Malignant lymphoma imitating hepatitis

Abstract

Involvement of the liver is common in low-grade lymphomas and usually occurs as disseminated disease. Less common causes include primary liver lymphoma, usually of B-cell origin, and hepatosplenic lymphoma, a recently described T-cell lymphoma. The medical records of three patients with clinical features of hepatitis who were found at autopsy to have lymphoma involving primarily the liver and spleen were reviewed. Tissue sections were stained with hematoxylin and eosin after fixation. Immunohistochemistry evaluation was performed by the immunoperoxidase technique on tissue fixed in formaldehyde solution and embedded in paraffin. Frozen tissue was available for additional immunophenotypic studies in one patient (Patient 1). Presenting signs included fever, jaundice, hepatomegaly, and elevated liver enzyme levels, especially serum alkaline phosphatase and bilirubin. Palpable lymphadenopathy was absent. Clinical evaluation indicated hepatitis. Lymphoma was the unexpected finding at postmortem examination after a rapidly deteriorating clinical course. The entire liver in each patient showed a predominant portal lymphomatous infiltration. Two patients had small cleaved cell lymphomas, and one had a large cell lymphoma. Immunologically, one of the small cleaved cell lymphomas was of B-cell phenotype and one was of T-cell origin. The large cell lymphoma showed immunologic staining only with the CD15 antibody (LeuM1). Lymphoma diffusely involving the liver frequently is associated with splenic involvement and may present as primary hepatic dysfunction. In contrast to previous reports of hepatosplenic T-cell lymphoma, this series suggests that lymphoma involving primarily the liver and spleen can be diverse in cytologic and immunologic characteristics.