HD remained unresolved after standard examination. We aimed to explore the contribution of liver biopsy in patients with both haematological malignancies and HD, describe the population of patients with HH, assess the prognostic impact of HH, and investigate haemophagocytic syndrome diagnostic score (HScore) utility in patients with HH. Between 2016 and 2019, 116 consecutive liver biopsies (76 transjugular, 40 percutaneous) were taken in 110 patients with haematological malignancy and HD (hyperbilirubinaemia, elevated transaminases, and/or cholestasis) and without a clear diagnosis. Liver biopsies were safe and diagnostically efficient. Predominant diagnoses included: HH (56%), graft-versus-host disease (55%), associated infections (24%), sinusoidal obstruction syndrome (15%), and tumoral infiltration (8%). Of patients, 35% were critically ill and 74% were allogeneic haematopoietic stem cell transplantation recipients, while 1-year overall survival (OS) was 35% with HH versus 58% without HH (p = 0.026). The 1-year OS was 24% with a HScore of ≥169 versus 50% with a HScore of <169 (p = 0.019). Liver biopsies are feasible in and contribute significantly to haematology patients with HD. HH occurred frequently and was associated with a poor prognosis. Combined with liver biopsy, the HScore may be helpful in refining haemophagocytic syndrome diagnosis.
Collapse
Affiliation(s)
- Pierre-Nicolas Bris
- Anaesthesia and Critical Care Department, Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
| | - Philippe Gauchez
- Pathology Department, Centre Hospitalier Universitaire de la Réunion, Saint Pierre, France
| | | | | | - Aude Collignon
- Hematology Department, Institut Paoli Calmettes, Marseille, France
| | - Gilles Piana
- Imagery Department, Institut Paoli Calmettes, Marseille, France
| | - Flora Poizat
- Pathology Department, Institut Paoli Calmettes, Marseille, France
| | - Marion Faucher
- Anaesthesia and Critical Care Department, Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
| | | | - Norbert Vey
- Hematology Department, Institut Paoli Calmettes, Marseille, France.,Aix-Marseille University, Marseille, France
| | - Frederic Gonzalez
- Anaesthesia and Critical Care Department, Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
| | - Luca Servan
- Anaesthesia and Critical Care Department, Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
| | - Laurent Chow-Chine
- Anaesthesia and Critical Care Department, Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
| | - Antoine Sannini
- Anaesthesia and Critical Care Department, Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
| | - Djamel Mokart
- Anaesthesia and Critical Care Department, Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
| | - Colombe Saillard
- Hematology Department, Institut Paoli Calmettes, Marseille, France
| | - Magali Bisbal
- Anaesthesia and Critical Care Department, Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
| |
Collapse
|
3
|
Primary Lymphoma of Liver-a Rare Space-Occupying Lesion. J Gastrointest Cancer 2021; 51:1057-1060. [PMID: 32333249 DOI: 10.1007/s12029-020-00381-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
4
|
Dantas E, Santos J, Coelho M, Sequeira C, Santos I, Cardoso C, Oliveira AP. Primary hepatic lymphoma in a patient with cirrhosis: a case report. J Med Case Rep 2020; 14:168. [PMID: 32977834 PMCID: PMC7519549 DOI: 10.1186/s13256-020-02471-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 07/28/2020] [Indexed: 02/07/2023] Open
Abstract
Background Primary hepatic lymphoma is a very uncommon disease. Due to its nonspecific clinical, laboratory, and imaging findings, it is often misdiagnosed. Liver biopsy is required to make a final diagnosis. Chemotherapy is the current gold standard of treatment. Case presentation An asymptomatic 65-year-old Caucasian man with Child-Pugh class A cirrhosis presented to our hospital with a nodular lesion seen on a routine surveillance abdominal ultrasound. His physical examination revealed hepatomegaly and no other significant findings. Magnetic resonance imaging of the abdomen showed a voluminous nodule on the left lobe with heterogeneous contrast enhancement. His liver biopsy was compatible with diffuse large B-cell lymphoma. Systemic staging showed no evidence of nodal or bone marrow involvement, confirming the diagnosis of primary hepatic lymphoma. He was treated with chemotherapy. However, he developed febrile neutropenia after one of the cycles and died. Conclusions In this article, we report a rare presentation of non-Hodgkin lymphoma and review the current literature on clinical features, diagnosis, and management.
Collapse
Affiliation(s)
- Eduardo Dantas
- Gastroenterology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal.
| | - Joana Santos
- Oncology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Mariana Coelho
- Gastroenterology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Cristiana Sequeira
- Gastroenterology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Inês Santos
- Gastroenterology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Cláudia Cardoso
- Gastroenterology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Ana Paula Oliveira
- Gastroenterology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| |
Collapse
|
5
|
Ippolito D, Porta M, Maino C, Pecorelli A, Ragusi M, Giandola T, Querques G, Talei Franzesi C, Sironi S. Diagnostic approach in hepatic lymphoma: radiological imaging findings and literature review. J Cancer Res Clin Oncol 2020; 146:1545-1558. [PMID: 32296934 DOI: 10.1007/s00432-020-03205-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 03/30/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE Imaging manifestations of hepatic lymphoma, both primary (PHL) and secondary (SHL), are extremely variable and non-specific, but some features are useful diagnostic clues in an appropriate clinical setting. Through a PubMed search, we found several published reviews focused on PHL and SHL diagnosis. However, to the best of our knowledge, few of them encompass a comprehensive analysis of all the diagnostic tools and relative radiological findings. The aim of this review is to provide a description of the radiological features of both PHL and SHL, by critically analyzing the available literature. MATERIALS AND METHODS An extensive review of published literature along with a description of personal case series of both PHL and SHL has been conducted. RESULTS SHL can be easily diagnosed with imaging techniques, as it is usually associated with node disease. On the contrary the diagnosis can be a challenge in PHL, often mimicking HCC or liver metastasis of adenocarcinoma. In this context, multiparametric MRI plays a fundamental role in the differential diagnosis. Both for PHL and SHL, liver involvement presents as solitary or multiple lesions or as diffuse infiltrative disease. CONCLUSION PHL and SHL may be correctly characterized using different radiological techniques. Both CT and MRI have showed a good correlation with histology, as they permit to distinguish between lymphomatous tissue, and necrotic and fibrotic areas.
Collapse
Affiliation(s)
- Davide Ippolito
- Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Marco Porta
- Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Cesare Maino
- Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Anna Pecorelli
- Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900, Monza, MB, Italy.
- School of Medicine, University of Milano-Bicocca, Milan, Italy.
| | - Maria Ragusi
- Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Teresa Giandola
- Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Giulia Querques
- Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Cammillo Talei Franzesi
- Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Sandro Sironi
- Department of Diagnostic Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| |
Collapse
|
6
|
Zhang SL, Chen C, Rao QW, Guo Z, Wang X, Wang ZM, Wang LS. Incidence, Prognostic Factors and Survival Outcome in Patients With Primary Hepatic Lymphoma. Front Oncol 2020; 10:750. [PMID: 32477954 PMCID: PMC7239999 DOI: 10.3389/fonc.2020.00750] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/20/2020] [Indexed: 12/14/2022] Open
Abstract
Aim: The objective of our study was to investigate the epidemiologic characteristics, prognostic factors and survival in patients with primary hepatic lymphoma (PHL). Methods: PHL patients diagnosed between 1983 and 2015 were identified from the SEER database. The temporal trend in PHL incidence was assessed using joinpoint regression software. Overall survival(OS) and disease-specific survival (DSS) was evaluated using the Kaplan-Meier method and log-rank test. Univariate and multivariate Cox regression analysis was performed to identify the independent prognostic factors for OS and DSS. Nomograms to predict survival possibilities were constructed based on the identified independent prognostic factors. Results: A total of 1,182 patients were identified with PHL. The mean age was 61.7 ± 17.1 years with a male to female of 1.6:1. Diffuse large B-cell lymphoma (59.8%) was the most common histological subtype. The incidence of PHL steadily increasing by an annual percentage change (APC) of 2.6% (95% CI 2.0-3.2, P < 0.05). The 1-, 5-, and 10-year OS rates were 50.85, 39.6, and 30.4%, respectively, and the corresponding DSS rates were 55.3, 47.9, and 43.3%, respectively. Multivariate Cox regression analysis revealed that age, sex, race, marital status, histological subtype, surgery, and chemotherapy were independent prognostic factors for survival. Nomograms specifically for DLBCL were constructed to predict 1-, 5-, and 10-year OS and DSS possibility, respectively. The concordance index (C-index) and calibration plots showed the established nomograms had robust and accurate performance. Conclusion: PHL were rare but the incidence has been steadily increasing over the past four decades. Survival has improved in recent years. Surgery or chemotherapy could provide better OS and DSS. The established nomograms specifically for DLBCL were robust and accurate in predicting 1-, 5-, and 10-year OS and DSS.
Collapse
Affiliation(s)
| | - Chen Chen
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qian-Wen Rao
- Minhang Hospital, Fudan University, Shanghai, China
| | - Zhe Guo
- Department of Internal Medicine, Ophthalmic Hospital of Hebei Province, Xingtai, China
| | - Xin Wang
- Department of Acupuncture and Moxibustion, Central Hospital of Shanghai Xuhui District, Shanghai, China
| | - Zhi-Ming Wang
- Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai, China.,Department of Medical Oncology, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
| | - Li-Shun Wang
- Minhang Hospital, Fudan University, Shanghai, China
| |
Collapse
|
7
|
|
8
|
El-Fattah MA. Non-Hodgkin Lymphoma of the Liver: A US Population-based Analysis. J Clin Transl Hepatol 2017; 5:83-91. [PMID: 28660145 PMCID: PMC5472928 DOI: 10.14218/jcth.2017.00015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 03/23/2017] [Accepted: 04/03/2017] [Indexed: 02/06/2023] Open
Abstract
Background and Aims: Non-Hodgkin lymphoma (NHL) of the liver is a rare lymphoid malignancy, accounting for less than 1% of extranodal lymphomas. Methods: I conducted an analysis of the U.S Surveillance, Epidemiology, and End Results (SEER) database to evaluate the histological subtypes and the survival outcomes of 785 cases with hepatic NHL between 1973 and 2012. Results: There were 785 of 312 459 cases with NHL had a first primary hepatic NHL (0.25%). Of the total 785 cases, the median age at diagnosis was 61 years (range 3-95 years) and male-female ratio of 1.7:1. The most common subtype was diffuse large B cell lymphoma (63.2%). In all patients, the median overall survival (OS) was 33 months (95%CI, 22-48 months). The 5-year OS rate for indolent B-cell NHLs was 62%, compared with 44% for an aggressive B-cell NHLs and 42% for T-cell NHLs. The median OS improved from 19 months in patients diagnosed in a period 1996-2000 to 60 months when diagnosed between 2006 and 2012 (p < .001). In a multivariable Cox regression analysis, the age ≥80 years (adjusted hazard ratio [aHR] 3.21, p < .001), male gender (aHR 1.26, p = .02), Black race (aHR, 1.70, p < .001), and T-cell NHL variants (aHR 1.73, p = .03) were unfavourable prognostic factors. Conclusion: NHL of the liver comprises about 0.3% of all NHLs and survival was improved in the recent calendar period.
Collapse
Affiliation(s)
- Mohamed Abd El-Fattah
- *Correspondence to: Mohamed Abd El-Fattah, Department of Internal Medicine, Faculty of Medicine, Suez Canal University, Ring Road, Ismailia City, Ismailia 41522, Egypt. Tel: +20-122-759-7912, +20-64-3215166, E-mail:
| |
Collapse
|
9
|
Hypercalcemia due to Primary Hepatic Lymphoma. Case Rep Hematol 2016; 2016:1876901. [PMID: 28116183 PMCID: PMC5220425 DOI: 10.1155/2016/1876901] [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: 10/04/2016] [Accepted: 12/06/2016] [Indexed: 12/11/2022] Open
Abstract
A 65-year-old female with a history of mixed connective tissue disease and pulmonary fibrosis on azathioprine, hydroxychloroquine, and prednisone (osteoporosis on teriparatide) presented with a 1-month history of hypercalcemia. After discontinuation of teriparatide, the patient's hypercalcemia persisted. Further evaluation revealed primary hepatic lymphoma as the source of her hypercalcemia.
Collapse
|
10
|
Matsukuma KE, Wei D, Sun K, Ramsamooj R, Chen M. Diagnosis and differential diagnosis of hepatic graft versus host disease (GVHD). J Gastrointest Oncol 2016; 7:S21-31. [PMID: 27034810 DOI: 10.3978/j.issn.2078-6891.2015.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Graft versus host disease (GVHD) is a common complication following allogeneic hematopoietic cell transplantation (HCT) that typically manifests as injury to the skin, gastrointestinal mucosa, and liver. In some cases, hepatic GVHD may be histologically indistinguishable from other disorders such as infection and drug-induced liver injury (DILI). Additionally, clinical signs and symptoms are frequently confounded by the superimposed effects of pretransplant chemoradiotherapy, immunotherapy (IT) (targeted to the underlying malignancy), GVHD prophylaxis, and infection. Thus, careful attention to and correlation with clinical findings, laboratory values, and histologic features is essential for diagnosis. This review, aimed at the practicing pathologist, will discuss current clinical and histologic criteria for GVHD, the approach to diagnosis of hepatic GVHD, and features helpful for distinguishing it from other entities in the differential diagnosis.
Collapse
Affiliation(s)
- Karen E Matsukuma
- 1 Department of Pathology and Laboratory Medicine, University of California, Davis Medical Center, Sacramento, CA 95817, USA ; 2 Department of Hematology, Zhengzhou University People's Hospital, Zhengzhou 450000, China
| | - Dongguang Wei
- 1 Department of Pathology and Laboratory Medicine, University of California, Davis Medical Center, Sacramento, CA 95817, USA ; 2 Department of Hematology, Zhengzhou University People's Hospital, Zhengzhou 450000, China
| | - Kai Sun
- 1 Department of Pathology and Laboratory Medicine, University of California, Davis Medical Center, Sacramento, CA 95817, USA ; 2 Department of Hematology, Zhengzhou University People's Hospital, Zhengzhou 450000, China
| | - Rajendra Ramsamooj
- 1 Department of Pathology and Laboratory Medicine, University of California, Davis Medical Center, Sacramento, CA 95817, USA ; 2 Department of Hematology, Zhengzhou University People's Hospital, Zhengzhou 450000, China
| | - Mingyi Chen
- 1 Department of Pathology and Laboratory Medicine, University of California, Davis Medical Center, Sacramento, CA 95817, USA ; 2 Department of Hematology, Zhengzhou University People's Hospital, Zhengzhou 450000, China
| |
Collapse
|
11
|
Nagral A, Jhaveri A, Kalthoonical V, Bhat G, Mahajan P, Borges A. Primary Liver Sinusoidal Non-Hodgkin's Lymphoma Presenting as Acute Liver Failure. J Clin Exp Hepatol 2015; 5:341-3. [PMID: 26900276 PMCID: PMC4723650 DOI: 10.1016/j.jceh.2015.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 10/26/2015] [Indexed: 12/12/2022] Open
Abstract
We describe a case of a middle-aged woman, who presented to us with fever, anorexia, abdominal distension from a massive hepatomegaly, low hemoglobin, and acute liver failure. A liver biopsy revealed B cell non-Hodgkin's lymphoma predominantly in the sinusoids with CD10, CD20, and Bcl-2 positive on immunohistochemistry. She initially responded well to chemotherapy but succumbed 6 months later to the recurrence of disease. Sinusoidal non-Hodgkin's lymphoma of the liver should be considered in the differential diagnosis of a patient with large hepatomegaly presenting with acute liver failure.
Collapse
Key Words
- AFP, alpha feto protein
- ALT, alanine aminotransferase
- AST, aspartate aminotransferase
- B cell
- Bcl 2, B cell lymphoma 2
- CD, cluster differentiation
- CECT, contrast enhanced computed tomography
- CHOP, cyclophosphamide hydroxydaunorubicin (adriyamycin) oncovin (vincristine) prednisolone
- CK, cyto keratin
- HBsAg, hepatitis B surface antigen
- HCV, hepatitis C virus
- HIV, human immunodeficiency virus
- IgM, immunoglobulin M
- NHL, non-Hodgkins lymphoma
- PET CT, positron emission tomography–computed tomography
- WBC, white blood cells
- chemotherapy
- hepatocyte
- liver failure
Collapse
Affiliation(s)
- Aabha Nagral
- Department of Gastroenterology, Jaslok Hospital and Research Centre, Mumbai, India,Address for correspondence: 7, Sneh Sagar, Second Floor, Prabha Nagar Society, Prabhadevi, Mumbai 400025, India.
| | - Ajay Jhaveri
- Department of Gastroenterology, Jaslok Hospital and Research Centre, Mumbai, India
| | - Vilesh Kalthoonical
- Department of Nephrology, Jaslok Hospital and Research Centre, Mumbai, India
| | - Ganapathi Bhat
- Department of Medical Oncology, Jaslok Hospital and Research Centre, Mumbai, India
| | - Pravin Mahajan
- Department of Histopathology, S. L. Raheja Hospital, Mumbai, India
| | - Anita Borges
- Department of Histopathology, S. L. Raheja Hospital, Mumbai, India
| |
Collapse
|
12
|
Patel SK, Shera IA. A rare tumor with unusual clinical presentation detected by positron emission tomography-computed tomography. Indian J Nucl Med 2015; 30:331-3. [PMID: 26430318 PMCID: PMC4579619 DOI: 10.4103/0972-3919.164024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Primary hepatic lymphoma represents <1% of extranodal lymphoma and predominantly seen in men older than 50 years of age. Exact etiology for these tumors is not certain yet, but presumed to be caused by certain viruses like Epstein-Barr virus and hepatitis C virus due to the frequent association of these viruses with disease. Most of these tumors are diffuse large B cell non-Hodgkin lymphoma. Direct tissue histopathology with immunochemistry may give clues about diagnosis and prognosis up to certain extent. The rituximab-based chemotherapy is the mainstay of therapy for these tumors; the role of radiotherapy is still not clear but used for management for bulky tumors.
Collapse
Affiliation(s)
- Sitendu Kumar Patel
- Department of Gastroenterology, Max Super Speciality Hospital, New Delhi, India
| | - Irfan Ali Shera
- Department of Gastroenterology, Max Super Speciality Hospital, New Delhi, India
| |
Collapse
|
13
|
Abe H, Kamimura K, Kawai H, Kamimura H, Domori K, Kobayashi Y, Nomoto M, Aoyagi Y. Diagnostic imaging of hepatic lymphoma. Clin Res Hepatol Gastroenterol 2015; 39:435-42. [PMID: 25541481 DOI: 10.1016/j.clinre.2014.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 10/10/2014] [Accepted: 11/03/2014] [Indexed: 02/06/2023]
Abstract
Hepatic lymphoma is a rare disease with poor prognosis because of delayed diagnosis. The disease comprises primary, metastatic, and intravascular hepatic lymphomas. The pathological characteristics of lymphomas differ contributing to difficulty in early diagnosis. Early diagnosis and appropriate treatment result in improved prognosis; therefore, diagnostic radiology and its development with various contrast agents are critical for improving disease outcomes. Herein, we review hepatic lymphomas and summarize the results of imaging studies in correlation with pathological characteristics. The information provided will help physicians in early diagnosis and thereby improving prognosis.
Collapse
Affiliation(s)
- Hiroyuki Abe
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, 951-8510, Japan
| | - Kenya Kamimura
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, 951-8510, Japan.
| | - Hirokazu Kawai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, 951-8510, Japan
| | - Hiroteru Kamimura
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, 951-8510, Japan
| | - Koji Domori
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, 951-8510, Japan
| | - Yuji Kobayashi
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, 951-8510, Japan
| | - Minoru Nomoto
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, 951-8510, Japan
| | - Yutaka Aoyagi
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, 951-8510, Japan
| |
Collapse
|
14
|
Castresana D, Azzouqah O, Kaza A. Vanishing Liver Lesions: Sounds Ultraconfusing? Dig Dis Sci 2015; 60:2267-9. [PMID: 26088372 DOI: 10.1007/s10620-015-3757-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 06/09/2015] [Indexed: 12/09/2022]
Affiliation(s)
- Daniel Castresana
- Division of Gastroenterology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA,
| | | | | |
Collapse
|
15
|
Laroia ST, Rastogi A, Panda D, Sarin SK. Primary Hepatic Non-Hodgkin's Lymphoma: An Enigma Beyond the Liver, a Case Report. World J Oncol 2015; 6:338-344. [PMID: 29147429 PMCID: PMC5649724 DOI: 10.14740/wjon900w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2015] [Indexed: 11/20/2022] Open
Abstract
We have discussed a unique presentation of primary diffuse large cell B-cell non-Hodgkin (DLBC NHL) hepatic lymphoma involving the porta hepatis and biliary confluence causing obstructive jaundice with contiguous soft tissue involvement of the right lobe of liver extending up to the right renal cortex. This appears to be the only case in literature where primary hepatic lymphoma has shown contiguous localized intra- and extrahepatic tumor infiltration. A 67-year-old gentleman presented with history of significant loss of appetite and weight in 2 months with associated progressive painless cholestatic jaundice. Physical evaluation revealed normal vitals with pallor, deep icterus, scratch marks over the abdomen, generalized muscle wasting, grade II clubbing and a palpable non-tender liver with a globular, firm mass beneath the liver. He had a total serum bilirubin of 15.9 mg/dL and direct bilirubin of 9.24 mg/dL. His liver enzymes were moderately elevated with raised serum creatinine and dyselectrolytemia. Serology for enterohepatic viruses was negative. Contrast-enhanced magnetic resonance imaging (CEMRI) showed poorly enhancing multiple soft tissue masses in both lobes of liver with the largest mass involving, biliary confluence and porta hepatis causing right bile duct and portal vein encasement. The mass occupied the posterior right lobe and extended to the inferior surface of liver with contiguous invasion of the right renal upper pole cortex. The mass was associated with a retracted liver capsule in the involved segments and delayed enhancement, mimicking a cholangiocarcinoma. Tissue biopsy revealed hepatic DLBC type NHL and patient was subsequently treated with a CHOP-R (cyclophosphamide-doxorubicin-vincristine-prednisolone/rituximab) regimen, on which he has shown non-progressive disease at 1-year follow-up. DLBC NHL of the liver is a very rare tumor with propensity for isolated involvement of the liver and minimal extrahepatic spread. This case shows many interesting features such as obstructive jaundice for 2 months, porta hepatis involvement and tumor infiltration up to the right renal parenchyma. We have illustrated various imaging findings which should be considered when evaluating such a lesion to help differentiate it from cholangiocarcinoma. The literature is extensively reviewed. The case demonstrates relevant diagnostic parameters for physicians, radiologists and oncologists who are likely to encounter patients with tumor-induced obstructive jaundice in their daily practice.
Collapse
Affiliation(s)
- Shalini Thapar Laroia
- Department of Radiology, Institute of Liver and Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi 110070, India
| | - Archana Rastogi
- Department of Hepatopathology, Institute of Liver and Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi 110070, India
| | - Dipanjan Panda
- Department of Oncology, Institute of Liver and Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi 110070, India
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi 110070, India
| |
Collapse
|
16
|
|
17
|
Zhang KJ, Chen S, Chen JL, Dong LH. Complete response to comprehensive treatment of a primary hepatic diffuse large B cell lymphoma: A case report. Oncol Lett 2015; 9:1557-1560. [PMID: 25789000 PMCID: PMC4356420 DOI: 10.3892/ol.2015.2920] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 12/16/2014] [Indexed: 01/20/2023] Open
Abstract
Primary hepatic lymphoma (PHL) is an uncommon lymphoid tumor with varied clinical features and treatment outcome. In the present study, the case of a 56-year-old patient with PHL and no clinical presentation was reported. During a routine physical examination, multiple hypodense nodules were incidentally detected in right lobes of the liver and hepatic portal in an abdominal computed tomography scan. A liver biopsy revealed the presence of a non-Hodgkin's lymphoma diffuse large B cell type that was CD20-positive, followed by the diagnosis of a PHL. The patient was treated with R-CHOP, radiotherapy and R-Hyper-CVAD/R-HD MTX-ara-C, and complete remission was achieved.
Collapse
Affiliation(s)
- Kai Jing Zhang
- Department of Hematology, Taizhou Central Hospital, Taizhou, Zhejiang 380000, P.R. China
| | - Sai Chen
- Department of Hematology, Taizhou Central Hospital, Taizhou, Zhejiang 380000, P.R. China
| | - Jian Lin Chen
- Department of Hematology, Taizhou Central Hospital, Taizhou, Zhejiang 380000, P.R. China
| | - Li Hua Dong
- Department of Hematology, Henan Provincial Tumor Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan 450008, P.R. China
| |
Collapse
|
18
|
Miyagawa K, Shibata M, Noguchi H, Hayashi T, Oe S, Hiura M, Abe S, Harada M. Methotrexate-related primary hepatic lymphoma in a patient with rheumatoid arthritis. Intern Med 2015; 54:401-5. [PMID: 25748956 DOI: 10.2169/internalmedicine.54.3361] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
A 56-year-old woman with rheumatoid arthritis treated with methotrexate (MTX) was admitted to our hospital due to multiple liver tumors. Contrast-enhanced computed tomography (CT) revealed multiple hypovascular masses, and 18F-fluorodeoxyglucose positron emission tomography CT showed diffuse abnormal accumulation in the liver only. We therefore made a diagnosis of MTX-related primary hepatic lymphoma (MTX-PHL) exhibiting features of diffuse large B-cell lymphoma. Although MTX has been reported to increase the risk of lymphoproliferative disorders, MTX-PHL has not been reported previously. The present case is the first case in which MTX appears to have been involved in the development of PHL.
Collapse
Affiliation(s)
- Koichiro Miyagawa
- The Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Wu GB, Huang CY, Huang S, Ru HM, Xiang BDE, Yuan WP, Wu FX, Liu JY, Zhang ZM, Ma L, Chen ZS, Zhao YN, Li LEQ. Primary hepatic non-Hodgkin's lymphoma with rectal cancer: A case report. Oncol Lett 2014; 9:324-326. [PMID: 25435985 PMCID: PMC4247066 DOI: 10.3892/ol.2014.2673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 10/15/2014] [Indexed: 12/03/2022] Open
Abstract
Primary hepatic non-Hodgkin’s lymphoma (NHL) is an extremely rare disease that is commonly neglected as a possible diagnosis. The present study reports the case of a middle-aged male with chronic hepatitis B in which primary hepatic NHL and rectal cancer occurred simultaneously. A large solitary tumor in the left lobe of the liver was incidentally detected on routine examination prior to the laparoscopic resection of the rectal cancer. Laparoscopic resection of the rectal cancer and a liver biopsy were performed simultaneously. The pathology revealed that the hepatic tumor was NHL and that the rectal cancer was adenocarcinoma. Systemic staging revealed no evidence of nodal or bone marrow involvement, therefore, primary hepatic lymphoma (PHL) was diagnosed. PHL associated with rectal adenocarcinoma is extremely rare and to the best of our knowledge, has never been reported. At present, the cause and most effective therapy for the condition remain unclear.
Collapse
Affiliation(s)
- Guo-Bin Wu
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital and Oncology School of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Chao-Yuan Huang
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital and Oncology School of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Shan Huang
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital and Oncology School of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Hai-Ming Ru
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital and Oncology School of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Bang-DE Xiang
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital and Oncology School of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Wei-Ping Yuan
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital and Oncology School of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Fei-Xiang Wu
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital and Oncology School of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Jian-Yong Liu
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital and Oncology School of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Zhi-Ming Zhang
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital and Oncology School of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Liang Ma
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital and Oncology School of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Zu-Shun Chen
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital and Oncology School of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Yin-Nong Zhao
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital and Oncology School of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - LE-Qun Li
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital and Oncology School of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| |
Collapse
|
20
|
HU HUIJUAN, LIAO MEIYAN, QU YANJUAN. Primary hepatic peripheral T-cell lymphoma: A case report. Oncol Lett 2014; 8:258-262. [PMID: 24959257 PMCID: PMC4063635 DOI: 10.3892/ol.2014.2119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 04/24/2014] [Indexed: 11/29/2022] Open
Abstract
Primary hepatic peripheral T-cell lymphoma (PHL) is extremely rare. A case of primary hepatic peripheral T-cell lymphoma of a 59-year-old male is presented in the current study. PHL lesions are diagnosed by the existence of a hepatic mass, in the absence of lymphadenopathy, splenomegaly or bone marrow involvement associated with normal tumor markers. Treatment options are surgical resection and subsequent chemotherapy. Histopathological examination by immunohistochemical staining of the tissue biopsies at laparotomy confirmed a diagnosis of PHL.
Collapse
Affiliation(s)
- HUI-JUAN HU
- Department of Computed Tomography, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - MEI-YAN LIAO
- Department of Computed Tomography, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - YAN-JUAN QU
- Department of Computed Tomography, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| |
Collapse
|
21
|
|
22
|
Primary hepatic lymphoma: a challenging diagnosis. Case Rep Oncol Med 2014; 2014:212598. [PMID: 24949208 PMCID: PMC4037615 DOI: 10.1155/2014/212598] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 04/28/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction. Primary hepatic lymphoma is an unusual malignancy and is very difficult to diagnose promptly. An intrigue case presenting with cholestatic jaundice is reviewed and main disease characteristics are further discussed. Case Report. A 70-year-old male presented with dull right upper quadrant abdominal pain and mild cholestatic jaundice. Initial evaluation revealed mildly elevated liver function tests and normal tumor markers, while imaging with an abdominal CT-scan showed multiple hypodense nodules in both liver lobes. First impression of metastatic deposits from gastrointestinal origin was not confirmed by endoscopic means. After CT-guided biopsy, primary diffuse large B-cells non-Hodgkin lymphoma was revealed. Appropriate chemotherapy improved patient's condition markedly. Discussion. Primary hepatic lymphoma is a rare form of extranodal lymphomas, accounting for less than 1% of all extranodal lymphomas in general. In order to define the condition as PHL, liver has to be the only site of lymphoma occurrence or to be involved in a major degree with minimal nonliver disease. Most PHLs are of B-cell origin with large cells as the main cell type.
Collapse
|
23
|
de Campos FPF, Felipe-Silva A, Zerbini MCN. Anaplastic large cell lymphoma ALK-negative clinically mimicking alcoholic hepatitis - a review. Autops Case Rep 2013; 3:11-19. [PMID: 31528614 PMCID: PMC6671891 DOI: 10.4322/acr.2013.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 08/22/2013] [Indexed: 11/24/2022]
Abstract
Anaplastic large cell lymphoma (ALCL), described less than 30 years ago by Karl Lennert and Herald Stein in Kiel, West Germany, is a T-cell or null non-Hodgkin lymphoma, with distinctive morphology (hallmark cells, prominent sinus and/or perivascular growth pattern), characteristic immunophenotype (CD30+, cytotoxic granules protein+, CD3-/+) and specific genetic features as translocations involving the receptor tyrosine kinase called anaplastic lymphoma kinase (ALK) on 2p23 and variable partners genes, which results in the expression of ALK fusion protein. The absence of ALK expression is also observed and is associated with poorer prognosis that seen with ALK expression. ALK-negative ALCL is more frequent in adults, with both nodal and extra nodal clinical presentation and includes several differential diagnoses with other CD30+ lymphomas. Liver involvement by ALCL is rare and is generally seen as mass formation; the diffuse pattern of infiltration is even more unusual. The authors present a case of a 72-year-old man who presented clinical symptoms of acute hepatic failure. The patient had a long history of alcohol abuse and the diagnosis of alcoholic hepatitis was highly considered, although the serum lactic dehydrogenase (LDH) value was highly elevated. The clinical course was fulminant leading to death on the fourth day of hospitalization. Autopsy demonstrated diffuse neoplastic hepatic infiltration as well as splenic, pulmonary, bone marrow, and minor abdominal lymph nodes involvement by the tumor. Based on morphological, immunophenotypical, and immunohistochemical features, a diagnosis of ALK- negative ALCL was concluded. When there is marked elevation of LDH the possibility of lymphoma, ALCL and other types, should be the principal diagnosis to be considered.
Collapse
Affiliation(s)
| | - Aloísio Felipe-Silva
- Anatomic Pathology Service - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil
| | | |
Collapse
|
24
|
Mastoraki A, Stefanou MI, Chatzoglou E, Danias N, Kyriazi M, Arkadopoulos N, Smyrniotis V. Primary hepatic lymphoma: dilemmas in diagnostic approach and therapeutic management. Indian J Hematol Blood Transfus 2013; 30:150-4. [PMID: 25114399 DOI: 10.1007/s12288-013-0263-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Accepted: 04/19/2013] [Indexed: 02/05/2023] Open
Abstract
Primary hepatic lymphoma (PHL) is a very rare malignancy and is characterized by liver involvement at presentation with no affectation of the spleen, lymph nodes, peripheral blood, bone marrow, or other tissues until at least 6 months after diagnosis. PHL should be considered in the differential diagnosis in a patient with space-occupying liver lesions and normal levels of alpha-fetoprotein and CEA. A computed tomography (CT) scan is the commonly used modality for staging lymphomas. The widespread use of positron emission tomography/CT results in the improvement in the accuracy of detecting the extent of disease, response evaluation, and prognostication. The liver biopsy, due to its pleomorphic appearances in the needle biopsy specimen, can be very challenging. Current literature favors the combination of chemotherapy as the frontline treatment for its least invasiveness and improved survival. Favorable prognosis of PHL can be obtained by early surgery combined with chemotherapy in strictly selected patients. However, the optimal therapy is still unclear and the outcomes are uncertain.
Collapse
Affiliation(s)
- Aikaterini Mastoraki
- 4th Department of Surgery, Athens University, Medical School, ATTIKON University Hospital, 1 Rimini Str., 12462 Chaidari, Athens, Greece ; Gr. Lambraki 112-114, Piraeus, Athens, Greece
| | - Maria Ioanna Stefanou
- 4th Department of Surgery, Athens University, Medical School, ATTIKON University Hospital, 1 Rimini Str., 12462 Chaidari, Athens, Greece
| | - Evangelos Chatzoglou
- 4th Department of Surgery, Athens University, Medical School, ATTIKON University Hospital, 1 Rimini Str., 12462 Chaidari, Athens, Greece
| | - Nikolaos Danias
- 4th Department of Surgery, Athens University, Medical School, ATTIKON University Hospital, 1 Rimini Str., 12462 Chaidari, Athens, Greece
| | - Maria Kyriazi
- 4th Department of Surgery, Athens University, Medical School, ATTIKON University Hospital, 1 Rimini Str., 12462 Chaidari, Athens, Greece
| | - Nikolaos Arkadopoulos
- 4th Department of Surgery, Athens University, Medical School, ATTIKON University Hospital, 1 Rimini Str., 12462 Chaidari, Athens, Greece
| | - Vasilios Smyrniotis
- 4th Department of Surgery, Athens University, Medical School, ATTIKON University Hospital, 1 Rimini Str., 12462 Chaidari, Athens, Greece
| |
Collapse
|
25
|
Abstract
Primary hepatic lymphoma (PHL) is rare and represents approximately 0.016% of all cases of non-Hodgkin's lymphoma (NHL). The majority of these are B-cell NHL of diffuse large B-cell type. Primary T-cell lymphoma constitutes approximately 5-10% of all PHLs arising in the liver, 90% being B-cell type. Peripheral T-cell lymphoma, γδ hepatosplenic T-cell lymphoma and αβ hepatosplenic T-cell lymphoma are the common T-cell lymphomas involving hepatic parenchyma. We encountered a case presenting with gross hepatomegaly extending beyond umbilicus, mild ascites, pedal oedema, icterus and dyspnoea. Haemogram showed moderate anaemia with counts. Bone marrow aspiration showed erythroid hyperplasia with dimorphic anaemia. There was no evidence of atypical lymphoid cells in peripheral blood of bone marrow. We present a rare case of primary T-cell lymphoma presenting as primary liver involvement without splenomegaly, lymphadenopathy, bone marrow or peripheral blood involvement.
Collapse
Affiliation(s)
- S Mishra
- Department of Clinical Hematology & Medical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India.
| | | | | | | |
Collapse
|
26
|
Abstract
Ultrasound is most useful in detecting and characterizing peripheral and abdominal lymph nodes and infiltration of solid organs. B-mode criteria, such as size, shape, number, distribution architecture, echogenicity and delineation of margins are the basis for characterizing lymph nodes. Additionally color coding techniques such as color Doppler, B-flow and contrast-enhanced ultrasound (CEUS) contribute to the evaluation of the nodal vasculature and vessel architecture. Whenever possible high frequency probes should not only be used for evaluating peripheral lymph nodes but also for lymphatic infiltration of solid organs, especially the spleen. The CEUS technique will be of additional benefit in detecting characterizing potential lymphatic organ infiltration. Ultrasound is an ideal tool for guided punctures, for which core biopsies should be preferred over fine needle aspiration biopsy and CEUS can also be used for proving residual viable tissue after chemotherapy or radiation therapy.
Collapse
Affiliation(s)
- H-P Weskott
- Zentrale Sonographie-Abteilung, Klinikum Siloah, Klinikum Region Hannover, Roesebeckstr. 15, 30449, Hannover, Deutschland.
| |
Collapse
|
27
|
Yu YD, Kim DS, Byun GY, Lee JH, Kim IS, Kim CY, Kim YC, Suh SO. Primary hepatic marginal zone B cell lymphoma : a case report and review of the literature. Indian J Surg 2012; 75:331-6. [PMID: 24426608 DOI: 10.1007/s12262-012-0695-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 06/28/2012] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Primary hepatic lymphoma (PHL) is a very rare malignancy, and constitutes about 0.016 % of all cases of non-Hodgkin's lymphoma and is often misdiagnosed. The optimal therapy is still unclear and the outcomes are uncertain. Among PHLs, a primary hepatic low-grade marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) is extremely rare. METHODS We present a case of primary hepatic lymphoma (MALT lymphoma) treated with surgical resection and adjuvant chemotherapy. A 38-year-old Korean man, who was diagnosed with chronic hepatitis B 20 years ago, was admitted for liver biopsy after liver lesions were detected on follow-up computed tomography scan (CT). Liver biopsy revealed the diagnosis of marginal zone B-cell malignant lymphoma (MALT lymphoma). The preoperative clinical staging was IE, given that no additional foci of lymphoma were found anywhere else in the body. The patient underwent left hemihepatectomy. Subsequently, the patient received two cycles of CHOP (cyclophosphamide, adriamycin, vincristine, and prednisone) regimen. RESULTS After 15 months of follow-up, the patient is alive and well without any evidence of disease recurrence. CONCLUSION Although the prognosis is variable, good response to early surgery combined with postoperative chemotherapy can be achieved in strictly selected patients.
Collapse
Affiliation(s)
- Young-Dong Yu
- Department of Surgery, Division of HBP Surgery & Liver Transplantation, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Dong-Sik Kim
- Department of Surgery, Division of HBP Surgery & Liver Transplantation, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea ; Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, Korea University Medical Center, Korea University Medical College, Seoul, Korea
| | - Geon-Young Byun
- Department of Surgery, Division of HBP Surgery & Liver Transplantation, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Jeong-Hyeon Lee
- Department of Pathology, Korea University Medical Center, Korea University Medical College, Seoul, Korea
| | - In-Sun Kim
- Department of Pathology, Korea University Medical Center, Korea University Medical College, Seoul, Korea
| | - Chung-Yun Kim
- Department of Surgery, Division of HBP Surgery & Liver Transplantation, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Young-Chul Kim
- Department of Surgery, Division of HBP Surgery & Liver Transplantation, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Sung-Ock Suh
- Department of Surgery, Division of HBP Surgery & Liver Transplantation, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| |
Collapse
|
28
|
Masood A, Kairouz S, Hudhud KH, Hegazi AZ, Banu A, Gupta NC. Primary non-Hodgkin lymphoma of liver. ACTA ACUST UNITED AC 2011; 16:74-7. [PMID: 19672429 PMCID: PMC2722057 DOI: 10.3747/co.v16i4.443] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Primary non-Hodgkin lymphoma (nhl) of liver is a very rare malignancy. Here, we report the case of a 65-year-old man who presented with constipation and right groin pain of 2 months’ duration. A computed tomography (ct) scan of the abdomen incidentally detected multiple hypodense nodules in both lobes of the liver. Diagnosis of primary nhl of liver was made using ultrasound-guided biopsy. Extensive investigations—which included bone marrow biopsy; fluorescence in situ hybridization; flow cytometry; ct scan of chest, abdomen, and pelvis; and whole-body positron-emission tomography—showed no involvement of bone marrow, lymph nodes, spleen, or any other organ. The patient is currently being treated with a chop-r (cyclophosphamide–doxorubicin–vincristine–prednisolone/rituximab) regimen. The case has many unique features, including normal liver function tests, especially that for lactate dehydrogenase; no type B symptoms; and negative serology for viruses. The case demonstrates that primary hepatic lymphoma should be considered in the differential diagnosis of space-occupying liver lesions in presence of normal levels of alpha-fetoprotein and carcinoembryonic antigen. The literature is extensively reviewed.
Collapse
Affiliation(s)
- A Masood
- Cancer Care Center of Frederick, 46B Thomas Johnson Drive, Frederick, Maryland, 21702, USA.
| | | | | | | | | | | |
Collapse
|
29
|
Al-Tonbary Y, Fouda A, El-Ashry R, Zalata K. Primary hepatic non-Hodgkin lymphoma presenting as acute hepatitis in a 2-year-old male. Hematol Oncol Stem Cell Ther 2010; 2:299-301. [PMID: 20063562 DOI: 10.1016/s1658-3876(09)50042-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Youssef Al-Tonbary
- Hematology/Oncology/BMT Unit, Mansoura University Children's Hospital, Mansoura, Egypt.
| | | | | | | |
Collapse
|
30
|
Stone VE, Bounds BC, Muse VV, Ferry JA. Case records of the Massachusetts General Hospital. Case 29-2009. An 81-year-old man with weight loss, odynophagia, and failure to thrive. N Engl J Med 2009; 361:1189-98. [PMID: 19759382 DOI: 10.1056/nejmcpc0900644] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
MESH Headings
- AIDS-Related Opportunistic Infections/diagnosis
- Acquired Immunodeficiency Syndrome/complications
- Acquired Immunodeficiency Syndrome/diagnosis
- Aged, 80 and over
- Candidiasis, Oral/diagnosis
- Candidiasis, Oral/etiology
- Deglutition Disorders/etiology
- Diabetes Mellitus, Type 2/complications
- Diagnosis, Differential
- Failure to Thrive/etiology
- Fatal Outcome
- Humans
- Liver/diagnostic imaging
- Liver/pathology
- Lung/diagnostic imaging
- Lung/pathology
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Tomography, X-Ray Computed
- Weight Loss
Collapse
|
31
|
Abstract
Hepatic encephalopathy is characterized by a wide spectrum of neuropsychiatric abnormalities and motor disturbances in patients with advanced liver disease. It is estimated to occur in 30% to 45% of patients with liver cirrhosis and in 10% to 50% of patients with transjugular intrahepatic portosystemic shunts. It can be seen in cancer patients due to multiple factors. Early diagnosis and treatment are important but can be challenging, especially in mild forms with subtle findings. This article reviews the pathogenesis, diagnostic criteria, grading, and management of hepatic encephalopathy.
Collapse
Affiliation(s)
- Yasemen Eroglu
- Division of Pediatric Gastroenterology, Department of Pediatrics, Oregon Health & Science University, CDRCP, Portland, OR 97239, USA.
| | | |
Collapse
|
32
|
Haider FS, Smith R, Khan S. Primary hepatic lymphoma presenting as fulminant hepatic failure with hyperferritinemia: a case report. J Med Case Rep 2008; 2:279. [PMID: 18710584 PMCID: PMC2542397 DOI: 10.1186/1752-1947-2-279] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 08/19/2008] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Primary hepatic lymphoma is an unusual form of non-Hodgkin's lymphoma that usually presents with constitutional symptoms, hepatomegaly and signs of cholestatic jaundice. Diffuse hepatic infiltration is uncommon and presentation with acute hepatic failure even more rare. The presence of markedly elevated ferritin levels can complicate the evaluation process and suggest alternative diagnoses.We present the case of a middle-aged woman exhibiting pancytopenia, hyperferritinemia and rapidly deteriorating to develop acute hepatic failure. Her initial clinical picture led to a working diagnosis of adult onset Still's disease with probable hemophagocytic syndrome before her worsening liver function necessitated a percutaneous liver biopsy and establishment of the final diagnosis of primary hepatic lymphoma. CONCLUSION Primary hepatic lymphoma is an uncommon malignancy and its manifestation as progressive hepatitis or acute fulminant hepatic failure can be difficult to diagnose. The presence of constitutional symptoms, pancytopenia and high ferritin levels can complicate the evaluation process. A liver biopsy early in the course of liver dysfunction may establish the diagnosis without a higher risk of bleeding complications seen once liver failure sets in.
Collapse
Affiliation(s)
- Fyeza S Haider
- Department of Internal Medicine/Hospitalist Medicine, Geisinger Medical Center, Danville, PA, USA.
| | | | | |
Collapse
|
33
|
|
34
|
Current Awareness in Hematological Oncology. Hematol Oncol 2006. [DOI: 10.1002/hon.755] [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]
|