Hepatic Lymphoma Research Articles

CT and MR imaging characteristics of primary hepatic lymphoma

BackgroundPrimary hepatic lymphoma (PHL) is a rare primary liver tumor. The purpose of this study was to investigate the crucial imaging characteristics of PHL.MethodsCT/MR data and clinical features of 16 patients with pathologically proven PHL were retrospectively reviewed. The assessed imaging characteristics included lesion distribution, growth appearance, density or signal characteristics, and typical signs during the dynamic enhancement.ResultsA total of sixteen patients were included in this study, ranging in age from 27 to 86 years (nine men and seven women; mean age, 62 years). Right upper abdominal pain, malaise, or first detection during physical examination were the chief complaint. Dynamic contrast-enhanced CT and MRI demonstrated focal masses in thirteen patients (13/16, 81%), and multiple nodules in three patients (3/16, 19%). The lesions showed vascular floating sign in 10 patients (10/16, 63%) and biliary pass-through sign in 6 patients (6/16, 37%). Necrosis in PHLs were observed in 10 patients (10/16, 63%) and presented target sign on T2WI in 5 out of 11 patients (5/11, 45%) undergoing MRI. After enhancement, PHLs had multinodular sign in the arterial phase in 10 patients (10/16, 63%), and presented washout of contrast medium in the portal-venous or delayed phase in 12 patients (12/16, 75%), pseudocapsule in the delayed phase in 15 patients (15/16, 94%), and double-ring sign in the delayed phase in 8 patients (8/16, 50%).ConclusionPHL is generally seen in elderly patients with elevated beta-2-microglobulin levels. Its distinctive imaging features including obviously low ADC value, biliary/vascular floating sign, multinodular sign and double-ring sign in the delayed phase, may help to diagnose and differentiate PHL.

ABCL-315 Diagnosis and Treatment of Primary Hepatic Lymphoma: Case Report

ABCL-315 Diagnosis and Treatment of Primary Hepatic Lymphoma: Case Report

Diagnosis and Treatment of Primary Hepatic Lymphoma: Case Report

Diagnosis and Treatment of Primary Hepatic Lymphoma: Case Report

OTMorph: Unsupervised Multi-domain Abdominal Medical Image Registration Using Neural Optimal Transport.

Deformable image registration is one of the essential processes in analyzing medical images. In particular, when diagnosing abdominal diseases such as hepatic cancer and lymphoma, multi-domain images scanned from different modalities or different imaging protocols are often used. However, they are not aligned due to scanning times, patient breathing, movement, etc. Although recent learning-based approaches can provide deformations in real-time with high performance, multi-domain abdominal image registration using deep learning is still challenging since the images in different domains have different characteristics such as image contrast and intensity ranges. To address this, this paper proposes a novel unsupervised multi-domain image registration framework using neural optimal transport, dubbed OTMorph. When moving and fixed volumes are given as input, a transport module of our proposed model learns the optimal transport plan to map data distributions from the moving to the fixed volumes and estimates a domain-transported volume. Subsequently, a registration module taking the transported volume can effectively estimate the deformation field, leading to deformation performance improvement. Experimental results on multi-domain image registration using multi-modality and multi-parametric abdominal medical images demonstrate that the proposed method provides superior deformable registration via the domain-transported image that alleviates the domain gap between the input images. Also, we attain the improvement even on out-of-distribution data, which indicates the superior generalizability of our model for the registration of various medical images. Our source code is available at https://github.com/boahK/OTMorph.

Hepatic T‐cell lymphoma in a dog with chronic hepatitis and presence of Leptospira spp. in hepatic tissue

AbstractA 7‐year‐old, female, neutered Border collie was referred for investigation of increased liver enzymes, accompanied by mild non‐specific clinical signs. Investigations subsequently revealed the presence of chronic pyogranulomatous hepatitis, copper accumulation and presence of multiplying Leptospira spp. in the liver tissue. Following treatment with doxycycline and D‐penicillamine, the liver parameters and clinical signs improved. However, 9 months after the treatment was initiated, the dog re‐presented for overall deterioration, small intestinal diarrhoea and cough. Investigations were consistent with a hepatic large cell lymphoma. The dog was euthanased shortly after diagnosis, and histopathology of the postmortem samples taken from the liver showed presence of CD3+, CD11d+ T‐cell lymphoma as well as multiplying Leptospira spp. in the tissue.

Multimodality Imaging of Primary Hepatic Lymphoma: A Case Report and a Literature Review

Primary hepatic lymphoma (PHL) is a rare form of non-Hodgkin lymphoma primarily affecting the liver. We present a case of an 84-year-old man diagnosed with PHL, incidentally detected during abdominal ultrasonography. The ultrasonography showed a hypoechoic nodule. When examined by CEUS, the nodule showed hyperenhancement in the arterial phase and hypoenhancement in the portal and late phases. Conversely, CECT demonstrated hypoenhancement through all the phases. The patient declined a tumor biopsy and opted for follow-up care. Ten months later, the lobular mass had increased from 15 mm to 65 mm, presenting as hypoechogenic and demonstrating the “vessel-penetrating sign” on color Doppler imaging. CEUS revealed reticulated enhancement, indicating intratumoral vessels. The mass displayed hypoattenuation on plain CT, hypointensity in T1-weighted images, and hyperintensity in T2-weighted images and exhibited significant restriction in diffusion-weighted images. Both CECT and contrast-enhanced MRI exhibited hypoenhancement. The patient underwent a partial hepatic segmentectomy, and the mass was pathologically diagnosed as a diffuse large B-cell lymphoma. Subsequent postoperative radiological examinations revealed no other lesions, confirming the diagnosis of PHL. Our report highlights specific ultrasonographic signs of PHL observed from an early stage and presents a review of the relevant literature.

Primary Hepatic Burkitt Lymphoma

The liver is an uncommon primary site for lymphoma, comprising only 0.4% of extranodal lymphomas, and liver involvement is almost always secondary to systemic lymphoma. Primary hepatic lymphoma has been reported to occur more frequently in immunosuppressed patients, especially with chronic hepatitis C infection, and may be associated with hepatitis B infection and the Epstein-Barr virus. Patients usually present with pain or a mass in the right upper quadrant, with or without jaundice, and it is more common in middle-aged males. The diagnosis of extranodal lymphoma or primary hepatic lymphoma can be difficult, especially in people living with human immunodeficiency virus (HIV) positivity or acquired immunodeficiency syndrome (AIDS). Due to its rarity, it is often overlooked as a possible differential diagnosis, with nonspecific imaging findings and a definitive diagnosis made only after anatomopathological and immunocytochemical examination. We present a rare case of Burkitt's lymphoma presenting as liver masses.

An Uncommon Presentation of a Common Disease: Periportal Infiltrating Form of Hepatic Lymphoma

An Uncommon Presentation of a Common Disease: Periportal Infiltrating Form of Hepatic Lymphoma

First Report of Asymptomatic Solitary High-Grade B-Cell Lymphoma NOS: An Enigmatic Entity

Background High-grade B cell lymphoma (HGBL) is a new disease entity introduced by WHO in 2016, including two types: HGBL with a double hit (DH) or triple hit (TH) and HGBL, not otherwise specified (NOS). HGBL DH/TH are defined by genetic rearrangements of specific oncogenes MYC, BCL2 and/or BCL6, while HGBL NOS is defined purely base on morphology in the absence of these genes. HGBL DH/TH is known for its poor prognostication given its propensity to rapidly progress and disseminate, however HGBL NOS remains ill-defined and poorly understood with no tangible literature describing its clinical nature and therapeutic susceptibility. Case presentation A 76-year-old post-menopausal woman with no significant PMH presented for evaluation of painless hematuria during a routine office visit. Evaluation with imaging showed a suspicious incidental liver mass concerning for possible metastatic or primary liver cancer. Obtained labs were unremarkable, including serum LDH, serological testing for hepatitis B/C and HIV1/2, and typical tumor markers. PET scan showed focal uptake of tracer in liver with no nodal involvement. Liver biopsy revealed diffuse infiltration by atypical lymphocytes. Immunohistochemical analysis showed CD20 and CD10 positivity, negative CD30, and high Ki-67 proliferation rate of 100%, however the absence of MYC, BCL6, BCL2, and t(8;14) rearrangements on FISH ruled out Burkitt and DH/TH lymphoma, consistent with HGBL-NOS. Following discussions with Henry Ford Lymphoma Tumor Board, patient was treated with six cycles of R-CHOP, where follow-up imaging indicated remission of her lymphoma. Conclusion This represents an extraordinary first report of HGBL NOS manifesting as an isolated primary hepatic lymphoma in the complete absence of clinical symptoms. The significance of this case lies in its atypical extra-nodal site of involvement and total absence of clinical symptoms and serological markers, underscoring the unfulfilled need to further describe this enigmatic entity.

Hepatic T‐cell lymphoma in a blue‐fronted Amazon parrot (Amazona aestiva) and subcutaneous T‐cell lymphoma in a grey parrot (Psittacus erithacus)

AbstractT‐cell lymphoma was diagnosed in a mature blue‐fronted Amazon parrot (Amazona aestiva) and a mature grey parrot (Psittacus erithacus). The Amazon parrot was diagnosed with soft tissue sarcoma in the neck and T‐cell hepatic lymphoma. The sarcoma was surgically removed, but chemotherapy for the lymphoma was declined by the owner. This parrot survived 24 months without treatment until it was euthanased for dyspnoea, the cause of which was not investigated. The grey parrot was diagnosed with subcutaneous T‐cell lymphoma on the left side of the neck that likely originated from the thymus. The mass was surgically excised without complications. The bird remained healthy 24 months after diagnosis, at which point follow‐up was lost. This case series documents the clinical presentation and diagnostic workup of T‐cell lymphoma in two Psittacidae patients. In both cases, T‐cell lymphomas were confirmed by histological examination and CD3 immunohistochemistry.

Nodular Lymphocyte-Predominant Hodgkin Lymphoma: A Rare Lymphoma with Isolated Hepatic Presentation.

Differential diagnosis of fever, especially in young patients, is very complex and complete investigation takes time, which can delay the diagnosis of malignancies such as primary hepatic lymphoma (PHL).PHL is very rare, and overlapping symptoms with other liver diseases can make the diagnosis very challenging.When the suspicion of PHL is very high, only the hepatic biopsy can lead to the correct diagnosis because the disease has no extrahepatic involvement.

Primary hepatic Burkitt lymphoma in a child and review of literature

BackgroundPrimary hepatic Burkitt lymphoma (PHBL) in children is an extremely rare hepatic malignancy with a dismal prognosis, unless it is detected and treated promptly.Case summaryAn 11-year-old child with abdominal pain was admitted to our hospital. No notable abnormalities were found during his physical examination or laboratory workup, but the abdominal computed tomography and magnetic resonance imaging both indicated a malignant hepatic mass measuring 9.2 × 7.1 × 7.5 cm in size. His postoperative pathology revealed an unexpected primary hepatic Burkitt lymphoma following a laparoscopic liver lobectomy. He then received rituximab and intense multi-agent chemotherapy as treatment. Despite post-chemotherapy bone marrow suppression, the patient eventually made a full recovery and had a good overall state.ConclusionIn this study, we describe a rare case of pediatric primary hepatic Burkitt lymphoma and review the literature on clinical features, diagnosis, and treatment for primary hepatic Burkitt lymphoma in children. We stress that this diagnosis should be taken into account in the absence of other single hepatic lesions or primary tumors of hematological disorders, particularly when there is a normal AFP level.

PRIMARY HEPATIC LYMPHOMA: ROLE OF LOW‐DOSE RADIOTHERAPY AND PAIRED LITERATURE REVIEW

Introduction: Primary hepatic lymphomas (PHL) are a rare form of non-Hodgkin lymphoma for which there are no established treatment guidelines. Available literature is largely comprised of small case reports and there are no reports on low-dose radiotherapy (RT) for indolent PHL. We report our institutional experience treating PHL within the context of existing literature to better understand the role of RT. We hypothesize that low-dose RT offers comparable outcomes to observation (obs), surgery and systemic therapy (ST) in select patients. Methods: We conducted a single-institution retrospective analysis of all biopsy-proven PHL patients (pts) diagnosed from 2000-2021 without other lymphomatous solid organ involvement. Subgroup analysis was performed for diffuse large B-cell lymphoma (DLBCL) and indolent lymphoma (IL). Univariable (UVA) and multivariable analysis (MVA) for overall survival (OS) was performed using the Cox proportional hazards model. Literature review was conducted using key words including “liver”, “lymphoma”, and “treatment” to identify all available reported cases of PHL. Results: We identified 30 PHL pts within our institution and 192 pts from literature review, with subgroup analysis of DLBCL and IL pts in the institutional cohort (n = 15, 9) and literature review (n = 78, 76), respectively (Table 1). Among the IL institutional cohort (n = 9), 3 pts underwent obs and 2 each received RT, ST and surgery. There were no recurrences among pts treated with RT, surgery or obs with median OS of 12.4 years, whereas both ST pts experienced either transformation to DLBCL or recurrence. Both RT patients received low-dose RT of 4Gy in 2 fractions. Literature review identified only 1 case report of RT use for IL with a dose of 41.4Gy. Conclusions: There is limited literature regarding use of RT in indolent PHLs. We present the first report of low-dose RT for indolent PHL with comparable outcomes to alternative modalities. PHL DLBCL is predominantly treated with ST in both our institutional experience and in the literature. Although our data is limited by the small cohort size reflective of the rarity of disease, our results are encouraging for the consideration of low-dose RT as a management option for appropriate patients with indolent PHL. Keywords: extranodal non-Hodgkin lymphoma, radiation therapy No conflicts of interests pertinent to the abstract.

Tissue Inhibitor of Metalloproteinase 3 as a potential staging biomarker in hepatocellular carcinoma

Objective: To assess the potential role of tissue inhibitor of metalloproteinase 3 as a staging marker of hepatocellular carcinoma.Method: The experimental study was conducted at Faculty of Pharmacy, Kafrelsheikh University, Egypt, from December 2020 to March 2022 after approval from the Faculty of Pharmacy, Kafrelsheikh University, Egypt, and comprised male albino rats. The subjects were divided into 4 groups. The control group was administrated a single intraperitoneal injection of normal saline, while the other groups were generated post-induction of hepatocellular carcinoma. The induction was done by injecting rats intraperitoneally with a single dose of 200mg/kg diethyl nitrosamine, followed by the administration of 0.05% phenobarbital sodium in drinking water daily. Rats were euthanised at 8, 16 and 24 weeks after the injection to obtain three groups related to the 3 stages of hepatocellular carcinoma. Serum was used for measuring the alpha protein level. Liver homogenates were used for the assessmentof the hepatic tissue inhibitor of metalloproteinase 3 expression, B-cell lymphoma 2-associated X protein expression, and the hepatic content of matrix metalloproteinase -9 and cyclin D1. Data was analysed using Graph Prism 8.Results: Of the 24 rats with weight range 120-130g, 6(25%) were in each of the 4 groups. The relative protein and messenger ribonucleic acid tissue inhibitor of metalloproteinase 3 expressions were significantly decreased in the intervention groups compared to the control group, with more decline as the hepatocellular carcinoma stage increased. The matrix metalloproteinase -9 and cyclin D1 concentrations and the relative hepatic protein Ki67 expression were significantly raised in the intervention groups compared to the control group (p<0.05). The relative expression of hepatic B-cell lymphoma 2-associated X protein was markedly decreased in the intervention groupscompared to the control group (p<0.05).Conclusion: Tissue inhibitor of metalloproteinase 3 might be a promising diagnostic and staging biomarker in hepatocellular carcinoma.Keywords: Carcinoma, Hepatocellular, Neoplasms, Fetoproteins, Metalloproteinase, Cyclin, Antigen, Phenobarbital, Nitrosamines.

An uncommon presentation of primary sclerosing cholangitis leading to the diagnosis of B cell lymphoma and common variable immunodeficiency

Abstract Common Variable Immunodeficiency (CVID) is a disorder of B cells, with hypogammaglobulinemia and an impaired immune response leading to increased risk of infection, autoimmune complications, and risk of malignancy. A 17-year-old, previously healthy male presented with three months of pruritus, jaundice and transaminitis. Imaging and biopsy showed liver heterogeneity without evidence of cholestasis or ductal dilation. Over time, imaging was consistent with primary sclerosing cholangitis (PSC). The patient eventually required liver transplant after several complications, despite stent therapy. Explant liver pathology revealed diffuse large B cell and follicular lymphoma, grade 3A with mature monoclonal B cells follicular in origin, negative for MYC rearrangement and MUM1. PCR detected IgH and IgK B cell clonality. He received chemotherapy without complication, for primary hepatic non-Hodgkin's lymphoma. Continued flatulence and diarrhea prompted endoscopy, revealing eosinophilic esophagitis. Due to his variable pathology, he was evaluated for a primary immunodeficiency. His labs demonstrated globally diminished immunoglobulins, a low Hib titer and one pathogenic mutation in TNFRSF13B (c.542C>A; p.Ala181Glu), a transmembrane activator and calcium-modulating cyclophilin ligand interactor (TACI). Thus, the patient was diagnosed with CVID. This case highlights a unique presentation of CVID from demonstration of PSC and primary hepatic diffuse large B cell lymphoma. Consideration of immunodeficiencies early on in challenging cases of autoimmune and unique oncologic diagnoses may lead to earlier treatment of underlying conditions and prevention of future complications.

The effect of flushing of the common bile duct on hepatobiliary markers and short-term outcomes in dogs undergoing cholecystectomy for the management of gall bladder mucocele: A randomized controlled prospective study.

To determine the effect of flushing of the common bile duct (CBD) on hepatobiliary markers and short-term outcome in dogs undergoing cholecystectomy for the management of gallbladder mucocele (GBM). Randomized, controlled, prospective study. Thirty-two client-owned dogs. Dogs were allocated randomly to either a "flush" group or a "non-flush group." Flushing was performed in a normograde fashion, followed by a routine cholecystectomy. Data collected included presenting clinical signs, preoperative and 3-day postoperative hepatobiliary markers (alkaline phosphatase, ALP; alanine aminotransferase, ALT; gamma glumatyl-transferase, GGT; bilirubin; cholesterol; triglycerides), duration of hospitalization, and complications. These data were compared between groups. Sixteen dogs were enrolled in each group. One dog (in the flush group) was excluded following diagnosis of hepatic lymphoma. Border terriers were overrepresented (20/31). Overall, there were marked reductions from preoperative to 3 days postoperative in serum bilirubin (p = .004), ALP (p = .020), ALT (p < .001), GGT (p = .025), and cholesterol (p < .001) values. There was no difference in any marker between groups. Survival to discharge was 90.3% (28/31 dogs). Cholestatic markers decreased significantly 3 days postcholecystectomy. No short-term clinical or clinico-pathological benefits were identified when flushing the CBD in dogs undergoing cholecystectomy for GBM. The findings of the study do not support routine flushing of the CBD during cholecystectomy for GBM in dogs.

Tissue Inhibitor Of Metalloproteinase 3 As A Potential Staging Biomarker In Hepatocellular Carcinoma.

To assessthe potential role of tissue inhibitor of metalloproteinase 3 as a staging marker of hepatocellular carcinoma. The experimental study was conducted at Faculty of Pharmacy, Kafrelsheikh University, Egypt, from December 2020 to March 2022 after approval from the Faculty of Pharmacy, Kafrelsheikh University, Egypt, and comprised male albino rats. The subjects were divided into 4 groups. The control group was administrated a single intraperitoneal injection of normal saline, while the other groups were generated post-induction of hepatocellular carcinoma. The induction was done by injecting rats intraperitoneally with a single dose of 200mg/kg diethyl nitrosamine, followed by the administration of 0.05% phenobarbital sodium in drinking water daily. Rats were euthanised at 8, 16 and 24 weeks after the injection to obtain three groups related to the 3 stages of hepatocellular carcinoma. Serum was used for measuring the alpha protein level. Liver homogenates were used for the assessment of the hepatic tissue inhibitor of metalloproteinase 3 expression, B-cell lymphoma 2-associated X protein expression, and the hepatic content of matrix metalloproteinase -9 and cyclin D1. Data was analysed using Graph Prism 8. Of the 24 rats with weight range 120-130g, 6(25%) were in each of the 4 groups. The relative protein and messenger ribonucleic acid tissue inhibitor of metalloproteinase 3 expressions were significantly decreased in the intervention groups compared to the control group, with more decline as the hepatocellular carcinoma stage increased. The matrix metalloproteinase -9 and cyclin D1 concentrations and the relative hepatic protein Ki67 expression were significantly raised in the intervention groups compared to the control group (p<0.05). The relative expression of hepatic B-cell lymphoma 2-associated X protein was markedly decreased in the intervention groups compared to the control group (p<0.05). Tissue inhibitor of metalloproteinase 3 might be a promising diagnostic and staging biomarker in hepatocellular carcinoma.

Primary hepatic extranodal marginal zone B-cell mucosa-associated lymphoid tissue lymphoma treated by laparoscopic partial hepatectomy: a case report

BackgroundPrimary hepatic extranodal marginal zone B-cell mucosa-associated lymphoid tissue (MALT) lymphoma is very rare, so it is difficult to diagnose preoperatively. And there is no established treatment for hepatic MALT lymphoma. We report herein a case of primary hepatic MALT lymphoma treated by laparoscopic partial hepatectomy, and discuss the usefulness of laparoscopic hepatectomy for a rare liver tumor.Case presentationThis patient was a woman in her 60s, who was diagnosed preoperatively as having synchronous liver metastasis from sigmoid colon cancer; therefore, laparoscopic partial hepatectomy was performed. She had a good course after the operation and was discharged on postoperative day 12. However, she was diagnosed pathologically as having primary hepatic MALT lymphoma. A bone marrow biopsy was also performed, and then she was finally diagnosed as having limited-stage primary hepatic MALT lymphoma. She received no postoperative treatment and showed no recurrence for 4 years postoperatively.ConclusionsWe experienced the good result of the patient with limited-stage primary MALT lymphoma treated by laparoscopic partial hepatectomy. Liver tumors are sometimes misdiagnosed by imaging examinations alone. Laparoscopic hepatectomy has been widespread recently as a minimally invasive procedure, and it may be useful for both diagnosis and treatment.

Multiple hepatic and osseous focal lesions without splenomegaly and/or lymph nodes enlargement

BackgroundHepatic involvement is a common extranodal manifestation of common and some rare hematologic malignancies. Although the imaging features of more common hepatic diseases such as hepatocellular carcinoma, metastases, and infection may overlap with those of hepatic hematologic malignancies, combining the imaging features with clinical manifestations and laboratory findings can facilitate correct diagnosis. Imaging has an important role in the diagnosis of hepatic focal lesions.Case presentationA case presented with isolated multiple hepatic focal lesions without nodal or spleen enlargement diagnosed only by immunohistochemical study and turned out to be primary hepatic lymphoma (PHL). PHL is rare with roughly 100 described cases and accounts for less than 1% of all non-Hodgkin lymphomas. Osseous involvement adds more challenge to the diagnosis.ConclusionHepatologists must be aware of PHL as it may be confused with more common hepatic diseases, mainly multifocal HCC and/or hepatic metastasis.

Patterns of Lymphocytic Infiltrates Can Differentiate Feline Hepatic Lymphoma from Lymphocytic Portal Hepatitis.

Hepatic lymphoma is poorly characterized in cats and differentiating between inflammation and lymphomas is often difficult. The diagnosis of hepatic lymphoma in humans relies on recognition of specific patterns of lymphocytic infiltrates and clonality testing of antigen receptors. Herein, we defined similar patterns of lymphocytic infiltrates in hepatic biopsies of cats and correlated them with clonality to determine which patterns are predictive of lymphoma. A retrospective study was performed on surgical biopsies from 44 cats. The immunophenotype was characterized using CD3 and CD20 on all 44 samples. All 44 samples were tested using PCR for T-cell receptor gamma-gene rearrangements. PCR for immunoglobulin heavy chain gene rearrangements was performed on 24 of these cats. Four patterns of lymphocytic infiltrates were characterized: (1) tightly periportal, (2) periportal and centrilobular, (3) nodular, and (4) periportal with sinusoidal extension. Other histomorphologic features (fibrosis, biliary hyperplasia, bile ductopenia, bile duct targeting, hepatic hematopoiesis, lipogranulomas, lymphonodular aggregates, other inflammatory cells) were also evaluated. The sensitivity and specificity of the lymphocytic patterns to diagnose lymphomas were determined using Bayesian Hui-Walter analysis (BLCM) against clonality results. Lymphocytic patterns 2, 3, and 4 accurately diagnosed hepatic lymphomas with a sensitivity and specificity of 82% (CI 95%: 0.65, 0.96) and 77% (CI 95%: 0.54, 1.00), respectively. None of the other microscopic features evaluated were predictive of a lymphoma or inflammation. Our study identified specific patterns of lymphocytic infiltration that differentiate feline hepatic lymphoma from inflammation while other histologic features were not associated with an accurate diagnosis.