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Primary lymphoma of the liver - A complex diagnosis  [cached]
Ernst JA Steller,Maarten S van Leeuwen,Richard van Hillegersberg,Marguerite EI Schipper
World Journal of Radiology , 2012, DOI: 10.4329/wjr.v4.i2.53
Abstract: A 59-year-old woman presented with the clinical symptoms and radiologic investigations of a liver lesion suspect of metastasis. However, postoperative histopathology revealed a primary hepatic lymphoma (PHL). The case of a patient with a solitary PHL, which was treated by resection and subsequent chemotherapy, will be discussed with a short overview of the literature.
Primary Liver Lymphoma: A Case Report and Literature Review  [PDF]
Bourhafour Mouna, Allam Wafae, M’rabti Hind, Errihani Hassan
Journal of Cancer Therapy (JCT) , 2011, DOI: 10.4236/jct.2011.25098
Abstract: Primary non-Hodgkin lymphoma of liver is a very rare malignancy. The disease is poorly understood and few clinical studies have been conducted to help elucidate the natural course of disease, pathogenesis, optimal therapy, response to therapy, and survival. Here, we present an interesting case of primary non-Hodgkin lymphoma (NHL) originating in liver. A literature review of clinical features, diagnosis, and management is also provided.
Primary Hepatic Lymphoma Is Difficult to Discriminate from a Liver Abscess  [PDF]
Nobuhiro Takeuchi,Kazuyoshi Naba
Case Reports in Gastrointestinal Medicine , 2014, DOI: 10.1155/2014/925307
Abstract: An 82-year-old woman presented with a high-grade fever of 40°C and was admitted to our institution for intensive examination and treatment. Noncontrast abdominal computed tomography (CT) revealed low-density masses at segments 5 and 8, suggestive of a liver abscess. On further examination, a contrast-enhanced abdominal CT showed a ?mm mass with an enhanced margin at segment 8 in the arterial phase; the contrast agents were washed out in the venous phase. In addition, a ?mm mass with a density lower than that of liver parenchyma was observed at segment 8 in the portal phase. On the basis of these findings, either a liver abscess or hepatocellular carcinoma was suspected. To confirm the diagnosis, a fine needle biopsy was scheduled. Histopathological analysis of the biopsied specimens confirmed the diagnosis of diffuse large B-cell lymphoma. Chemotherapy was not indicated owing to the patient’s age and poor performance status; thus, best supportive care was planned. On day 22 after admission, the patient died of pneumonia. We experienced a case of PHL that was difficult to discriminate from a liver abscess. Imaging alone is insufficient to diagnose PHL; therefore, fine needle biopsy is recommended for a definitive diagnosis. 1. Introduction Primary hepatic lymphoma (PHL) is a rare entity comprising only 0.48% of all malignant lymphoma. PHL is sometimes difficult to diagnose accurately as there are no specific imaging characteristics associated with this disease and confirmation requires a fine needle biopsy. Here we present a case of PHL that was difficult to discriminate from a liver abscess; fine needle biopsy facilitated diagnosis confirmation. 2. Case Presentation An 82-year-old woman presented with a high-grade fever of 40°C and was admitted to our institution for intensive examination and treatment. The patient’s medical history included type 2 diabetes mellitus diagnosed at 52 years, and oral hypoglycaemic agents were administered thereafter. She had no history of alcohol consumption or smoking. On admission, her consciousness level was alert; height, 145.6?cm; weight, 49.7?kg; body mass index, 23.4?kg/m2; blood pressure, 120/67?mmHg; heart rate, 81/min; respiratory rate, 14/min; body temperature, 38.0°C; saturated oxygen in arterial blood, 96% (room air). Mild anaemia was evident in her palpebral conjunctiva. Chest auscultation revealed no abnormal findings. The abdomen was soft and flat, with normal bowel sounds; slight tenderness was observed over the upper abdomen. Leg oedema was not evident. Chest radiography revealed a cardiothoracic ratio of
Celiac Disease, Enteropathy-Associated T-Cell Lymphoma, and Primary Sclerosing Cholangitis in One Patient: A Very Rare Association and Review of the Literature  [PDF]
N. Majid,Z. Bernoussi,H. Mrabti,H. Errihani
Case Reports in Oncological Medicine , 2013, DOI: 10.1155/2013/838941
Abstract: Enteropathy-associated T-cell lymphoma (EATL) is a very rare peripheral T-cell lymphoma which is mostly associated with celiac disease. However, the association of primary sclerosing cholangitis and enteropathy-associated T-cell lymphoma is uncommon. Herein we report and discuss the first case of patient who presented simultaneously with these two rare diseases. It is a 54-year-old man who stopped gluten-free diet after 15 years history of celiac disease. The diagnosis was based on the histological examination of duodenal biopsy and the diagnosis of primary sclerosing cholangitis was made on liver biopsy, as well as the magnetic resonance cholangiogram. The treatment of EATL is mainly based on chemotherapy in addition to the optimal management of complications and adverse events that impact on the response to treatment and clinical outcomes, although the prognosis remains remarkably very poor. 1. Introduction Celiac disease is a common systemic disorder. It is associated with autoimmune disorders and increased risk of malignancy including an increased risk of non-Hodgkin’s lymphoma especially of the T-cell type [1]. Enteropathy-associated T-cell lymphoma (EATL) is a rare form of aggressive-cell lymphoma which accounts for fewer than 5% of all gastrointestinal tract lymphomas [2]. It is classified into two groups based on morphology, immunohistochemistry, and genetic profile: type I is more common in frequency and highly associated with celiac disease compared with type II [3]. Concerning primary sclerosing cholangitis (PSC) it is defined as a chronic cholestatic liver disease of unknown aetiology characterised by inflammation and fibrosis of the biliary tree [4]. The relationship between PSC and celiac disease remains unknown, although an immunologic connection is suspected. The outcome is very poor with an overall survival rate of 15–20% in 2 years [5]. Thus, the objective of this paper is to remind clinicians about the importance of adherence to a gluten-free diet that decreases the risk of developing enteropathy-type T-cell lymphoma with its associated autoimmune diseases and poor prognosis. 2. Case Presentation Herein we describe a case of a 54-year-old man who stopped gluten-free diet for more than 8 years after a 15-year history of celiac disease (antiendomyseal and antitransglutaminase antibody tests were positive). The patient was admitted to the hospital for evaluation of vomiting and weight loss; the history was negative for fever or night sweats. Clinical examination revealed pallor of the skin, splenomegaly +1?cm without ascites or
Magnetic resonance imaging findings in primary lymphoma of the liver: a case report  [cached]
Bilaj Fatmir,Berdica Leart,Dhima Arben,Vreto Gjergji
Journal of Medical Case Reports , 2012, DOI: 10.1186/1752-1947-6-282
Abstract: Introduction Primary lymphoma of the liver is an extremely rare finding, with the few such cases reported in the literature to date describing indeterminate imaging findings, being focused more on computed tomography. To the best of our knowledge, there is no prior report describing magnetic resonance imaging scan findings with such a lesion. In the case reported here, magnetic resonance imaging gave us the opportunity to ascertain the correct diagnosis, confirmed by histopathology, thus avoiding unnecessary surgery or other treatments. Although this condition is rare, knowledge of magnetic resonance imaging findings will be invaluable for radiologists and other medical subspecialties that may face such cases in the future in helping to provide adequate management for affected patients. Case presentation A focal lesion was incidentally detected by ultrasound in a 75-year-old asymptomatic Albanian man being treated for benign hypertrophy of prostate. Chest and abdomen computed tomography scans did not reveal any abnormal findings besides a solid focal lesion on the right lobe of the liver and a mild homogenous enlargement of the prostate gland. Subsequently, magnetic resonance imaging of the upper abdomen was performed for better characterization of this lesion. Our patient was free of symptoms and his laboratory test results were normal. Conclusions The magnetic resonance imaging scan results showed some distinctive features that helped us to make the correct diagnosis, and were thus very important in helping us provide the correct treatment for our patient.
An operative case of hepatic pseudolymphoma difficult to differentiate from primary hepatic marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue
Michihiro Hayashi, Noboru Yonetani, Fumitoshi Hirokawa, Mitsuhiro Asakuma, Katsuhiko Miyaji, Atsushi Takeshita, Kazuhiro Yamamoto, Hironori Haga, Takayuki Takubo, Nobuhiko Tanigawa
World Journal of Surgical Oncology , 2011, DOI: 10.1186/1477-7819-9-3
Abstract: A primary hepatic lymphoma (PHL) is defined as lymphoma localized and limited in the liver [1], not the secondary involvement of high- or intermediate grade non-Hodgkin's lymphoma, and accounts for less than 1% of all extranodal lymphomas [2]. Among them, a primary hepatic low-grade marginal zone B cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) is extremely rare.On the other hand, hepatic pseudolymphoma (HPL), also termed as reactive lymphoid hyperplasia, or nodular lymphoid lesion, is extremely rare disease and characterized by the proliferation of non-neoplastic, polyclonal lymphocytes forming follicles with an active germinal center [3], and most importantly, is mimicking clinicopathologically to low grade lymphoma including MALT lymphoma.The etiology, pathogenesis and clinical implications of these two diseases remain unknown to a large extent. Reported underlying liver diseases include chronic viral hepatitis, autoimmune liver diseases, etc [4].Since clinical diagnosis is often difficult especially at its earlier stage, surgical resection appears a mainstay for diagnostic/therapeutic purpose.We herein present a laparoscopically operated case of hepatic pseudolymphoma which was difficult to differentially diagnose from primary hepatic MALT lymphoma, and discuss the clinicopathological features and clinical implications of these two disease entity.In April 2009, a 56-year-old Japanese woman was pointed out to have a space occupying lesion in the lateral segment of the liver on abdominal ultrasonography during health examination. Her social and family history was noncontributory and she had a previous medical history of appendectomy for acute appendicitis and laparoscopic cholecystectomy for cholecystolithiasis. She showed no abnormal physical findings, including lymphadenopathy and hepatosplenomegaly.Laboratory findings of blood examination were almost normal, including blood cell counts and differentiation, serochemical tests including liver
Primary lymphoma of the liver treated by extended hepatectomy and chemotherapy: a case report
Chaib, Eleazar;Leite, Katia Ramos Moreira;Saad, Willian Abr?o;Gama-Rodrigues, Joaquim;
Revista do Hospital das Clínicas , 2002, DOI: 10.1590/S0041-87812002000500006
Abstract: primary lymphoma of the liver is an extremely rare entity. a case of anaplastic large b-cell (both cd-20 and lambda positive) non-hodgkin's lymphoma that was confined to the liver in a 33-year-old man is reported. the patient was treated with an extended right hepatectomy and combination chemotherapy: cyclophosphamide, adriamycin, vincristine, and prednisone. the patient was disease free 24 months after the procedure.
Primary lymphoma of the liver treated by extended hepatectomy and chemotherapy: a case report  [cached]
Chaib Eleazar,Leite Katia Ramos Moreira,Saad Willian Abr?o,Gama-Rodrigues Joaquim
Revista do Hospital das Clínicas , 2002,
Abstract: Primary lymphoma of the liver is an extremely rare entity. A case of anaplastic large B-cell (both CD-20 and lambda positive) non-Hodgkin's lymphoma that was confined to the liver in a 33-year-old man is reported. The patient was treated with an extended right hepatectomy and combination chemotherapy: cyclophosphamide, adriamycin, vincristine, and prednisone. The patient was disease free 24 months after the procedure.
Primary hepatic lymphoma presenting as fulminant hepatic failure with hyperferritinemia: A case report
Fyeza S Haider, Robert Smith, Sharif Khan
Journal of Medical Case Reports , 2008, DOI: 10.1186/1752-1947-2-279
Abstract: We present the case of a middle-aged woman exhibiting pancytopenia, hyperferritinemia and rapidly deteriorating to develop acute hepatic failure. Her initial clinical picture led to a working diagnosis of adult onset Still's disease with probable hemophagocytic syndrome before her worsening liver function necessitated a percutaneous liver biopsy and establishment of the final diagnosis of primary hepatic lymphoma.Primary hepatic lymphoma is an uncommon malignancy and its manifestation as progressive hepatitis or acute fulminant hepatic failure can be difficult to diagnose. The presence of constitutional symptoms, pancytopenia and high ferritin levels can complicate the evaluation process. A liver biopsy early in the course of liver dysfunction may establish the diagnosis without a higher risk of bleeding complications seen once liver failure sets in.Primary Hepatic Lymphoma (PHL) is a rare variant of non-Hodgkin's lymphoma with an incidence of < 1%. The presence of diffuse hepatic involvement is uncommon and therefore presentation as hepatocellular jaundice or acute fulminant hepatic failure is rare.We present a case where persistent fever, non-specific symptoms, pancytopenia and strikingly high levels of serum ferritin preceded the presentation of acute liver failure. Due to these findings, alternative diagnoses were entertained including hemophagocytic syndrome in association with adult onset Still's disease (AOSD).A 53-year-old Caucasian woman was transferred to our facility for 3 weeks of intermittent fevers, chills, weight loss, myalgias and arthralgias. She had mild epigastric discomfort with nausea and vomiting. Dalteparin and warfarin were started for a recently diagnosed pulmonary embolism. Her past history was remarkable for diabetes mellitus type 2, hypertension and villous adenoma of the colon. Subsequent colonoscopies were normal. Except for mild epigastric tenderness, her physical examination findings were normal. White blood cell (WBC) count was 4.5 K
Concurrent Liver Hodgkin Lymphoma and Nodular Regenerative Hyperplasia on an Explanted Liver with Clinical Diagnosis of Alcoholic Cirrhosis at University Hospital Fundación Santa Fe de Bogotá  [PDF]
R. López,L. Barrera,A. Vera,R. Andrade
Case Reports in Pathology , 2014, DOI: 10.1155/2014/193802
Abstract: Liver involvement by Hodgkin lymphoma (HL) is well documented. However, secondary liver failure to this neoplastic process is rare and usually presents late in the course of the disease. We present a case of a HL associated with nodular regenerative hyperplasia (NRH) diagnosed on an explanted liver from a 53-year-old patient with clinical diagnosis of alcoholic cirrhosis. Hematoxylin and eosin stain (H&E) showed abnormal liver architecture with hepatocytes nodules highlighted by reticulin stain with absent fibrosis on the trichrome stain. The portal spaces had diffuse infiltration by Reed-Sternberg cells positive for CD15, CD30, and latent membrane protein (LMP) on immunohistochemical studies. The patient also had a concurrent hilar lymph node biopsy that also showed HL involvement. Liver failure as the initial presentation of Hodgkin’ lymphoma is rare. We believe that more research about the utility of performing liver biopsies in patients candidates for transplantation with noncirrhotic hepatic failure is needed in order to establish the etiology and the optimal treatment. 1. Introduction Liver involvement by Hodgkin’s lymphoma (HL) is well documented [1] and secondary liver failure usually presents late in the course of the disease; however, there are some HL cases that present as a primary acute liver failure [2]. It is believed that hepatic failure by HL is due to bile duct destruction and direct tissue infiltration by the neoplastic cells [1, 2]. 2. Case Report The clinical history is that of a 53-year-old man who presented to our hospital with hepatic encephalopathy; his clinical history was positive for 18 years of alcohol abuse. He referred; recurrent ascites and six episodes of upper gastrointestinal bleeding from portal origin. Laboratory tests showed aspartate aminotransferase (AST) 35?U/L (5–34?U/L), alanine transaminase (ALT) 31?U/L (<55?U/L), alkaline phosphatase 215?U/L (woman >15 years old: 40–150), gamma-glutamyltransferase (GGTP) 368?U/L (Adult woman: 9–36), serum bilirubin 1.6?mg/dL (Total 0,2–1?mg/dL), direct bilirubin 0.76?mg/dL (0.10–0.5?mg/dL), indirect bilirubin 0.85?mg/dL, albumin 3.5?g/dL (3.4–5.4?g/dL), platelets 147?(10)3/mm3 (150–450?(10)3/mm3), creatinine 0.71?mg/dL (0.7–1.3?mg/dL), prothrombin time (PT) 14,4?sec (Control 11.1), partial thromboplastin time (PTT) 33.2?sec (Control 28,1), and INR 1.29. The patient was on propranolol 40?mgr once a day, gabapentin 600?mgr three times a day, and omeprazole 20?mgr once a day. Abdominal computed tomography (CT) showed diffuse hypervascular lesions on the liver parenchyma, portal
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