Abstract
Hepatic pseudolymphoma (HPL) and primary hepatic marginal zone B cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) are rare diseases and the differential diagnosis between these two entities is sometimes difficult. We herein report a 56-year-old Japanese woman who was pointed out to have a space occupying lesion in the left lateral segment of the liver. Hepatitis viral-associated antigen/antibody was negative and liver function tests including lactic dehydrogenase, peripheral blood count, tumor markers and soluble interleukin-2 receptor were all within normal limit. Imaging study using computed tomography and magnetic resonance imaging were not typical for hepatocellular carcinoma, cholangiocarcinoma, or other metastatic cancer. Fluorodeoxyglucose-positron emission tomography examination integrated with computed tomography scanning showed high standardized uptake value in the solitary lesion in the liver. Under a diagnosis of primary liver neoplasm, laparoscopic-assisted lateral segmentectomy was performed. Liver tumor of maximal 1.0 cm in diameter was consisted of aggregation of lymphocytes of predominantly B-cell, containing multiple lymphocyte follicles positive for CD10 and bcl-2, consistent with a diagnosis of HPL rather than MALT lymphoma, although a definitive differentiation was pending. The background liver showed non-alcoholic fatty liver disease/early non-alcoholic steatohepatitis. The patient is currently doing well with no sign of relapse 13 months after the surgery. Since the accurate diagnosis is difficult, laparoscopic approach would provide a reasonable procedure of diagnostic and therapeutic advantage with minimal invasiveness for patients. Considering that the real nature of this entity remains unclear, vigilant follow-up of patient is essential.
Highlights
A primary hepatic lymphoma (PHL) is defined as lymphoma localized and limited in the liver [1], not the secondary involvement of high- or intermediate grade non-Hodgkin’s lymphoma, and accounts for less than 1% of all extranodal lymphomas [2]
Ki67 index of those lymphoid cells was 25%. These findings were consistent with diagnosis of both extranodal marginal zone B-cell lymphoma and non-neoplastic lesion mimicking MALT lymphoma including Hepatic pseudolymphoma (HPL), reactive lymphoid hyperplasia, or nodular lymphoid lesion, but still insufficient to distinguish these conditions
Primary hepatic marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue type (MALT lymphoma), rare entity with only 48 cases being reported in the worldwide literature [11,12,13,14,15,16,17,18,19,20,21,22] since the first report by Isaacson et al [23], accounts for 1.6-3% of PHL [24,25], is the most important differential diagnosis from HPL
Summary
A primary hepatic lymphoma (PHL) is defined as lymphoma localized and limited in the liver [1], not the secondary involvement of high- or intermediate grade non-Hodgkin’s lymphoma, and accounts for less than 1% of all extranodal lymphomas [2]. Hepatic pseudolymphoma (HPL), termed as reactive lymphoid hyperplasia, or nodular lymphoid lesion, is extremely rare disease and characterized by the proliferation of non-neoplastic, polyclonal lymphocytes forming follicles with an active germinal center [3], and most importantly, is mimicking clinicopathologically to low grade lymphoma including MALT lymphoma. Case presentation In April 2009, a 56-year-old Japanese woman was pointed out to have a space occupying lesion in the lateral segment of the liver on abdominal ultrasonography during health examination Her social and family history was noncontributory and she had a previous medical history of appendectomy for acute appendicitis and laparoscopic cholecystectomy for cholecystolithiasis. Ki67 index of those lymphoid cells was 25% Taken together, these findings were consistent with diagnosis of both extranodal marginal zone B-cell lymphoma and Figure 3 FDG-PET CT demonstrated the tumor had a high standardized uptake value (SUVmax: 3.6) for FDG. Any adjuvant chemotherapy or radiotherapy was not indicated, considering that the tumor was confined in the liver with no extrahepatic involvement, and she is currently doing well with no sign of relapse 13 months after the surgery
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