The liver is usually affected in advanced stages of lymphoproliferative diseases, but primary liver lymphomas (PLLs) are rare. The diagnosis is usually late, especially in patients without identifiable risk factors, with consequent worse prognosis. We report the case of a 59-year-old female with progressive worsening pain in the right hypochondrium and weight loss. She was previously healthy and had a family history of gastrointestinal and gynecologic neoplasms. During the initial investigation, three liver nodules suggestive of liver metastases were found. Nevertheless, no primary neoplasm was identified in a subsequent evaluation with imaging and endoscopic exams. Laboratory exams excluded hepatic infections, metabolic diseases, and acquired immunosuppression. Biopsy of the lesions revealed diffuse large B-cell lymphoma. Lymph node and medullar involvement were excluded, and the diagnosis of PLL was assumed. The patient started chemotherapy with R-CHOP. With this case, we intend to alert for this differential diagnosis of liver nodules, even in the absence of predisposing conditions for lymphoma. We point out the need to define universal diagnosis criteria for this pathology.
A 38-year-old woman presented to the emergency department with a history of thoracic pain and anorexia for 1 week. Thoracic CT scan showed bilateral pleural effusion, a thoracentesis was performed revealing a transudate liquid with polymorphonuclears and predominance of eosinophils. After admission, the patient developed abdominal pain and the abdominal CT scan showed densification of the mesenteric fat characteristic of mesenteric panniculitis (MP). The patient went through investigation for secondary causes of panniculitis including infection, neoplasia and autoimmune diseases, and no abnormalities were found. The patient was treated with corticosteroids over a period of 3 months with complete resolution and without any signs of remission or secondary cause of MP. Moreover, the patient remained asymptomatic for 2 years after being discharged, which strengthens the diagnosis of MP that presented with eosinophilic pleural effusion.
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