Ann Hepatobiliary Pancreat Surg.  2017 Aug;21(3):163-167. 10.14701/ahbps.2017.21.3.163.

Primary hepatic lymphoma treated with liver resection followed by chemotherapy: a case report

• Park JI
• Jung BH

• KMID: 2389994
• DOI: http://doi.org/10.14701/ahbps.2017.21.3.163

Abstract

Non-Hodgkin lymphoma often involves the liver. However, primary hepatic lymphoma (PHL) confined to the liver without evidence of lymphomatous involvement is rare. The optimal therapy for PHL is still unclear. Most patients present with poor prognostic features. Here, we report a case of PHL treated with liver resection followed by chemotherapy. A 65-year-old male was referred for further evaluation about a liver mass detected on ultrasound. Abdominal computed tomography (CT) scan showed well-defined single mass of 6 cm in diameter. Positron emission tomography/CT scan revealed a hot uptake lesion on the segment 8 of the liver. Colonoscopy showed no abnormal finding. It was diagnosed as intrahepatic cholangiocarcinoma. A right anterior sectionectomy was performed. Postoperative pathology revealed diffuse large B-cell lymphoma. Bone marrow biopsy showed normal findings. The final diagnosis was confirmed as PHL. The patient subsequently received six cycles of R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisolone) regimen. The patient is doing well without relapse after 60 months of follow-up. Because of its rarity and the lack of specific laboratory, radiological, or clinical finding, liver biopsy is essential for definite diagnosis of PHL. Optimal treatment for PHL is currently uncertain. However, surgical resection followed by adjuvant chemotherapy should be considered for select individuals to achieve better outcome.

Keyword

Liver neoplasms; Lymphoma

MeSH Terms

Aged
Biopsy
Bone Marrow
Chemotherapy, Adjuvant
Cholangiocarcinoma
Colonoscopy
Cyclophosphamide
Diagnosis
Doxorubicin
Drug Therapy*
Electrons
Follow-Up Studies
Humans
Liver Neoplasms
Liver*
Lymphoma*
Lymphoma, B-Cell
Lymphoma, Non-Hodgkin
Male
Pathology
Recurrence
Ultrasonography
Vincristine
Cyclophosphamide
Doxorubicin
Vincristine

Figure

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  Fig. 1 Abdominal computed tomography showing a 6×6 cm-sized, slightly lobulated, contoured, low-density mass in segment 8 with a peripheral rim-like enhancement and mild dilatation of the peripheral intrahepatic duct. Splenomegaly or abdominal lymphadenopathy is not observed.

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  Fig. 2 Magnetic resonance imaging of the liver mass lesion revealing low-signal intensity on T1-weighted image (A) and high-signal intensity lobulating contoured mass on T2-weighted image (B).

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  Fig. 3 F-18 FDG PET scan showing hypermetabolic mass lesion in the liver.

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  Fig. 4 Macroscopic examination of the resected specimen revealing a grayish white well encapsulated mass.

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  Fig. 5 Microscopic findings of the liver confirming non-Hodgkin's diffuse large B-cell lymphoma. (A) Diffuse proliferation of lymphoid cells (H&E, ×400); (B) Negative for hepatocyte marker; (C) Positive for LCA (leukocyte common antigen); (D) positive for CD20; and (E) negative for CD3.

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