Hematologic Malignancies of the Liver: Spectrum of Disease

Abstract

The incidence of hematologic malignancies and their extranodal manifestations is continuously increasing. Previously unsuspected hepatic involvement in hematologic malignancies such as Hodgkin disease and non-Hodgkin lymphoma, posttransplant lymphoproliferative disorder, myeloid sarcoma (chloroma), multiple myeloma, Castleman disease, and lymphohistiocytosis may be seen by radiologists. Although the imaging features of more common hepatic diseases such as hepatocellular carcinoma, metastases, and infection may overlap with those of hepatic hematologic malignancies, combining the imaging features with clinical manifestations and laboratory findings can facilitate correct diagnosis. Clinical features that suggest a hematologic neoplasm as the cause of liver lesions include a young patient (<40 years of age), no known history of cancer, abnormal bone marrow biopsy results, fever of unknown origin, and night sweats. Imaging features that suggest hematologic malignancy include hepatosplenomegaly or splenic lesions, vascular encasement by a tumor without occlusion or thrombosis, an infiltrating mass at the hepatic hilum with no biliary obstruction, and widespread adenopathy above and below the diaphragm. Familiarity with the imaging features of hepatic hematologic malignancies permits correct provisional diagnosis and may influence therapeutic management. For example, when biopsy is performed, core biopsy may be needed in addition to fine-needle aspiration so that the tissue architecture of the neoplasm can be discerned. The predominant treatment of hematologic malignancies is chemotherapy or radiation therapy rather than surgery. Online supplemental material is available for this article.

Liver Involvement in Hodgkin's Lymphoma: Types of Injuries and Therapeutic Implications

“…This clinical picture is supported by the following imaging features: polyadenopathies located above and below the diaphragm, hepatosplenomegaly or splenic lesions, an infiltrating tumor at the liver hilum without biliary obstruction, and a vascular encasement by a mass which do not produces thrombosis or occlusion. A core needle biopsy is frequently useful for the diagnosis [7].…”

“…HL can produce liver damage in various ways: hepatitis, liver infiltration, biliary obstruction by lymphomatous compressions, sepsis, vanishing bile duct syndrome [8], hemophagocytic lymphohistiocytosis [9], posttransplant lymphoproliferative disorders [7], liver adverse effect of chemotherapy [8] or peliosis hepatis [10]. After serum ferritin, serum alkaline phosphatase and alanine aminotransferase (ALT) are two parameters that can make the best prediction on treatment response of HL (according to the results of a study which investigated 35 clinical and biological parameters at the time of HL diagnosis, prior any therapy), which stresses the importance of liver damage in this type of lymphoma.…”

“Periportal neoplasms”—a CT perspective: review article

“…It has a wide age of presentation but is commonly seen in children (,15 years) with no gender predilection. 7,8 Leukaemic involvement of the liver is extremely rare and usually occurs secondary to extensive marrow infiltration. Rare case reports in literature describe an entity called primary biliary chloroma, with isolated involvement of the peribiliary space in the absence of bone marrow involvement.…”

“…Owing to the paucity of lymphocytes, primary hepatic lymphoma (PHL) is an extremely rare entity and is diagnosed by the absence of extrahepatic involvement for at least 6 months after the onset of hepatic disease. 8 On imaging, there can be various patterns of involvementdiffusely infiltrating form resulting in hepatomegaly, discrete nodules or masses, combined nodular infiltrating and an extremely rare periportal infiltrating form ( Figure 3). Diffusely infiltrating is the most common pattern in secondary hepatic lymphoma, whereas in the primary form, solitary nodules are more common (Table 4).…”

“…Hence, differentiating amongst these conditions is a holistic approach requiring correlation of the imaging findings with clinical, laboratory profile and histopathological analysis (Table 2). 8,11 "Periportal halo" resulting from dilated obstructed lymphatics can be seen in any morphological form of lymphoma. It differs from periportal lymphoma in being a linear circumferential hypoattenuation along the portal triad as opposed to the latter, which presents as a circumscribed mass in peribiliary distribution.…”