Liver Lymphoma Research Articles

Primary Liver Lymphoma with Hypercalcemia: A Case Report

Primary liver lymphoma is extremely rare. The diagnosis depends on the physician's suspicions and histological examination. We report the case of a man aged 38 years who suffered from abdominal discomfort and hypercalcemia. Sonography showed a huge, solid liver tumor, and magnetic resonance imaging showed the tumor had characteristics of hypointensity on T1-weighted and hyperintensity on T2-weighted imaging. Primary liver lymphoma was diagnosed by histological examination from biopsy. We report this rare type of liver tumor and review the clinical presentation and treatment of the disease.

Clinicopathological features of primary liver lymphoma and its surgical therapy

Clinicopathological features of primary liver lymphoma and its surgical therapy

Part I: Cancer in Indigenous Africans—burden, distribution, and trends

Cancer is an under-emphasised issue in Africa, partly because of the overwhelming burden of communicable diseases. However cancer is a common disease in Africa with 650 000 people, of a population of 965 million, diagnosed annually. Furthermore, the lifetime risk in females (between 0 and 64 years) of cancer is about 10%, which is only about 30% lower than the risk in developed countries. In females, the lifetime risk of dying from cancer in Africa is almost double the risk in developed countries. This Review is the first of two papers and focuses on the current knowledge of the distribution and trends of the most common cancers in Africa. The cancers with the highest incidence are cervical, breast, and now HIV-associated Kaposi's sarcoma. The top five cancers in males--Kaposi's sarcoma (constituting 12.9% of all cancers in males) and cancer of the liver (14.8%), prostate (9.5%), bladder (6.1%), and non-Hodgkin lymphoma (5.7%)--and in females--cancer of the cervix (constituting 23.3% of all cancers in females) and breast (19.2%), Kaposi's sarcoma (5.1%), cancer of the liver (5.0%), and non-Hodgkin lymphoma (3.7%)--are discussed in detail. The second paper will focus on the causes and control of cancer in Africa. The cancer burden in Africa is likely to increase as a result of increases in HIV-associated cancers, changes in lifestyles associated with economic development, and the increasing age of the population (despite AIDS). Although the knowledge of cancer in this region is improving, better surveillance of cancer incidence, mortality, and prevalence of risk factors is urgently needed to monitor the development of the cancer epidemic, formulate appropriate cancer-control strategies, and assess the outcomes of these strategies.

Cancers in Northern Thailand

A retrospective study was undertaken to assess cancers in northern Thailand using the Chiang Mai Cancer registry and Maharaj Nakorn Chiang Mai Hospital records from January 2001 to December 2005. Maharaj Nakorn Chiang Mai Hospital is the university hospital for the Faculty of Medicine, Chiang Mai University. There were 4,108 new cancer cases being treated at the institution. The distribution of patients were (a) 32% from Chiang Mai, (b) 42% from nearby provinces of Lampoon, Phayao, and Chiang Rai, (c) 20.4% from other northern provinces, and (d) 1.2% from other parts of Thailand. Based on the data, the most common cancers by relative frequency are cancers of the lung, cervix, liver, breast, and non-Hodgkin's lymphoma. The current treatment options used to manage these most common cancers are described in this article.

Fine‐needle trucut biopsy versus fine‐needle aspiration cytology with ultrasound guidance in the abdomen

Historically, fine-needle aspiration cytology (FNAC) has varying sensitivity, specificity and accuracy in the diagnosis of abdominal lesions with a high insufficient sampling rate. We compared 20-G fine-needle trucut biopsy (FNTB) with FNAC results in the biopsy of solid abdominal tumours. A retrospective review of 171 (128x 20-G FNTB and 43x FNAC) ultrasound-guided biopsies of abdominal tumours on 157 patients (male : female 85:72, mean age 61.25 years) were carried out. One hundred and seventy-one biopsies were carried out: liver 109, pancreas 19, lymph node 10, omentum 5, right iliac fossa mass 6, adrenal 6 and others 16. An average of 2.06 and 1.97 passes (range 1-4) were carried out per FNTB and FNAC, respectively. A definitive diagnosis was made in 122/128 biopsies (95.3%) and 32/43 biopsies (74.4%) for FNTB and FNAC, respectively. Diagnoses consisted of metastatic liver disease (74/171), pancreatic adenocarcinoma (10/171), lymphoma (8/171) and others (33/171) and benign (29/171). No significant complications occurred in either group. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 87, 100, 100, 50, 84.4 and 93.1, 100, 100, 60, 71.4 for FNTB and FNAC, respectively. A greater and more consistent positive diagnosis rate is yielded by 20-G FNTB (95.3%) than FNAC (74.4%). The diagnostic accuracy of FNTB is 84.4% compared with 69.8% for FNAC. A greater insufficient sampling rate occurs with FNAC (25.6%) than with FNTB (4.7%). For abdominal biopsy, 20-G FNTB needles have a much higher yield than FNAC with no increase in complications. FNTB is the preferred choice, particularly where cytological assistance at the time of biopsy is unavailable.

Malignant histiocytosis-like B-cell lymphoma of liver: report of a case

患者男,73岁.以乏力、食欲不振2周,加重伴发热、尿黄1周于2007年1月30日人院.人院前2周无明显诱因出现乏力、食欲下降,未予诊治.1周前上述症状加重,尿黄如浓茶样,伴发热,自测体温37.8℃,夜间盗汗明显,于当地医院就诊,口服中药汤剂后盗汗症状好转,但发热黄疸及乏力加重,并出现下腹部轻度疼痛,近1个月体重下降5 kg。

Rapid xenograft tumor progression in beta‐arrestin1 transgenic mice due to enhanced tumor angiogenesis

beta-arrestins (beta-Arrs) are known to be associated with tumor signaling pathways such as transforming growth factor-beta1 (TGF-beta1), P53/Murine double minute (MDM2) and NF-kappaB. To investigate the role of beta-Arr in tumor progression in vivo, we generated beta-Arr transgenic mice by subcutaneously inoculating tumor cells in them. We found that the xenograft tumor initiated earlier and grew more rapidly in beta-Arr1 transgenic mice than in both the beta-Arr2 transgenic and wild-type mice after inoculating murine liver cancer Hepa1-6 cells or lymphoma EL4 cells. Moreover, matrix metalloproteinase 9 (MMP9) activity, vascular endothelial growth factor (VEGF) concentration in plasma and new small blood vessel formation in tumor tissues were enhanced in beta-Arr1 transgenic mice compared with those in control mice. In addition, injection of MMP9 inhibitors in beta-Arr1 transgenic mice abrogated all these effects and suppressed rapid tumor progression. Similar results were observed in human microvascular endothelial cells, where overexpressed beta-Arr1 did increase MMP9 activity and small blood vessel formation. Furthermore, phosphatidylinositol 3-kinase (PI3K) inhibitors could suppress beta-Arr1-enhanced MMP9 activity and the C-terminal 181-418 amino acids (aa) of beta-Arr1 was largely responsible for this effect. Our data reveal a functional role for beta-arrestin1 in tumor progression in vivo, in which overexpression of beta-Arr1 promotes MMP9 activity and tumor angiogenesis by providing a suitable microenvironment for tumor progression.

Causes of death in symptomatic cryoglobulinemia: 30 years of observation in a Department of Internal Medicine

Cryoglobulinemic Syn&come (CS) is a multi-systemic disease, and its fatal evolution can involve different organs. Aims: To describe the most frequent causes of death in CS, by researching different evolutions between older cases and those of the last 15 years. Patients: The data of 238 patients affected by symptomatic cryoglobulinemia followed by our Medicine Department in the last 30 years are recorded in a database. 54 are presently living and being followed, 70 (36F, 34M) have died. The type II/type III ratio is 5/4. We distinguish between two groups, the oldest, without any data on HCV, and the most recent who were tested for HCV. The follow-up ranges from 0.5 to 16 years. Results: Liver diseases (25 cases, 9 with hepatic carcinomas), lymphomas and myeloproliferative diseases (12), and cardiovascular events (8) are the most reported causes of death. Sepsis, neurological syndromes, nephropathy, other malignancies and diffuse vasculitis are also reported. The median age at death was 67.2 years (58.4 in the oldest group, 71.9 in the other). Hepatic carcinomas are reported only after 1991. Conclusion: Cirrhosis complications are more frequent in patients affected by HCV. The increase in instrumental diagnostic ability and the improved survival of patients with cirrhosis account for the increase in patients with hepatic carcinomas. Improved treatment has resulted in a reduction of deaths from renal failure.

Treatment of Inflammatory Bowel Disease with 6-Thioguanine (6-TG): Retrospective Case Series from a Tertiary Care Center

Purpose: 6-TG has been suggested as an alternative treatment option for patients with inflammatory bowel disease (IBD). However, hepatotoxicity, especially nodular regenerative hyperplasia (NRH) has been described leading to recommendation not to consider the drug for long term treatment of IBD. We would like to report our experience from a single tertiary referral center with the use of 6-TG for treatment of IBD. Methods: Retrospective case series study. We reviewed patient charts including hospital and outpatient electronic record/chart of all patients followed in our adult IBD clinic over past 5 years. We identified patients on 6-TG and reviewed their charts for duration of treatment with 6-TG and adverse reactions, specifically abnormal liver function tests (LFTS), NRH and lymphoma during their follow-up. Results: We reviewed the medical records of 289 patients followed in our adult IBD clinic over the past 5 years. Of these, 24 patients were treated with 6-TG, 7 male (29%) and 17 (71%) female patients, mean age of 48 years (range 17 to 86 years), 23 patients had crohn's disease and one had ulcerative colitis. The mean duration of treatment with 6-TG was 21 months (range from 2 months to 72 months). Only 2 patients, 1 male and 1 female, had significant elevation in their LFTs on 6-TG. Both underwent liver biopsy with only one (4%) reported to have NRH on liver biopsy. This patient discontinued 6-TG, with complete normalization of his LFTs. No lymphoma was detected in any patients receiving 6-TG. Conclusion: 6-TG is rarely associated with NRH. This drug has been used at our center for treatment of patients who cannot tolerate on other immunosuppressive agents. 6-TG is an alternative immunosupressive agent that can be safely considered in the treatment of IBD. Prospective studies will be needed to further evaluate for long term safety and efficacy of 6-TG in treatment of IBD.

Granulomatous infiltration with replacement of liver parenchyma: first case report

A 76-year-old man presented with fever, weight loss and abnormal liver function tests. Imaging demonstrated a diffusely abnormal liver, and a liver biopsy revealed a fibrosing granulomatous process infiltrating and replacing liver parenchyma. There was no clinical, radiological or laboratory evidence of autoimmune liver disease, sarcoidosis, lymphoma or tuberculosis. Treatment with steroids resulted in a remarkable resolution of the clinical symptoms and radiology. This is the first case of granulomatous infiltration of the liver replacing normal hepatic parenchyma.

Sonographic Features of Biliary Hamartomas With Histopathologic Correlation

Biliary hamartomas (BH) are uncommon benign biliary malformations composed of disorganized bile ducts and fibrocollagenous stroma. Biliary hamartomas are associated with autosomal dominant polycystic kidney disease (ADPKD), polycystic liver disease (PLD), Caroli disease, and congenital hepatic fibrosis. The major clinical importance of BH is that they may be misdiagnosed as multiple liver metastases, microabscesses, lymphoma, leukemia, Candida albicans, or extrapulmonary Pneumocystis carinii infection at initial imaging. In patients with ADPKD, these may be mistaken for small cysts, cirrhotic changes, or one of these more ominous diseases. The following report illustrates the distinguishing sonographic features of BH in a patient with ADPKD with histopathologic correlation.

Lymphome non hodgkinien primitif du foie : à propos d'un cas et revue de la littérature

Purpose was to describe the clinical, radiological and therapeutic features in primary liver lymphoma. We report the case of a 54-year-old patient, who is followed since the age of 20 years for neutropenia associated with mediastinal adenopathy. Systematical ultrasound find a mass of the left liver confirmed by Computed tomography (CT). Histological examination of laparoscopic liver biopsy specimens confirmed diffuse large-cell non-Hodgkin's lymphoma. The disease was confined to the liver without any evidence of extrahepatic involvement. The serology of Epstein Barr virus was highly positive. PET-scan show increased FDG uptake at the site of hepatic lesion and the mediastin. The patient received chemotherapy followed by radiation therapy of the left liver at the dose of 31 Gy. The patient was alive and free of disease 20 months after the diagnosis of primary liver lymphoma. The primary hepatic lymphoma is a rare malignancy, which classically affects 50-year-old patients with a male preponderance. The incidence is increased in immunosuppressed patients and some authors have suggested an association with hepatitis B or C infection, and with the Epstein Barr virus. The imaging studies including ultrasound, CT, magnetic resonance imaging (MRI) and now PET-scan help to establish the diagnosis and to the following. Treatment options are surgery, radiation, chemotherapy, or a combination.

Primary liver AIDS-related lympoma

Non-Hodgkin's lymphomas (NHL) are the second most frequent malignancies in AIDS patients. The majority of NHL associated with AIDS involves extranodal sites, especially the digestive tract and the central nervous system. Primary liver lymphoma (PLL) is an uncommon neoplasm among these patients. Ultrasonography and computed tomography scans may be helpful in the diagnosis of focal hepatic lymphoma. Image-guided fine-needle biopsy with histopathology of the liver lesions is the gold standard for the diagnosis of hepatic lymphoma. We report a case of PLL as the initial manifestation of AIDS in a patient without any previous infection by hepatitis C or B virus, presented as multiple and large hepatic masses.

化学療法後に切除した肝原発悪性リンパ腫の1例

化学療法後に切除した肝原発悪性リンパ腫の1例

Primary Liver Lymphoma in a Patient with Chronic Hepatitis C

Primary liver lymphoma is a very rare disease and is frequently overlooked as a possible diagnosis. We report the case of an asymptomatic middle-aged man with chronic hepatitis C who developed primary liver lymphoma (PLL). A large solitary tumor in the left lobe of the liver was incidentally detected on routine ultrasound examination. Imaging studies showed mixed iso- and hypoechogenicity with hypoechoic rim, hypodense in the pre-contrast phase and thick wall enhancement in the post-contrast phase on computed tomographic study, hypointensity on T1WI, and hyperintensity of the central portion and slightly higher intensity in the peripheral wall on T2WI. These pictures were different from focal nodular hyperplasia, hepatocellular carcinoma, cholangiocarcinoma or metastases. Atypical hepatectomy was performed and the pathology of the hepatic tumor revealed non-Hodgkin's lymphoma. Systemic staging revealed no evidence of nodal or bone marrow involvement, so PLL was diagnosed. There was no tumor recurrence more than 4 years after operation and chemotherapy. PLL should be included in the differential diagnosis of solitary hepatic tumor in patients who are hepatitis C virus-positive, and who have atypical imaging and no known malignancy or elevated tumor marker levels.

Cancer in Persons Working in Dry Cleaning in the Nordic Countries

U.S. studies have reported an increased risk of esophageal and some other cancers in dry cleaners exposed to tetrachloroethylene. We investigated whether the U.S. findings could be reproduced in the Nordic countries using a series of case–control studies nested in cohorts of laundry and dry-cleaning workers identified from the 1970 censuses in Denmark, Norway, Sweden, and Finland. Dry-cleaning work in the Nordic countries during the period when tetrachloroethylene was the dominant solvent was not associated with an increased risk of esophageal cancer [rate ratio (RR) = 0.76; 95% confidence interval (CI), 0.34–1.69], but our study was hampered by some unclassifiable cases. The risks of cancer of the gastric cardia, liver, pancreas, and kidney and non-Hodgkin lymphoma were not significantly increased. Assistants in dry-cleaning shops had a borderline significant excess risk of cervical cancer not found in women directly involved in dry cleaning. We found an excess risk of bladder cancer (RR = 1.44; 95% CI, 1.07–1.93) not associated with length of employment. The finding of no excess risk of esophageal cancer in Nordic dry cleaners differs from U.S. findings. Chance, differences in level of exposure to tetrachloroethylene, and confounding may explain the findings. The overall evidence on bladder cancer in dry cleaners is equivocal.

Lymphome non hodgkinien primitif du foie chez un patient infecté par le VIH : à propos d'une observation

Introduction. – Primary liver non-Hodgkin’s lymphoma, are extremely rare in HIV-infected patient. Most of them are diffuse large-cell lymphoma with B cell type. Exegesis. – We report here the case of a 34-year-old HIV-infected patient, admitted for jaundice and fever since 15 days. Abdominal computerised tomography showed numerous hypodense lesions on all liver segments. The various biological, microbiological and morphological examinations (ultrasound, MRI with intravenous contrast agent specific for the liver) initially suggested a tumoral origin. The liver biopsy concluded to a large B-cell lymphoma. A chemotherapy (CHOP) with anti-CD20 monoclonal antibody (rituximab) was initiated without discontinuing antiretroviral therapy. Conclusion. – This case-report does emphasize on the numerous presentations of primary liver lymphoma in HIV-Infected patient, and we illustrate the interest of MRI using a new intravenous contrast agent critical for differential diagnosis.

Changes in glutathione-related enzymes in tumor-bearing mice after cisplatin treatment.

The effect of cisplatin on five glutathione-related enzymes was studied in liver, kidney, and Dalton lymphoma cells of tumor-bearing mice. In liver, the activities of glutathione S-transferase, glutathione peroxidase, catalase, and superoxide dismutase decreased approximately 30-40%, 60-67%, 35-50% and 70-80% respectively, while glutathione reductase increased about 36-45% after cisplatin treatment. In kidney, catalase activity decreased by 47-82% at all time points (24-96 h) of cisplatin treatment, while glutathione S-transferase activity decreased significantly (approximately 24%) mainly at 72 h of treatment. An increase in glutathione reductase (approximately 1.5-2.5 times), glutathione peroxidase (significant at 24 h, 47%), and superoxide dismutase (approximately 15-60%) was noted in kidney after the treatment. In Dalton lymphoma cells, the activities of glutathione S-transferase, glutathione peroxidase, and catalase decreased very distinctly (approximately 2-5, 2-5 and 5-11 times, respectively) at all time points, but glutathione reductase decreased significantly only at 72 h of cisplatin treatment. Interestingly, the superoxide dismutase activity in Dalton lymphoma cells increased initially at 24-48 h and then decreased (approximately 60%) during later periods (72-96 h) of treatment. Cisplatin treatment caused a decrease in glutathione level in Dalton lymphoma cells (approximately 14-20%) and kidney (approximately 18-28%) but no change in liver. In view of the results, a definite correlation with the changes in glutathione concentrations and enzymatic activities in a tissue could not be firmly derived. It is suggested that the changes in various glutathione-related enzymes and glutathione levels in the tissues of the host during cisplatin-mediated chemotherapy could affect cellular antioxidant defense potential, which may play an important contributory role in cisplatin-mediated toxicity, particularly nephrotoxicity, and anticancer activity in the host.

Primary non-Hodgkin’s lymphomas of the liver with nodular and diffuse infiltration patterns have different prognoses

Primary liver non-Hodgkin's lymphomas have peculiar clinical and biological patterns. This study correlates these patterns with pathology and outcome. Clinical records and histology of patients with primary liver non-Hodgkin's lymphoma, treated at our institution over a 20-year period, were reviewed. Lymphoproliferations occurring after liver transplantation were excluded. Survival analyses were performed with patients from the other published series (62 patients). Our series included eight patients. Three patients had a nodular liver infiltration, corresponding to a large B-cell lymphoma. Five patients had a diffuse liver infiltration, of whom three had a T-cell lymphoma with predominant sinusoid infiltration, and two had a large B-cell lymphoma. Patients with diffuse liver infiltration presented with hepatomegaly, and two of these also had acute liver failure. Diffuse infiltration had a worse prognosis than nodular infiltration (P = 0.0033). Among these latter patients, those treated with an anthracycline-based chemotherapy had a better outcome (P < 0.0001). Patients with primary liver lymphomas can be classified in two groups, depending on the type of infiltration. Those with nodular infiltration may benefit from anthracycline-based chemotherapy. Diffuse infiltration has a bad prognosis, and should be suspected in patients presenting with altered liver functions and hepatomegaly.

Imaging of Primary Non-Hodgkin's Lymphoma of the Liver

AIM: To describe the radiological findings in primary liver lymphoma, which is a rare entity, presenting usually as a localized liver mass. MATERIALS AND METHODS: We reviewed retrospectively the imaging findings at presentation, of patients in whom a diagnosis of primary liver lymphoma was finally made histologically. The study period covered a 10-year period between January 1990 and December 1999. There were seven patients, all men, with a mean age of 49.6 years. Each patient presented with hepatobiliary disease without peripheral adenopathy. Imaging prior to diagnosis included ultrasonography (seven patients), computed tomography (seven patients) and magnetic resonance imaging (MRI) (two patients). Appearances during and after aggressive chemotherapy were reviewed. RESULTS: Imaging appearances were of either single or multiple liver lesions simulating liver metastases. On ultrasound all foci of primary hepatic lymphoma (PHL) were hypoechoic relative to normal liver. Computed tomography (CT) showed hypoattenuating lesions in all cases, and two cases showed rim enhancement following contrast administration. The MRI appearances were variable, and no pathognomonic feature of PHL was identified, so that histology was required in all patients to establish the diagnosis. CONCLUSIONS: This paper demonstrates the spectrum of findings encountered on various imaging modalities in PHL. We conclude that although PHL is a rare condition, it should always be considered in the differential diagnosis of liver metastases when no primary tumour is apparent. Maher, M. M.et al. (2001). Clinical Radiology56, 295–301.