Primary liver cancer complicated with non-Hodgkin’s lymphoma: two cases analysis and literature review

Abstract

Objective To investigate the clinical characteristics of primary liver cancer (PLC) complicated with non-Hodgkin’s lymphoma. Methods Clinical data of 2 patients with PLC complicated with non-Hodgkin's lymphoma admitted and treated in the Third Affiliated Hospital of Sun Yat-sen University between January 2006 and July 2015 as well as 18 patients reported by the literature were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. The incidence, diagnosis and treatment process, therapeutic regimen, curative effect and prognosis were observed. Relevant literature in PubMed database from January 1994 to December 2015 was searched for literature review. Results Among the patients, 17 were males and 3 were females with the onset age ranging from 35 to 80 years old and the median of 64 years old. Nineteen cases were with hepatocellular carcinoma and 1 with mixed type liver cancer. Hepatitis virus infection was found in 90%(18/20) of the patients with 8 cases of hepatitis B virus (HBV) infection and 10 of hepatitis C virus (HCV) infection. All patients were complicated with B-cell non-Hodgkin's lymphoma. The main type was diffuse large B-cell lymphoma, accounting for 60%(12/20). And the other types were follicular lymphoma (n=5), mucosa-associated lymphoid tissue (MALT) lymphoma (n=1), marginal zone lymphoma (n=1) and unspecified lymphoma (n=1). The main lesions of non-Hodgkin's lymphoma respectively located in the liver (n=9), spleen (n=3), lymph node (n=3), stomach (n=3), vertebral body (n=1), other non-tissue and visceral organ (n=1). The therapeutic regimens were operation + chemotherapy (n=9), radiofrequency ablation or transcatheter arterial chemoembolization (TACE) + chemotherapy (n=6), liver transplantation (n=1) and palliative treatment (n=4). The median postoperative survival time of the patients was 48(5-105) months, while the survival time of the patients receiving palliative treatment was less than 1 month. Conclusions Most PLC patients complicated with non-Hodgkin's lymphoma are male, and the pathological type of all the non-Hodgkin's lymphoma is B-cell type. The morbidity is closely associated with HBV infection. There are no specific clinical manifestations, and the confirmed diagnosis depends on the pathological examination. Radical resection is the first choice for treatment. Key words: Carcinoma, hepatocellular; Lymphoma, non-Hodgkin; Hepatitis B virus; Pathology; Surgical procedures, operative