Background. Reactive lymphoid hyperplasia (RLH) of the liver is a benign focal liver mass that may mimic a malignant liver tumor. Although rarely encountered in clinical practice, it often poses diagnostic and management dilemmas. Methods. Cases diagnosed as hepatic RLH between January 1996 and June 2011 were investigated in a retrospective study. Clinicopathological features as well as follow-up information of the cases were studied. Results. A total of seven cases of hepatic RLH were investigated, with a median age of 46 years (range: 33–76 years). Hepatic RLH was accompanied by concomitant diseases in some patients. The average size of hepatic lesions of our cases was 45？mm (range: 15–105？mm). All of the cases were not accurately diagnosed until confirmed by pathological findings, and surgical resections were performed for all. Postoperative course was uneventful for all of the patients during followup. Conclusions. RLH of the liver is a rare benign disease with a female predilection of unknown etiology. It is very difficult to correctly diagnose this disease without pathological results. Subtle differences on radiological findings of it may be helpful for differential diagnosis from other diseases. Curative resection of the lesion is suggested for the treatment of this disease. 1. Introduction Reactive lymphoid hyperplasia (RLH), also termed as nodular lymphoid lesion [1, 2] or pseudolymphoma [3–8], is a rare benign condition which forms a liver mass typically infiltrated by massive heterogeneous mature lymphoid cells without prominent nuclear atypia, with formation of follicles and germinal centers. Up to now, there have been only scattered case reports about hepatic RLH [1–24]; the paucity of information about its clinicopathological features poses diagnostic and management dilemmas. Manifested as a focal liver mass, hepatic RLH may mimic a malignant liver tumor, often giving rise to misdiagnosis. Therefore, we reviewed our experience in a series of 7 patients with hepatic RLH who were treated by surgical resection. This was the largest series of cases of this disease so far, and a detailed evaluation of its clinical features, radiologic characteristics, and pathologic findings will assist in future diagnosis of this disease. 2. Methods The data of all cases diagnosed as hepatic RLH or pseudolymphoma and treated by surgery in Eastern Hepatobiliary Surgery Hospital, a tertiary university hospital in China, between January 1996 and June 2011 were obtained from the computerized files. Results of imaging studies such as ultrasonography (US),
References
[1]
S. Sharifi, M. Murphy, M. Loda, G. S. Pinkus, and U. Khettry, “Nodular lymphoid lesion of the liver: an immune-mediated disorder mimicking low-grade malignant lymphoma,” American Journal of Surgical Pathology, vol. 23, no. 3, pp. 302–308, 1999.
[2]
K. Willenbrock, S. Kriener, S. Oeschger, and M. L. Hansmann, “Nodular lymphoid lesion of the liver with simultaneous focal nodular hyperplasia and hemangioma: discrimination from primary hepatic MALT-type non-Hodgkin's lymphoma,” Virchows Archiv, vol. 448, no. 2, pp. 223–227, 2006.
[3]
V. Grouls, “Pseudolymphoma (inflammatory pseudotumor) of the liver,” Zentralblatt fur Allgemeine Pathologie und Pathologische Anatomie, vol. 133, no. 6, pp. 565–568, 1987.
[4]
T. Ohtsu, Y. Sasaki, H. Tanizaki et al., “Development of pseudolymphoma of liver following interferon-alpha therapy for chronic hepatitis B,” Internal Medicine, vol. 33, no. 1, pp. 18–22, 1994.
[5]
K. Katayanagi, T. Terada, Y. Nakanuma, and T. Ueno, “A case of pseudolymphoma of the liver,” Pathology International, vol. 44, no. 9, pp. 704–711, 1994.
[6]
S. R. Kim, Y. Hayashi, K. B. Kang et al., “A case of pseudolymphoma of the liver with chronic hepatitis C,” Journal of Hepatology, vol. 26, no. 1, pp. 209–214, 1997.
[7]
H. Okubo, H. Maekawa, K. Ogawa et al., “Pseudolymphoma of the liver associated with Sj？gren's syndrome,” Scandinavian Journal of Rheumatology, vol. 30, no. 2, pp. 117–119, 2001.
[8]
D. C. Snover, A. H. Filipovich, L. P. Dehner, and W. Krivit, “'Pseudolymphoma'. A case associated with primary immunodeficiency disease and polyglandular failure syndrome,” Archives of Pathology and Laboratory Medicine, vol. 105, no. 1, pp. 46–49, 1981.
[9]
H. Isobe, S. Sakamoto, H. Sakai et al., “Reactive lymphoid hyperplasia of the liver,” Journal of Clinical Gastroenterology, vol. 16, no. 3, pp. 240–244, 1993.
[10]
H. Takahashi, H. Sawai, Y. Matsuo et al., “Reactive lymphoid hyperplasia of the liver in a patient with colon cancer: report of two cases,” BMC Gastroenterology, vol. 6, article 25, 2006.
[11]
K. Nagano, Y. Fukuda, I. Nakano et al., “Case report: reactive lymphoid hyperplasia of liver coexisting with chronic thyroiditis: radiographical characteristics of the disorder,” Journal of Gastroenterology and Hepatology, vol. 14, no. 2, pp. 163–167, 1999.
[12]
N. Maehara, K. Chijiiwa, I. Makino et al., “Segmentectomy for reactive lymphoid hyperplasia of the liver: report of a case,” Surgery Today, vol. 36, no. 11, pp. 1019–1023, 2006.
[13]
K. Sato, Y. Ueda, M. Yokoi, K. Hayashi, T. Kosaka, and S. Katsuda, “Reactive lymphoid hyperplasia of the liver in a patient with multiple carcinomas: a case report and brief review,” Journal of Clinical Pathology, vol. 59, no. 9, pp. 990–992, 2006.
[14]
T. Tanizawa, Y. Eishi, R. Kamiyama et al., “Reactive lymphoid hyperplasia of the liver characterized by an angiofollicular pattern mimicking Castleman's disease,” Pathology International, vol. 46, no. 10, pp. 782–786, 1996.
[15]
K. Shiozawa, H. Kinoshita, H. Tsuruta et al., “A case of pseudolymphoma of the liver diagnosed before operation,” Nipponn Syoukakibyou Gakkai Zassi, vol. 101, no. 7, pp. 772–778, 2004.
[16]
H. S. Park, K. Y. Jang, Y. K. Kim, H. C. Baik, and S. M. Woo, “Histiocyte-rich reactive lymphoid hyperplasia of the liver: unusual morphologic features,” Journal of Korean Medical Science, vol. 23, no. 1, pp. 156–160, 2008.
[17]
N. Matsumoto, M. Ogawa, M. Kawabata et al., “Pseudolymphoma of the liver: sonographic findings and review of the literature,” Journal of Clinical Ultrasound, vol. 35, no. 5, pp. 284–288, 2007.
[18]
T. Okada, H. Mibayashi, K. Hasatani et al., “Pseudolymphoma of the liver associated with primary biliary cirrhosis: a case report and review of literature,” World Journal of Gastroenterology, vol. 15, no. 36, pp. 4587–4592, 2009.
[19]
T. Machida, T. Takahashi, T. Itoh, M. Hirayama, T. Morita, and S. Horita, “Reactive lymphoid hyperplasia of the liver: a case report and review of literature,” World Journal of Gastroenterology, vol. 13, no. 40, pp. 5403–5407, 2007.
[20]
H. Ota, N. Isoda, F. Sunada et al., “A case of hepatic pseudolymphoma observed without surgical intervention,” Hepatology Research, vol. 35, no. 4, pp. 296–301, 2006.
[21]
R. Jiménez, A. Beguiristain, I. Ruiz-Montesinos, F. Garnateo, and M. Echenique Elizondo, “Nodular lymphoid hyperplasia of the liver. Pseudolymphoma,” Revista Espa？ola de Enfermedades Digestivas, vol. 99, no. 10, pp. 299–306, 2007.
[22]
E. Lin, “Reactive lymphoid hyperplasia of the liver identified by FDG PET,” Clinical Nuclear Medicine, vol. 33, no. 6, pp. 419–420, 2008.
[23]
K. Yoshikawa, M. Konisi, T. Kinoshita et al., “Reactive lymphoid hyperplasia of the liver: literature review and 3 case reports,” Hepato-Gastroenterology, vol. 58, no. 109, pp. 1349–1353, 2011.
[24]
J. Tuckett, M. Hudson, S. White, and J. Scott, “Reactive lymphoid hyperplasia of the liver: a case report and review of imaging characteristics,” European Journal of Radiology Extra, vol. 79, no. 1, pp. e11–e14, 2011.
[25]
E. Sabattini, K. Bisgaard, S. Ascani et al., “The EnVision++ system: a new immunohistochemical method for diagnostics and research. Critical comparison with the APAAP, ChemMate(TM), CSA, LABC, and SABC techniques,” Journal of Clinical Pathology, vol. 51, no. 7, pp. 506–511, 1998.
[26]
S. L. Abbondanzo and L. H. Sobin, “Gastric “pseudolymphoma”: a retrospective morphologic and immunophenotypic study of 97 cases,” Cancer, vol. 79, no. 9, pp. 1656–1663, 1997.
[27]
D. M. Knowles, F. A. Jakobiec, L. McNally, and J. S. Burke, “Lymphoid hyperplasia and malignant lymphoma occurring in the ocular adnexa (orbit, conjunctiva, and eyelids): a prospective multiparametric analysis of 108 cases during 1977 to 1987,” Human Pathology, vol. 21, no. 9, pp. 959–973, 1990.
[28]
S. L. Abbondanzo, W. Rush, K. E. Bijwaard, and M. N. Koss, “Nodular lymphoid hyperplasia of the lung: a clinicopathologic study of 14 cases,” American Journal of Surgical Pathology, vol. 24, no. 4, pp. 587–597, 2000.
[29]
M. F. Baldassano, E. M. Bailey, J. A. Ferry, N. L. Harris, and L. M. Duncan, “Cutaneous lymphoid hyperplasia and cutaneous marginal zone lymphoma: comparison of morphologic and immunophenotypic features,” American Journal of Surgical Pathology, vol. 23, no. 1, pp. 88–96, 1999.
[30]
Y. Mizukami, N. Ikuta, T. Hashimoto et al., “Pseudolymphoma of the thyroid,” Acta Pathologica Japonica, vol. 38, no. 10, pp. 1329–1336, 1988.
[31]
L. Pantanowitz, P. F. Saldinger, and M. E. Kadin, “Pathologic quiz case: hepatic mass in a patient with renal cell carcinoma,” Archives of Pathology and Laboratory Medicine, vol. 125, no. 4, pp. 577–578, 2001.
[32]
S. I. Sato, T. Masuda, H. Oikawa et al., “Primary hepatic lymphoma associated with primary biliary cirrhosis,” American Journal of Gastroenterology, vol. 94, no. 6, pp. 1669–1673, 1999.
[33]
A. Nonomura, H. Minato, K. Shimizu et al., “Pseudolymphoma (reactive lymphoid hyperplasia) of the liver containing epithelioid cell granulomas and Schaumann's bodies in giant cells: a case report,” International Journal of Surgical Pathology, vol. 6, no. 2, pp. 101–108, 1998.
[34]
R. Jiménez, A. Beguiristain, I. Ruiz-Montesinos et al., “Image of the month: reactive lymphoid hyperplasia,” Archives of Surgery, vol. 143, no. 8, pp. 805–806, 2008.
[35]
Y. Zen, T. Fujii, and Y. Nakanuma, “Hepatic pseudolymphoma: a clinicopathological study of five cases and review of the literature,” Modern Pathology, vol. 23, no. 2, pp. 244–250, 2010.
[36]
C. J. Story, A. A. Morley, D. R. Turner, and R. Seshadri, “Diagnostic use of immunoglobulin and T-cell receptor gene rearrangements in lymphoproliferative disease,” Australian and New Zealand Journal of Medicine, vol. 17, no. 1, pp. 1–8, 1987.
[37]
P. G. Isaacson, P. M. Banks, P. V. Best, S. P. McLure, H. K. Muller-Hermelink, and J. I. Wyatt, “Primary low-grade hepatic B-cell lymphoma of mucosa-associated lymphoid tissue (MALT)-type,” American Journal of Surgical Pathology, vol. 19, no. 5, pp. 571–575, 1995.
[38]
J. P. Bronowicki, C. Bineau, P. Feugier et al., “Primary lymphoma of the liver: clinical-pathological features and relationship with HCV infection in French patients,” Hepatology, vol. 37, no. 4, pp. 781–787, 2003.
[39]
C. M. Kirk, D. Lewin, and J. Lazarchick, “Primary hepatic B-cell lymphoma of mucosa-associated lymphoid tissue,” Archives of Pathology and Laboratory Medicine, vol. 123, no. 8, pp. 716–719, 1999.
[40]
M. Maes, C. Depardieu, J. L. Dargent et al., “Primary low-grade B-cell lymphoma of malt-type occurring in the liver: a study of two cases,” Journal of Hepatology, vol. 27, no. 5, pp. 922–927, 1997.
[41]
R. M. Prabhu, L. J. Medeiros, D. Kumar et al., “Primary hepatic low-grade B-cell lymphoma mucosa-associated lymphoid tissue (MALT) associated with primary biliary cirrhosis,” Modern Pathology, vol. 11, no. 4, pp. 404–410, 1998.
[42]
M. Q. Ye, A. Suriawinata, C. Black, A. D. Min, J. Strauchen, and S. N. Thung, “Primary hepatic marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue type in a patient with primary biliary cirrhosis,” Archives of Pathology and Laboratory Medicine, vol. 124, no. 4, pp. 604–608, 2000.
[43]
E. Zucca, A. Conconi, E. Pedrinis et al., “Nongastric marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue,” Blood, vol. 101, no. 7, pp. 2489–2495, 2003.
[44]
M. N. Koss, L. Hochholzer, and P. W. Nichols, “Primary non-Hodgkin's lymphoma and pseudolymphoma of lung: a study of 161 patients,” Human Pathology, vol. 14, no. 12, pp. 1024–1038, 1983.
[45]
J. J. Brooks and H. T. Enterline, “Gastric pseudolymphoma. Its three subtypes and relation to lymphoma,” Cancer, vol. 51, no. 3, pp. 476–486, 1983.
[46]
E. A. Holland, G. G. Ghahremani, W. A. Fry, and T. A. Victor, “Evolution of pulmonary pseudolymphomas: clinical and radiologic manifestations,” Journal of Thoracic Imaging, vol. 6, no. 4, pp. 74–80, 1991.
[47]
B. F. Kulow, H. Cualing, P. Steele et al., “Progression of cutaneous B-cell pseudolymphoma to cutaneous B-cell lymphoma,” Journal of Cutaneous Medicine and Surgery, vol. 6, no. 6, pp. 519–528, 2002.
