Abstract
This report describes a case of primary hepatic diffuse large B-cell lymphoma (DLBCL) in a 64-year-old male who presented with constitutional symptoms, jaundice, abdominal swelling, and right upper quadrant pain. The diagnosis was confirmed on percutaneous liver biopsy. Notably, there was no evidence of extra-hepatic involvement. The patient received methylprednisolone and cyclophosphamide with good response but was lost to follow-up upon being transferred. This case highlights the importance of considering primary hepatic DLBCL in patients with unexplained abnormal liver tests and atypical imaging without solitary or discrete lesions, as this rare malignancy can present furtively.
Highlights
Primary hepatic diffuse large B-cell lymphoma (DLBCL) is an uncommon type of non-Hodgkin’s lymphoma, accounting for ~0.4% of extra-nodal non-Hodgkin’s lymphoma, and it rarely presents without spread to the lymph nodes, bone marrow, or other organs [1]
Immune suppressed patients are more susceptible, yielding hypotheses that certain viral (Epstein-Barr virus, hepatitis B, hepatitis C, human immunodeficiency virus) or autoimmune conditions may promote development of this rare cancer. Since it presents with non-specific symptoms and inconclusive radiographic findings, a high index of clinical suspicion and low threshold to obtain a targeted biopsy is critical to confirming the diagnosis of primary hepatic DLBCL
A 64-year-old male with a past medical history of morbid obesity, Roux-en-Y gastric bypass, cholecystectomy, type II diabetes mellitus, and hypertension presented with lower extremity and abdominal swelling, right upper quadrant pain, jaundice, myalgia, and fatigue
Summary
Primary hepatic diffuse large B-cell lymphoma (DLBCL) is an uncommon type of non-Hodgkin’s lymphoma, accounting for ~0.4% of extra-nodal non-Hodgkin’s lymphoma, and it rarely presents without spread to the lymph nodes, bone marrow, or other organs [1]. Immune suppressed patients are more susceptible, yielding hypotheses that certain viral (Epstein-Barr virus, hepatitis B, hepatitis C, human immunodeficiency virus) or autoimmune conditions may promote development of this rare cancer Since it presents with non-specific symptoms and inconclusive radiographic findings, a high index of clinical suspicion and low threshold to obtain a targeted biopsy is critical to confirming the diagnosis of primary hepatic DLBCL. Axial image at the level of the liver demonstrates a mildly enlarged liver without a discrete focal mass (arrow) He presented to our institution with right upper quadrant pain and abdominal swelling with constitutional symptoms and lower extremity swelling. Liver core biopsy extensively involved by lymphoid cells with sparse hepatic parenchyma (*) Higher magnification of this diffuse infiltrate (*) reveals frequent morphological characteristics of DLBCL including large sized lymphoid cells with irregular nuclei, vesicular chromatin, small nucleoli, and moderate amount of cytoplasm. The patient chose to seek a second opinion and was lost to follow-up
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