Primary Hepatic Lymphoma in an African-American Male: A Case Report

Abstract

Purpose: To highlight a case of primary hepatic lymphoma presenting in an African-American male. Methods: The study design is a retrospective chart review. The study subject was identified through the pathology department via histologic evaluation from biopsy data consistent with primary hepatic lymphoma. Exclusion criteria included patients with other hepatic lesions, including metastatic disease, hepatocellular carcinoma, or hepatic hemangioma. Case: A 45-year-old African-American male with a history of hepatitis-C presented with complaints of left upper quadrant pain, fatigue, purities, 15 lbs weight loss, and night sweats for three months. Physical examination was significant for icteric sclera, jaundice, and non-tender hepatomegaly. Laboratory investigation showed normal electrolytes, total bilirubin of 6.1, AST 150, ALT 142, alk phos 282, and AFP of 2. Hepatitis serologies were negative. CT showed multiple masses in right lobe of liver, with the largest mass measuring 8.1 x 6.7 x 8.8 cm. EGD and colonoscopy were negative for malignancy, and a liver biopsy showed diffuse infiltration by lymphoid cells with focal areas of necrosis, with immunohistochemistry positive for CD20, CD10, and bcl6. Thus, a diagnosis of primary diffuse large B cell lymphoma was made. During his hospital course, his total bilirubin increased to 23, and the patient received adjuvant radiation therapy to relieve his biliary. Subsequently, his bilirubin improved facilitating initiation of R-CHOP chemotherapy, to which the patient responded. He is still currently undergoing chemotherapy at our institution. Discussion: Primary hepatic lymphoma is a rare disease that accounts for less than 1% of primary liver tumors [2]. Published case reports have focused on Japanese and Chinese patients [1,4,5,10], but very few include African-American patients. Areas of the world are known for higher incidences of both hepatitis B virus and hepatitis C virus, and lymphoma has been associated with chronic long-standing liver disease of many etiologies [1,4,5,9]. Patients with lymphoma in the liver, primary or extranodal in origin, will present with constitutional symptoms. It is important to be aware of this rare tumor being associated with minority patients. The literature has shown the efficacy of CHOP chemotherapy for such lesions [3, 12, 19], and our patient has responded well to this therapy to this date. This case demonstrates a rare primary tumor not previously associated with the African-American population. As more patients present with chronic liver disease, it will be important to recognize this rare, but treatable, disease within the African-American community.