Hepatic Lymphoma Research Articles

Primary Hepatic Lymphoma: A Large Mass Surrounding Multiple Intrahepatic Vessels

A man was hospitalized for a 7-day history of right upper-quadrant abdominal pain. Physical examinaion revealed mild hepatomegaly. Laboratory results showed a emoglobin level of 94 g/L, a platelet count of 66 109 g/L, a actate dehydrogenase level of 554 U/L, an alkaline phosphatase evel of 118 U/L, and a -glutamyl transpeptidase level of 65 U/L. Tumor markers were negative. Abdominal computed tomography (CT) with contrast revealed a 15.0 10.0 8.4 cm3 nonenhancing mass involving the right and left lobes of the liver on portal phase imaging (Figure A). Magnetic resonance imaging showed low signal on T1-weighted and high signal on T2-weighted fat-saturated sequences (Figure B). The mass showed mild rim enhancement on portal phase postcontrast T1-weighted sequence and surrounded the inferior vena cava, hepatic middle and right vein, and right portal vein without any deformity (Figure C). There was no mediastinal lymphadenopathy on chest radiography and no evidence of lymphoma on bone marrow biopsy. Liver biopsy showed diffuse lymphocytic infiltrate (Figure D). Immunohistochemical stains were positive for CD20 (Figure E), CD79a, and Ki-67 ( 40%), and negative for CD45RO. The diagnosis of diffuse B-cell lymphoma was made. After 6 cycles of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone, CT showed a dramatic reduction in the size of the tumor (Figure F). The patient was followed up for 2 years without recurrence or the need for additional therapy. This case highlighted several important points. A large mass surrounding multiple intrahepatic blood vessels without any architectural distortion was the characteristic of this tumor, which was to some extent similar to the sandwich sign for mesenteric lymphoma and the CT angiogram sign or floating aorta sign for retroperitoneal lymphoma. This finding is helpful in differentiating primary hepatic lymphoma (PHL) from most benign or malignant hepatic tumors that usually displace or invade the adjacent intrahepatic vessels. Lymphoma in general tends to surround adjacent vessels without compressing their lumen.1 Furthermore, although rare,2 it is important to rec-

Histopathologic Features, Immunophenotyping, Clonality, and Eubacterial Fluorescence In Situ Hybridization in Cats With Lymphocytic Cholangitis/Cholangiohepatitis

Feline lymphocytic cholangitis is a poorly characterized disease complex with respect to histologic lesions, immunophenotype, and etiopathogenesis. Seventy-eight cases of feline lymphocytic cholangitis (n = 51) and feline hepatic lymphoma (n = 27) were reviewed using standardized histopathology, immunophenotyping (B cell and T cell), polymerase chain reaction for T-cell receptor (TCR) gene rearrangement, and fluorescence in situ hybridization (FISH) for eubacteria. Five histopathologic features in cases of lymphocytic cholangitis assisted in its differentiation from hepatic lymphoma: bile duct targeting (n = 32, 62.7%), ductopenia (n = 9, 17.6%), peribiliary fibrosis (n = 37, 72.5%), portal B-cell aggregates (n = 36, 70.6%), and portal lipogranulomas (n = 38, 74.5%). The majority of lymphocytic cholangitis cases (n = 35, 68.6%) were T cell predominant; 15 (29.4%) had an equal mix of B cells and T cells, and 1 (1.9%) had a B cell-predominant infiltrate; 66.6% of hepatic lymphoma cases were T-cell lymphomas. TCR clonality results were unexpected, with 17.1% of cases of lymphocytic cholangitis having clonal or oligoclonal populations and with T-cell lymphomas having variable TCR clonality (63.6% clonal or oligoclonal, 36.3% polyclonal). The majority of lymphocytic cholangitis (n = 32 of 36, 88.8%) and all hepatic lymphoma cases had no detectable eubacteria using FISH. As demonstrated here, bile duct targeting, ductopenia, peribiliary fibrosis, portal B-cell aggregates, and portal lipogranulomas are lymphocytic cholangitis features that, along with polyclonal TCR (83%), help differentiate it from hepatic lymphoma. No strong evidence was found implicating in situ bacterial colonization as an etiopathogenesis of lymphocytic cholangitis.

Hepatobiliary Disorders in Celiac Disease: An Update

This communication reviews recent literature and summarizes hepatobiliary abnormalities that may complicate the clinical course of celiac disease. A wide spectrum of hepatobiliary diseases has been described, including asymptomatic elevations of liver enzyme levels, nonspecific hepatitis, nonalcoholic fatty liver disease, and autoimmune and cholestatic liver disease. Moreover, in the majority of patients, liver enzyme levels will normalize on a gluten-free diet. In addition, celiac disease may be associated with rare hepatic complications, such as hepatic T-cell lymphoma. Because many celiac patients do not have overt gastrointestinal symptoms, a high index of suspicion is required. Simple methods of detecting celiac disease such as serum antibody tests help in the early identification of the disease, thus preventing serious complications of the disorder. The IgG DGP antibody test and IgA tTG antibody test used in combination are an excellent screening test for suspected cases of celiac disease.

Non-Hodgkin's lymphoma of the bone and the liver without lymphadenopathy revealed on FDG-PET/CT

Primary extranodal lymphomas are much less frequent than nodal lymphomas. Osseous and hepatic lymphomas commonly present with additional nodal lesions. Primary lymphoma of the bone or of the liver without nodal disease is uncommon. We describe a case of extranodal non-Hodgkin's lymphoma with numerous osseous and hepatic lesions without any lymph node involvement on FDG-PET/CT images. This is the first report of the coexistence of both osseous and hepatic lymphoma in the same patient without any lymph node involvement.

Positron emission tomography scan for a hepatic mass

A 66-year-old male patient who is hepatitis C RNA positive, without cirrhosis, has been found to have a mass on ultrasound examination of the liver. Physical examination is unremarkable. The hemoglobin, white cell count and platelet counts are normal. The alkaline phosphatase is mildly elevated to 212 U/L(normal <115), the AST 112 U/L, and the ALT 128 U/L. The CA 19-9 is 82 U/mL (normal < 55 U/mL) and the alpha fetoprotein 12 ng /mL. A CT scan of the abdomen shows a vague mass in segment V of the liver without definite arterial enhancement. An MRI of the abdomen is carried out with contrast but the mass is still indeterminate on T1 and T2 imaging.

Role of Contrast-Enhanced Ultrasonography in Primary Hepatic Lymphoma

Ultrasonography is the first examination performed for screening of hepatocellular carcinoma (HCC); contrast-enhanced ultrasonography (CEUS) can help discriminate between HCC and other lesions. Primary hepatic lymphoma (PHL), even if rare, should be considered in the differential diagnosis of focal liver lesions (FLLs). Few data are available in the literature about the role of CEUS in the diagnosis of PHL; we tried to determine whether CEUS could have a role in this setting. we describe 2 cases of primary non-Hodgkin lymphoma of the liver associated with hepatitis B virus (HBV) infection. The first patient was a 62-year-old man who was an HBV-inactive carrier, and the second was a 58-year-old man with type 2 diabetes and chronic HBV hepatitis. in both cases, ultrasonography showed a hypoechoic liver lesion (4 and 3 cm, respectively) with irregular margins in segment 4 of the liver. On CEUS, these lesions were inhomogeneously hyperenhanced in the arterial phase and hypoenhanced in the portal and late phases. Contrast-enhanced computed tomography (CT) in both patients showed slight hyperenhancement in the arterial phase and hypoenhancement in the remaining phases. Needle biopsy showed marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue type in both patients. Contrast-enhanced ultrasonography and CT did not help us differentiate PHL from HCC; in fact, in both cases we saw the characteristic findings of primary HCC. Primary hepatic lymphoma is a rare condition, but it should always be considered in the differential diagnosis of FLLs. We stress the important role of liver biopsy when imaging indicates HCC in patients without underlying cirrhosis.

CHEMOTHERAPY FOLLOWED BY ABDOMINAL CAVITY IRRADIATION FOR FELINE LYMPHOBLASTIC LYMPHOMA

Combination chemotherapy is standard care for feline lymphoma, although clinically relevant improvements in remission duration are unlikely to result from manipulations of chemotherapy agents alone. Lymphopoietic tissues generally are sensitive to radiation, and support for chemoradiotherapy as a treatment for lymphoma is found in both humans and dogs. The goal of this prospective pilot study was to determine the normal tissue tolerance to 15 Gy total abdomen fractionated radiation therapy following induction chemotherapy in cats with lymphoblastic lymphoma. Eight cats with lymphoblastic gastrointestinal or multicentric lymphoma confined to the abdominal cavity were treated with a 6-week combination chemotherapy protocol followed 2 weeks later by whole-abdomen radiation therapy consisting of 10 daily fractions of 1.5 Gy. Treatment was well tolerated; renal insufficiency documented in one cat at the start of radiation therapy progressed to stable chronic renal failure. One cat not in complete remission at the time of radiation therapy relapsed 2 weeks later, one cat with multicentric lymphoma relapsed with hepatic large granular lymphoma, and one cat was euthanatized 3 weeks following completion of radiation therapy for other reasons; no evidence of lymphoma or radiation toxicoses was identified on post mortem evaluation. The remaining five cats remain in remission at least 266 days after starting therapy; median remission duration has not been reached (range, > 266 to > 1332 days). Results of this study suggest that 15 Gy total abdomen fractionated radiation therapy after induction chemotherapy is tolerated satisfactorily. This protocol is suitable for further testing to quantify efficacy.

Clinicopathologic feature of primary hepatic mantle cell lymphoma: report of a case

患者女,73岁.以左腰部皮肤起疹,疼痛2个月余为主诉于2009年3月9日入院.患者8年前因结肠癌行手术治疗(此次复查原病理切片为中分化腺癌),术后恢复好.体检:左腰部皮肤有呈条带状分布的点、片状色素沉着斑,边界清楚,未见水疱及红斑疹,全身浅表淋巴结未触及肿大。

Hepatic manifestations of celiac disease

Different hepatic and biliary tract disorders may occur with celiac disease. Some have been hypothesized to share genetic or immunopathogenetic factors, such as primary biliary cirrhosis, primary sclerosing cholangitis, and autoimmune hepatitis. Other hepatic changes in celiac disease may occur with malnutrition resulting from impaired nutrient absorption, including hepatic steatosis. In addition, celiac disease may be associated with rare hepatic complications, such as hepatic T-cell lymphoma.

Primary Hepatic Burkitt Lymphoma Presenting with Acute Liver Failure

We report the first case of immunophenotypically confirmed primary hepatic Burkitt lymphoma presenting with acute liver failure. The patient survived following an aggressive diagnostic approach followed by emergent chemotherapy. Data from the primary hepatic non-Hodgkin lymphoma literature show a survival rate of 87% at 5 years with combination regimens of chemotherapy. However, mortality rate in this population is 85% in patients with acute liver failure. Primary hepatic Burkitt lymphoma may respond well to emergent chemotherapy even in the setting of acute liver failure.

FDG PET/CT diagnosis of hepatic lymphoma mimicking focal fatty infiltration on CT

Areas of hypoattenuation in the liver which do not have mass effect are typically thought to represent focal fatty infiltration. Rarely, tumors can present without mass effect in the liver. We present a case in which areas of liver hypoattenuation which were initially thought to represent focal fatty infiltration on CT due to lack of mass effect had abnormal uptake on a FDG PET/CT exam; these areas were due to secondary hepatic involvement from non-Hodgkin's lymphoma.

21 Primary hepatic low-grade B-cell lymphoma: A case report

21 Primary hepatic low-grade B-cell lymphoma: A case report

Primary hepatic (extranodal) lymphoma: utility of [18F]fluorodeoxyglucose-PET/CT

Primary hepatic lymphoma is extremely rare. Although the utility of fluorodeoxyglucose (FDG)-positron emission tomography (PET) for imaging extranodal lymphoma has been reported, there is very little literature describing its use in primary hepatic lymphoma. This case report demonstrates the effect of FDG-PET/computed tomography (CT) in a case of unifocal primary hepatic lymphoma and its usefulness in the assessment of treatment response.

Primary Hepatic Lymphoma: MR Imaging and Pathologic Correlation

Primary hepatic lymphoma is extremely rare, representing less than 1% of all extranodal lymphomas. We report MR imaging features and pathologic correlation of a case of primary hepatic lymphoma. MR images showed a large lobulated mass with gradual contrast enhancement, resembling intrahepatic cholangiocarcinoma. However, both hepatobiliary phase image obtained 20 minutes after injection of hepatocyte specific contrast agent and diffusion-weighted image demonstrated characteristic three layered pattern representing viable lymphoma in the outer layer, tumor necrosis in the middle layer and necrotic hepatic parenchyma in the center.

Progress in research of primary hepatic lymphoma

Progress in research of primary hepatic lymphoma

Primary Hepatic Lymphoma

Primary Hepatic Lymphoma

One case of primary hepatic adnexal mucosa-associated lymphoid tissue lymphoma

病人,男,57岁.因发热待查收住呼吸科,诊断为上呼吸道感染,给予抗炎、补液、退热等治疗,症状消失,体温降至正常.查体B超示:肝内左叶6.7 cm×9.0 cm异常回声(非均质脂肪肝?左肝占位?)、肝囊肿、胆囊多发结石伴慢性胆囊炎、肝外胆管扩张、双肾结石、前列腺增生。

Isolated Recurrent Hepatic Marginal Zone B-Cell Lymphoma

Isolated Recurrent Hepatic Marginal Zone B-Cell Lymphoma

Primary Non-Hodgkin Lymphoma of Liver

Primary non-Hodgkin lymphoma (NHL) of liver is a very rare malignancy. Here, we report the case of a 65-year-old man who presented with constipation and right groin pain of 2 months' duration. A computed tomography (CT) scan of the abdomen incidentally detected multiple hypodense nodules in both lobes of the liver. Diagnosis of primary NHL of liver was made using ultrasound-guided biopsy. Extensive investigations--which included bone marrow biopsy; fluorescence in situ hybridization; flow cytometry; CT scan of chest, abdomen, and pelvis; and whole-body positron-emission tomography--showed no involvement of bone marrow, lymph nodes, spleen, or any other organ. The patient is currently being treated with a CHOP-R (cyclophosphamide-doxorubicin-vincristine-prednisolone/rituximab) regimen. The case has many unique features, including normal liver function tests, especially that for lactate dehydrogenase; no type B symptoms; and negative serology for viruses. The case demonstrates that primary hepatic lymphoma should be considered in the differential diagnosis of space-occupying liver lesions in presence of normal levels of alpha-fetoprotein and carcinoembryonic antigen. The literature is extensively reviewed.

Primary hepatic lymphoma: Imaging findings

Primary hepatic lymphoma (PHL) is rare, accounting for less than 1% of all extranodal lymphomas. In this article, we retrospectively reviewed the imaging features of 12 pathologically proven cases of primary hepatic lymphoma.