J Korean Soc Magn Reson Med.  2010 Dec;14(2):151-155. 10.13104/jksmrm.2010.14.2.151.

Primary Hepatic Lymphoma: MR Imaging and Pathologic Correlation

• Kim H
• Shin YR
• Rha SE
• Jung ES
• Oh SN
• Choi JI
• Jung SE
• Lee YJ

• KMID: 2206914
• DOI: http://doi.org/10.13104/jksmrm.2010.14.2.151

Abstract

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.

Keyword

Lymphoma; Liver; Magnetic resonance imaging (MRI)

MeSH Terms

Cholangiocarcinoma
Hepatocytes
Liver
Liver Neoplasms
Lymphoma
Necrosis
Cholangiocarcinoma
Liver Neoplasms

Figure

• 

  Fig. 1 A 78-year-old man with primary hepatic lymphoma. (a) Axial fat suppressed T2-weighted fast spin echo image shows a large lobulated hyperintense mass (arrows) in the left hepatic lobe. (b) Coronal T2-weighted single shot fast spin echo image shows a large lobulated heterogeneous hyperintense mass (arrows), surrounding the fissure for ligamentum teres (arrowhead). (c) Axial pre-contrast T1-weighted image shows hypointense mass (arrow) in the left hepatic lobe. (d, e) Axial portal venous (d) and equilibrium (e) phase contrast-enhanced T1-weighted image show poor, heterogeneous enhancement of the mass (arrow). Progressive enhancement is seen in the central portion of the mass. (f) Axial 20 minute-delayed hepatobiliary phase contrast-enhanced T1-weighted image clearly shows two different signal intensity of the lesion: lymphoma with very low signal intensity area (arrow) and slightly low signal intensity entrapped by the tumor with necrotic hepatic parenchyma (dotted arrow). (g) Axial diffusion-weighed image (b = 800) shows three different signal intensity of the lesion: a band-like high signal intensity of the tumor (arrow), thin linear dark signal intensity along the medial margin of the high signal intensity (arrowhead), consistent with necrotic tumor, and intermediate signal intensity area (dotted arrow) entrapped by the tumor consistent with necrotic hepatic parenchyma. (h) F-18 FDG PET-CT shows a band-like hot uptake showing the same configuration with that of diffusion-weighted image, suggestive of a viable tumor. (i) Gross specimen shows three different zones consisting of a band-like lobulated tumor (arrow), focal tumoral necrosis (arrowhead), and necrotic hepatic parenchyma without tumor involvement (dotted arrow). (j) Photomicrography of specimen (immunohistochemical staining for CD20, ×400) shows multiple large atypical lymphoid cells expressing CD20, consistent with diffuse large B-cell lymphoma.

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