Primary Hepatic Lymphoma Is Difficult to Discriminate from a Liver Abscess

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