Hepatic Pseudolymphoma: Case Report and Review

Abstract

Purpose: Hepatic Pseudolymphoma or Reactive Lymphoid Hyperplasia is a rare benign neoplasia characterized by a polyclonal lymphocytes proliferation gathered in nodes with an active germinal center. It`s pathophysiology is uncertain though it is clearly related to inflammatory or infectious diseases, collagen disorders and malignancy. Diagnosis is often difficult due to its similarities to malignant tumors. If diagnostic is confirmed, a conservative approach may be applied. Method: A 57 years old woman with a history of lung adenocarcinoma T1a surgically managed by a left inferior lobectomy in 2015. That same year the patient develops an idiopathic autoimmune hemolytic anemia treated with steroids. During follow-up dissociated cholestasis is detected with elevation of hepatic enzymes. Primary Biliary Cholangitis was suspected. Imaging studies (RMI, US) show an 18mm hypervascular nodule between liver segments II and III. Core Needle Biopsy is performed showing polymorphic lymphoid infiltrations, polyclonal lymphocytes B and T, and germinal center cells, findings compatible with hepatic pseudolymphoma or low grade lymphoma. Results: Segment III hepatectomy was performed, without postoperative complications. Patient was discharged 2 days after surgery. Studies confirm hepatic pseudolymphoma. After 54 months follow up no recurrence has been detected. Conclusion: Hepatic Pseudolymphoma is a rare (less than 70 published cases) benign disease, often associated to autoimmune disorders, malignancy or collagen disorders. Treatment of this pathology could be conservative, but the difficulties regarding differential diagnosis (malignancy) makes surgical approach often required. If diagnostic is confirmed, a conservative approach may be applied.