Primary hepatic lymphoma

Abstract

BACKGROUND Primary hepatic non‐Hodgkin lymphoma (PHL) is a rare and difficult to diagnose lymphoproliferative disorder of unknown etiology. It is believed that the prognosis in affected patients is dismal, consisting of early recurrence and short survival. METHODS A retrospective cohort review of patients with PHL diagnosed between 1974 and 1995 at a university cancer center was performed. RESULTS Twenty‐four patients with PHL were identified. Typically, the disease occurred in middle‐aged men (median age, 50 years). The primary presenting complaint was right upper quadrant abdominal pain, with hepatomegaly found at physical examination. Serum liver enzymes, lactate dehydrogenase, and β‐2‐microglobulin levels all were elevated, but α‐fetoprotein and carcinoembryonic antigen levels were within normal range. Hypercalcemia was found in 6 of 15 patients who were tested. Six of 10 patients who were tested were positive for the hepatitis C virus (HCV). Liver scans demonstrated either a solitary lesion or multiple lesions. Pathologic examination revealed diffuse large cell lymphoma in 23 patients (96%). Combination chemotherapy was the mainstay of treatment; surgery consisted of diagnostic biopsy. The complete remission rate was 83.3%, and the 5‐year cause specific and failure free survival rates were 87.1% and 70.1%, respectively. HCV infection did not appear to influence the outcome of therapy. CONCLUSIONS The outcome of patients with PHL who are treated with combination chemotherapy may be more favorable than that reported elsewhere. The frequent association of PHL with HCV infection observed in this series warrants further investigation. Cancer 2001;92:2023–9. © 2001 American Cancer Society.

Primary Hepatic Lymphoma: A Complex and Challenging Diagnosis

“…PHL typically occurs in middle-aged men (median age, 50 to 55 years) 9,10 , with the most common presentation being pain in the right upper quadrant, fever, weight loss, and night sweats as were present in our patient. [9][10][11][12] Prodromal symptoms may accompany these symptoms.…”

“…[9][10][11][12] Prodromal symptoms may accompany these symptoms. 9,11 A physical examination commonly reveals hepatomegaly (in approximately 80% of cases) and, less frequently, jaundice, splenomegaly, ascites, or pleural effusions.…”

“…Adjuvant chemotherapy after complete surgical resection results in complete remission of disease. 10 Poor prognostic features include advanced age, constitutional symptoms, bulky disease, unfavorable histologic subtype, elevated levels of LDH and β2-microglobulin, a high proliferation rate, cirrhosis, and comorbid conditions. 21 The appreciation of prognostic factors in our patient through the assessment of these prognostic features enabled us to predict a moderately good prognosis.…”

Primary non-Hodgkin’s lymphoma of liver

“…The current indications that necessitate a surgery are cases of patients with a localized disease www.ijhpd.com Kostov et al 50 that can undergo radical liver resection or if there is presence of a persistent respectable disease followed by chemotherapy [5]. Chemotherapy with CHOP-R based regimens is the gold standard [6].…”

Primary hepatic lymphoma with spindle cell components: a case report

“…d Lymphoma cells are positive for CD20 (brown), but negative for SMA (dark blue), as evaluated by double-immunostaining for SMA and CD20 chemical examinations [2]. The majority of PHL cases is DLBCL [2,15,20]. Other histologies have been described in less than 5% of cases [15,18,20] and include diffuse lymphoma of the mucosa-associated lymphoid tissue (MALT) type [2,17], mixed small and large cell, lymphoblastic, diffuse immunoblastic, diffuse histiocytic, mantle cell, and small noncleaved or Burkitt lymphoma.…”