Korean J Gastroenterol.  2014 Sep;64(3):168-172. 10.4166/kjg.2014.64.3.168.

Synchronous Hepatocellular Carcinoma and B-Cell Non-Hodgkin's Lymphoma in Chronic Hepatitis C Patient

• Lee SI
• Heo NY
• Park SH
• Joo YD
• Kim IH
• Park JI
• Kim JY
• Kim SH
• Shim HK

• KMID: 2160660
• DOI: http://doi.org/10.4166/kjg.2014.64.3.168

Abstract

Hepatitis C virus (HCV) is one of the main viral causes of hepatocellular carcinoma (HCC) and is associated with lymphoproliferative disorder such as non-Hodgkin's lymphoma (NHL). However, there are only few case reports on concomitantly induced NHL and HCC by HCV. Herein, we report a case of synchronous NHL and HCC in a patient with chronic hepatitis C which was unexpectedly diagnosed during liver transplantation surgery. This case suggests that although intrahepatic lymph node enlargements are often considered as reactive or metastatic lymphadenopathy in chronic hepatitis C patients with HCC, NHL should also be considered as a differential diagnosis.

Keyword

Hepatocellular carcinoma; Hepatitis C; Non-Hodgkin lymphoma

MeSH Terms

Antineoplastic Agents/therapeutic use
Carcinoma, Hepatocellular/complications/*diagnosis/radiotherapy
Drug Therapy, Combination
Embolization, Therapeutic
Fluorodeoxyglucose F18
Gadolinium DTPA
Genotype
Hepatitis B virus/genetics
Hepatitis C, Chronic/complications/*diagnosis/*virology
Humans
Liver Neoplasms/complications/*diagnosis/radiotherapy
Lymph Nodes/pathology
Lymphoma, Non-Hodgkin/complications/*diagnosis/drug therapy
Magnetic Resonance Imaging
Male
Middle Aged
Positron-Emission Tomography
Tomography, X-Ray Computed
Antineoplastic Agents
Fluorodeoxyglucose F18
Gadolinium DTPA

Figure

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  Fig. 1. Gadoxetic acid-enhanced magnetic resonance image shows a 2.3 cm sized hepatic nodule in S8 (white arrows), which is enhanced on arterial phase (A) and washed-out on equilibrium phase (B). Another 2.1 cm sized hepatic nodule in S4 (white arrows) is noted with same enhancement pattern on arterial (C) and equilibrium phase (D). An enlarged lymph node is also seen along the common hepatic artery, and it is enhanced on arterial phase (E) and iso-attenuated on equilibrium phase (F). After the first transarterial chemoembolization, the compact lipiodol uptake by both hepatic nodules is shown in pre-enhanced phase (G, H).

• 

  Fig. 2. (A) Axial and (B) maximum intensity projection image of 18 F-FDG PET-CT shows hyper-metabolic activity in the enlarged periportal lymph node (white arrow), the maximum standar-dized uptake value (SUVmax) of which is 6.8. The SUVmax of the hepatic nodules is 3.45, which is iso-metabolic compared to normal hepatic paren-chyma.

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  Fig. 3. Low-power photomicrograph of the periportal lymph node reveals characteristic nodular growth pattern in H&E (A; ×20) and CD20 immunohistochemical stain (B; ×20). At high-power microscopic view, each follicle is comprised predominantly of large cells resembling centroblasts (C; H&E, ×400). The neoplastic lymphocytes are positive for Bcl-6, which is expressed in germinal center cells (D; ×200).

Reference

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