Hepatic Lymphoma Research Articles

Primary Hepatic Burkitt Lymphoma: A Bizarre Site and Triumph Tale

Primary hepatic Burkitt lymphoma (PHBL) is an extremely rare form extra nodal lymphoma and till now only 11 case reports have been found in the literature. We are reporting an adult female with primary hepatic Burkitt's lymphoma, who achieved complete remission after 5 months of combination chemotherapy containing vincristine, cyclophosphamide, doxorubicin, methotrexate, prednisolone and intrathecal chemotherapy. She is under regular follow up at our institute.

Primary hepatic lymphoma.

Primary hepatic lymphoma (PHL) is a lymphoproliferative disorder confined to the liver without evidence of involvement of spleen, lymph nodes, bone marrow or other lymphoid structures. This is in contrast to Non Hodgkin's Lymphoma (NHL) that often involves the liver as a secondary manifestation. PHL is a rare disease and constitutes 0.016% of all cases of NHL. PHL typically occurs in middle aged men, and usually the chief presenting symptoms are non specific which includes right upper quadrant pain, B symptoms like fever and weight loss and constitutional symptoms. Most frequent physical finding is hepatomegaly which occurs in 75% of patients. Jaundice is rare and present only in less than 5% of patients. Majority of PHL originates from B cells. The blood investigations and imaging findings are nonspecific. Histopathology is essential and confirms the diagnosis. Treatment modalities include combination of surgical resection, chemotherapy and radiotherapy. The prognosis without therapy is grim. The prognosis and management of PHL is different from hepatocellular carcinoma or metastatic disease, hence it is essential to differentiate it from these diseases. The purpose of this review is to emphasize the importance of accurate diagnosis before implementing therapeutic plan for any hepatic space occupying lesion in liver.

A concurrent primary hepatic MALT lymphoma and hepatocellular carcinoma

A concurrent primary hepatic MALT lymphoma and hepatocellular carcinoma

Primary non-Hodgkin's lymphoma of the liver: sonographic and CT findings

A preoperative diagnosis of primary hepatic lymphoma (PHL) can have profound therapeutic and prognostic implications. Because of the rarity of PHL, however, there are few reports on diagnostic imaging. We reviewed the clinical and radiologic findings of 29 patients with PHL, the largest series to date, to evaluate the diagnostic features of this disease. Clinical data and radiologic findings at presentation were retrospectively reviewed for 29 patients with pathologically confirmed PHL from January 2005 to June 2013. Imaging studies, including ultrasound (US) (n=29) and contrast-enhanced computed tomography (CECT) (n=24), were performed within 2 weeks before biopsy or surgery. Among the 29 patients, 23 (79%) were positive for hepatitis B virus (HBV) and 26 (90%) had a significantly elevated level of serum lactate dehydrogenase (LDH). There were two distinct types of PHL on imaging: diffuse (n=5) and nodular (n=24). Homogeneous or heterogeneous hepatomegaly was the only sign for diffuse PHL on both US and CECT, without any definite hepatic mass. For the nodular type, 63% (15/24) of patients had solitary lesions and 38% (9/24) had multiple lesions. On US, seven patients displayed patchy distribution with an indistinct tumor margin and a rich color flow signal. CECT showed rim-like enhancement (n=3) and slightly homogeneous or heterogeneous enhancement (n=14) in the arterial phase and isoenhancement (n=5) and hypoenhancement (n=12) in the portal venous and late phases. Furthermore, in five patients, CT revealed that hepatic vessels passed through the lesions and were not displaced from the abnormal area or appreciably compressed. The infiltration type of PHL was associated with the histologic subtype. Considered together with HBV positivity and elevated LDH, homogeneous or heterogeneous hepatomegaly may indicate diffuse PHL, whereas patchy distribution with a rich color flow signal on US or normal vessels extending through the lesion on CECT may be the diagnostic indicators of nodular PHL.

Complete response to comprehensive treatment of a primary hepatic diffuse large B cell lymphoma: A case report.

Primary hepatic lymphoma (PHL) is an uncommon lymphoid tumor with varied clinical features and treatment outcome. In the present study, the case of a 56-year-old patient with PHL and no clinical presentation was reported. During a routine physical examination, multiple hypodense nodules were incidentally detected in right lobes of the liver and hepatic portal in an abdominal computed tomography scan. A liver biopsy revealed the presence of a non-Hodgkin’s lymphoma diffuse large B cell type that was CD20-positive, followed by the diagnosis of a PHL. The patient was treated with R-CHOP, radiotherapy and R-Hyper-CVAD/R-HD MTX-ara-C, and complete remission was achieved.

Primary Hepatic Diffuse Large B-Cell Lymphoma: Unusual Presentation and Imaging Features

Primary hepatic lymphoma is an uncommon malignancy affecting the liver, with limited reports and series in the literature. Imaging appearance is not well described, with no definite features suggesting a diagnosis, and it may mimic other focal hepatic lesions. However, biopsy is needed in most of the cases for confirmation. We report a case of 22-year-old pregnant woman who on ultrasonography showed a large heteroechoic solitary liver mass mimicking focal nodular hyperplasia. Further evaluation after parturition with contrast-enhanced magnetic resonance imaging showed a large mass with central scar and peripheral diffusion restriction and contrast enhancement, which was atypical. Biopsy confirmed it as lymphoma. The case illustrates unusual presentation and magnetic resonance imaging features, including diffusion-weighted imaging, of primary hepatic lymphoma in a young female.

Hepatic Lymphoma Representing Iso-Signal Intensity on Hepatobiliary Phase, in Gd-EOB-DTPA-Enhanced MRI: Case Report

The liver is an extranodal organ that is frequently invaded by lymphomas, with most cases involving secondary lymphomas (1). The image findings of hepatic lymphoma have been reported as variable, ranging from single or multiple nodules to diffuse infiltrates (1, 2). It is known that hepatic lymphomas show low signal intensity on T1 weighted images, high signal intensity on T2 weighted images, and low signal intensity on hepatobiliary phase image, using hepatocyte-specific contrast agents (3, 4). Here, we report an atypical case of hepatic lymphoma showing iso-signal intensity on hepatobiliary phase of contrast-enhanced MRI using gadoxetic acid (Gd-EOB-DTPA, Primovist; Bayer Schering Pharma, Berlin, Germany).

11. A case of extranodal marginal zone lyphoma of mucosa-associated lymphoid tissue (MALT) type and hepatocellular carcinoma

Primary hepatic mucosa-associated lymphoid tissue (MALT) lymphoma is a rare disease. MALT lymphoma is a type of low grade extranodal B-cell lymphoma which is commonly diagnosed in the stomach where there is a well-documented association with Helicobacter pylori infection. In reported cases of primary liver MALT, it is often an incidental finding during imaging or surgery for other disease and patients usually do not have symptoms specifically related to the lymphoma. The information available from reported cases of primary liver MALT lymphoma have included associated inflammatory diseases of the liver including hepatitis B or hepatitis C (either with or without cirrhosis) or primary biliary cirrhosis. This supports the role of chronic inflammation in the pathogenesis of the condition regardless of primary site. As primary hepatic MALT lymphoma is usually asymptomatic it is likely to be an under-reported diagnosis. Only one case of concurrent hepatocellular carcinoma with hepatic MALT lymphoma on a background of hepatitis B infection is reported in the literature. We present a case of a 62 year old patient who presented with non-cirrhotic hepatocellular carcinoma on a background of cleared chronic hepatitis B infection. The patient has positive hepatitis B core antibody with negative hepatitis B surface antigen. The right hepatectomy specimen showed moderately differentiated hepatocellular carcinoma as well as an incidental diagnosis of extranodal marginal zone lymphoma of MALT type and the gallbladder specimen also showed involvement. We present this additional case of concurrent hepatocellular carcinoma and hepatic MALT lymphoma to bring to attention this extremely rare entity.

Dual time point fluorodeoxyglucose positron emission tomography/computed tomography in differentiation between malignant and benign lesions in cancer patients. Does it always work?

Objectives:Assess the added value of dual time point F-18-fluorodeoxyglucose positron emission tomography/computed tomography (DTP F-18-FDG-PET/CT) in the differentiation of malignant from a benign lesion in cancer patients.Materials and Methods:Totally, 140 F-18-FDG PET/CT scans of 60 cancer patients who underwent DTP protocol (early whole body PET/CT [E] at 60 min [range, 45–76 min] and delayed limited PET/CT [D] on areas of interest at 120 min [range, 108–153 min] after the tracer injection) were retrospectively reviewed. Visual and semi-quantitative analysis was performed on both early and delayed images. All findings were confirmed by histopathology and/or at least 3 months follow-up (F-18-FDG PET/CT, CT, or magnetic resonance imaging). The result was considered true positive (TP) if delayed standardized uptake value (SUV) of suspicious lesions increased and confirmed to be malignant, false positive (FP) if delayed SUV increased and confirmed to be benign, true negative (TN) if delayed SUV unchanged or decreased and confirmed to be benign, and false negative (FN) if delayed SUV unchanged or decreased and confirmed to be malignant.Results:A total of 164 suspicious lesions were detected (20 presacral lesions, 18 lung nodules, 18 Hodgkin's disease (HD) lesions, 16 rectal lesions, 16 head and neck (H and N) lesions, 14 hepatic lesions, 14 non-Hodgkin's lymphoma (NHL) lesions, 12 mediastinal lymph nodes (LNs), 10 focal gastric uptake, 10 soft tissue lesions, 8 breast lesions, 4 peritoneal nodule, and 4 others). Sixty-four lesions were pathologically confirmed, and 100 lesions were confirmed based on 3–6 months follow-up. There were 62 TP lesions, 44 FP, 58 TN and no FN results. The overall sensitivity was 100% of DTP F-18-FDG PET/CT in detecting suspicious lesions. The specificity was 57% in differentiating malignant from benign lesions, and the accuracy was 73%. Positive predictive value was 59%, negative predictive value (NPV) 100%. All hepatic lesions were TP. Accuracy in metastatic hepatic lesions HD, presacral soft tissue, lung nodules, H, and N cancer, breast cancer, NHL and mediastinal LN was100%, 88.8%, 80%, 78%, 75%, 75%, 71%, and 33.3%, respectively.Conclusions:DTP F-18-FDG-PET/CT protocol does not always work in differentiation between benign and malignant lesions. However; it has high NPV, and promising results was noted in hepatic lesions, lymphoma, and recurrent rectal cancer.

画像診断上多血性肝細胞癌との鑑別が困難であった肝MALTリンパ腫の2例

画像診断上多血性肝細胞癌との鑑別が困難であった肝MALTリンパ腫の2例

直腸癌が併存した肝原発悪性リンパ腫の1例

直腸癌が併存した肝原発悪性リンパ腫の1例

Diagnostic imaging of hepatic lymphoma

Hepatic lymphoma is a rare disease with poor prognosis because of delayed diagnosis. The disease comprises primary, metastatic, and intravascular hepatic lymphomas. The pathological characteristics of lymphomas differ contributing to difficulty in early diagnosis. Early diagnosis and appropriate treatment result in improved prognosis; therefore, diagnostic radiology and its development with various contrast agents are critical for improving disease outcomes. Herein, we review hepatic lymphomas and summarize the results of imaging studies in correlation with pathological characteristics. The information provided will help physicians in early diagnosis and thereby improving prognosis.

Alteration of angiogenesis in Helicobacter heilmannii‐induced mucosa‐associated lymphoid tissue lymphoma: Interaction with c‐Met and hepatocyte growth factor

The hepatocyte growth factor (HGF)/c-Met pathway has attracted attention in the formation of malignant tumors, as HGF secreted from the microcirculatory components as well as residing macrophages has been suggested to act on the c-Met receptors of cancer cells to decrease apoptosis and increase proliferation, invasion, and metastasis. The present study was undertaken to elucidate the interaction of the gastric, hepatic, and pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma induced by Helicobacter heilmannii infection with c-Met and HGF. C57BL/6 female mice, infected with H. heilmannii for 3 months were used. The localization of the HGF, c-Met, and HGF activator immunoreactivities was observed by the indirect immunohistochemical methods. In addition, the effect of c-Met antibody and c-Met inhibitor, PHA-665752, was also investigated. c-Met immunoreactivity was found in the lymphocytes composing the MALT lymphoma, and HGF immunoreactivity was recognized mostly in the endothelial cells and macrophages in the MALT lymphoma. HGFA was localized on mesenchymal cells other than the lymphocytes. The administration of the antibody against c-Met or the c-Met inhibitor to the infected mice induced the significant suppression of hepatic and pulmonary MALT lymphoma, while the gastric MALT lymphoma showed only a tendency to decrease in size, while the active caspase 3 positive cells markedly decreased in the gastric, hepatic, and pulmonary MALT lymphoma after the treatment with the c-Met antibody or the c-Met antagonist. HGF and c-Met pathway were suggested to contribute to the lymphomagenesis in the MALT lymphoma after H. heilmannii infection.

Primary hepatic non-Hodgkin's lymphoma with rectal cancer: A case report.

Primary hepatic non-Hodgkin’s lymphoma (NHL) is an extremely rare disease that is commonly neglected as a possible diagnosis. The present study reports the case of a middle-aged male with chronic hepatitis B in which primary hepatic NHL and rectal cancer occurred simultaneously. A large solitary tumor in the left lobe of the liver was incidentally detected on routine examination prior to the laparoscopic resection of the rectal cancer. Laparoscopic resection of the rectal cancer and a liver biopsy were performed simultaneously. The pathology revealed that the hepatic tumor was NHL and that the rectal cancer was adenocarcinoma. Systemic staging revealed no evidence of nodal or bone marrow involvement, therefore, primary hepatic lymphoma (PHL) was diagnosed. PHL associated with rectal adenocarcinoma is extremely rare and to the best of our knowledge, has never been reported. At present, the cause and most effective therapy for the condition remain unclear.

Primary hepatic peripheral T-cell lymphoma: A case report.

Primary hepatic peripheral T-cell lymphoma (PHL) is extremely rare. A case of primary hepatic peripheral T-cell lymphoma of a 59-year-old male is presented in the current study. PHL lesions are diagnosed by the existence of a hepatic mass, in the absence of lymphadenopathy, splenomegaly or bone marrow involvement associated with normal tumor markers. Treatment options are surgical resection and subsequent chemotherapy. Histopathological examination by immunohistochemical staining of the tissue biopsies at laparotomy confirmed a diagnosis of PHL.

Role of substance P and CGRP in gastric MALT lymphoma induced by Helicobacter heilmannii infection (1052.5)

Recently, many neuroendocrine mediators have been reported to be related to the formation and enlargement of the neoplasm. From our electron microscopic analysis of the gastric MALT lymphoma, many unmyelinated nerve fiber‐like structures have been detected especially in the early stage of the tumor formation. Thus, the present study was undertaken to clarify the localization of choline acetyltransferase (ChAc), substance P, its receptor NK‐1R, CGRP and RAMP‐1, in the MALT lymphoma tissues. The effect of eradication of the bacilli as well as spantide II, a substance P antagonist, was also investigated. Materials and Methods The gastric, hepatic and pulmonary MALT lymphoma was formed by the per oral administration of homogenized gastric mucosa from Helicobacter heilmannii‐infected mice. The localization of ChAc, substance P, NK‐1R, CGRP and RAMP‐1 was observed by the indirect immunohistochemisty. The eradication treatment was performed by the combined administration of amoxicillin, chlarithromycin and lansoprazole for seven days. Results Substance P immunoreactivity (Ir) was observed in perivascular area within the tumor tissues, and the NK‐1R Ir was distributed mostly on the lymphoma cells. On the other hand, CGRP Ir was recognized in the area surrounding the MALT lymphoma. After the eradication treatment, the substance P Ir as well as CGRP Ir decreased in the reduced lymphoma tissues. Spantide II also induced the size of the tumor. In conclusion, the importance of substance P was shown in the maintenance and enlargement of the MALT lymphoma, having the clinical relevance.

FDG and other radiopharmaceuticals in the evaluation of liver lesions

Liver nodules are common findings in medical practice, both in patients with and in those without chronic liver disease. These lesions have to be interpreted according to clinical history and biochemical findings. Conventional imaging (US, CT and MRI) is still the gold standard for evaluating liver nodules, while diagnostic flowcharts do not currently include PET/CT. Since the 1990s many studies have been conducted to assess a possible role for FDG PET or PET/CT in several liver pathologies. According to the literature, FDG PET (and later PET/CT) could be useful in detecting, staging and grading hepatocellular carcinoma, often leading to a change in therapy, and may even detect intrahepatic cholangiocarcinoma with adequate sensitivity. Moreover, FDG can allow more accurate staging of hepatic involvement deriving from other tumors (often underestimated by conventional imaging) and, therefore, more appropriate therapy in affected patients. Finally, FDG PET can also be used to evaluate 90Y microsphere therapy response. Other conditions (e.g., primary hepatic lymphoma when conventional imaging is inconclusive) may benefit from the use of FDG PET/CT, while benign lesions (e.g., focal nodular hyperplasia) show low FDG avidity. As regards non-FDG tracers, choline and acetate (ACE) have been evaluated in comparison with FDG and found to show good efficacy in detecting and staging well- or moderately differentiated HCC. However, their sensitivity in poorly differentiated HCC is very low, suggesting that dual-tracer investigation (FDG and choline/FDG and ACE) could be useful when non-invasive grading is required. Despite promising results, PET evaluation of liver nodules still seems to be far from routine application, mostly because of cost-related issues.

Primary hepatic lymphoma: a challenging diagnosis.

Introduction. Primary hepatic lymphoma is an unusual malignancy and is very difficult to diagnose promptly. An intrigue case presenting with cholestatic jaundice is reviewed and main disease characteristics are further discussed. Case Report. A 70-year-old male presented with dull right upper quadrant abdominal pain and mild cholestatic jaundice. Initial evaluation revealed mildly elevated liver function tests and normal tumor markers, while imaging with an abdominal CT-scan showed multiple hypodense nodules in both liver lobes. First impression of metastatic deposits from gastrointestinal origin was not confirmed by endoscopic means. After CT-guided biopsy, primary diffuse large B-cells non-Hodgkin lymphoma was revealed. Appropriate chemotherapy improved patient's condition markedly. Discussion. Primary hepatic lymphoma is a rare form of extranodal lymphomas, accounting for less than 1% of all extranodal lymphomas in general. In order to define the condition as PHL, liver has to be the only site of lymphoma occurrence or to be involved in a major degree with minimal nonliver disease. Most PHLs are of B-cell origin with large cells as the main cell type.

Early Diagnosis of Hepatic Intravascular Lymphoma: A Case Report and Literature Review

Hepatic intravascular large B-cell lymphoma (IVL) is a rare disease entity that involves invasion into various organs. Due to the aggressive behavior and poor prognosis of the disease and the difficulty in making an early diagnosis, some cases are diagnosed at autopsy. Early suspicion and the use of imaging studies and liver biopsies are key for diagnosing IVL; however, no reports have described the results of imaging studies due to the limited number of cases. We herein report the results of imaging studies of hepatic IVL, including the findings PET-CT, dynamic-CT, EOB-MRI and CEUS. These results may help physicians to make an early diagnosis and improve the prognosis.

Primary and Secondary Hepatic Lymphomas Diagnosed by Image-Guided Fine-Needle Aspiration

To explore the diagnosis of hematolymphoid malignancies of the liver (hepatic lymphoma [HeL]) by image-guided fine-needle aspiration (FNA), which can often be difficult due to a low index of suspicion and nonspecific patient presentations, especially in the rare cases where the liver is the only site of disease (primary HeL [PHeL]). Understanding the clinical setting in which such lesions arise, as well as the cytomorphologic findings, may assist cytopathologists in making an accurate diagnosis and triaging samples for ancillary studies. In this retrospective study of 32 patients with HeL, the largest such study to our knowledge, we review the clinical and diagnostic features of HeL. HeL and especially PHeL most commonly show a diffuse large B-cell lymphoma phenotype and have a poor prognosis (median survival of seven months). PHeL is strongly associated with human immunodeficiency virus infection (12/16 patients). Image-guided FNA with immediate evaluation is a reliable means to obtain diagnostic material and triage for ancillary tests.