Abstract
Lymphomas arising in the liver are extremely rare. Here, we describe a case of Hepatitis C virus infection with primary hepatic lymphoma (PHL) presenting with hyperbilirubinemia. A 45-year-old African American male presented with abdominal pain, pruritus, and itching for two days. CT of abdomen and pelvis with contrast showed numerous masses in the liver. The liver biopsy was consistent with diffuse large B cell lymphoma (DLBCL). Conventional chemotherapy was avoided initially because of hyperbilirubinemia. Hence, radiation therapy was given initially to reduce his bilirubin levels and tumor size. The patient was able to complete six cycles of rituximab combined with cyclophosphamide, adriamycin, vincristine, and prednisone (R-CHOP) chemotherapy and achieved a complete response verified by positron emission tomography-computed tomography (PET-CT). PHL should be considered when there are numerous space occupying liver lesions seen on imaging. Hyperbilirubinemia may be a reason for delay in treatment for some of these patients. Hence, the role of radiation therapy prior to treatment with R-CHOP is an alternative to management for stage IV diffuse large B cell lymphoma.
Highlights
Lymphomas arising in liver are extremely rare
We present a case of Primary hepatic lymphoma (PHL) in a patient with Hepatitis C virus (HCV) infection presenting with significant hyperbilirubinemia and highlight his response to radiation therapy and systemic chemotherapy
Jaundice in PHL patients can be due to the following reasons: (a) patients having a concomitant history of cirrhosis, (b) patients presenting with fulminant liver failure due to massive sinusoidal infiltration by lymphoma, and (c) lymphoma causing intra- or extrahepatic biliary obstruction
Summary
Lymphomas arising in liver are extremely rare. They can be primary (extranodal lymphoma arising solely in the liver without involvement of any other organ) or secondary (secondary involvement of liver in systemic non-Hodgkin’s lymphoma (NHL)). Primary hepatic lymphoma (PHL) comprises only about 0.016% of all cases of non-Hodgkin’s lymphoma [1]. PHL have been described in patients with Hepatitis C virus (HCV) infection [2]. Because of nonspecific clinical symptoms or imaging pattern, PHL is often misdiagnosed as hepatocellular carcinoma, metastatic tumor, or liver abscess. We present a case of PHL in a patient with HCV infection presenting with significant hyperbilirubinemia and highlight his response to radiation therapy and systemic chemotherapy
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
