Ann Surg Treat Res.  2017 Aug;93(2):110-114. 10.4174/astr.2017.93.2.110.

Primary hepatic peripheral T-cell lymphoma mimicking hepatocellular carcinoma: a case report

• Lee J
• Park KS
• Kang MH
• Kim Y
• Son SM
• Choi H
• Choi JW
• Ryu DH

• KMID: 2387342
• DOI: http://doi.org/10.4174/astr.2017.93.2.110

Abstract

Peripheral T-cell lymphomas (PTCLs) are aggressive neoplasms which may involve the liver. The imaging manifestations of hepatic lymphoma are highly variable and show overlapping appearances of numerous other hepatic diseases. As the management and prognosis of lymphoma differ markedly from those of other malignant diseases, prompt diagnosis and early effective treatment are very important. Here, we report an atypical case of primary PTCL not otherwise specified involving the liver that exhibited a solitary hepatic mass mimicking hepatocellular carcinoma (HCC) on CT. Liver biopsy is not commonly recommended in highly suspicious cases of HCC. However, in a patient without risk factors for HCC, consideration of other diagnostic possibilities is required and needle biopsy may be a more rational choice. An imaging approach, based on a careful review of clinical and laboratory findings is essential to prevent false-positive diagnosis of HCC and subsequent invasive treatment.

Keyword

Lymphoma; Liver; Hepatectomy; Hepatocellular carcinoma

MeSH Terms

Biopsy
Biopsy, Needle
Carcinoma, Hepatocellular*
Diagnosis
Hepatectomy
Humans
Liver
Lymphoma
Lymphoma, T-Cell, Peripheral*
Prognosis
Risk Factors

Figure

• 

  Fig. 1 A 50-year-old male patient with primary peripheral T-cell lymphoma, not otherwise specified involving the liver. Prior to contrast material injection (A), CT revealed a well circumscribed, round, homogeneous, and low-density mass (arrow) that measured 65 mm × 60 mm in the largest diameter located in segment V of the liver. Dynamic contrast-enhanced CT revealed a welldefined mass with moderate enhancement (arrow) in the arterial phase (B) and washout of contrast media (arrow) in the portal venous phase (C) and delayed phase (D). (D) Peripheral rim-enhancement (asterisk) was observed and was more obvious in the delayed phase. (E) CT also revealed multiple enlarged mesenteric and retroperitoneal lymph nodes (arrowheads) with homogeneous enhancement, and this finding suggested a malignant lymphoproliferative disorder such as lymphoma.

• 

  Fig. 2 (A) The surgical specimen exhibited a grey-white mass (arrow), measuring 70 mm × 50 mm × 50 mm in segment V of the liver. The mass was firm and well demarcated from the surrounding tissue with capsule-like lining (asterisk) measuring 5 mm. (B) A photomicrograph showed a diffuse infiltration of medium-sized monotonous lymphoid cells indicative of lymphoma surrounded by peritumoral fibrosis and ductular reaction (asterisk) (H&E, ×40). (C) Additionally, tumor cells stained positive for CD31 (×400), which is known to be an endothelial marker of microvessels.

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