Primary hepatic lymphoma: A case report

Abstract

INTRODUCTIONPrimary hepatic lymphoma is a rare malignancy which misdiagnosis and mistreatment is very frequent. Differential diagnosis of the hepatic lesion, based on the noninvolvement of blood vessels, includes: fatty infiltration, cirrhosis, amyloid infiltration, primary hepatomas, and metastatic neoplasms.PRESENTATION OF CASEWe describe a case of a 69-year-old man who presented with 15% weight loss and general fatigue over the previous 9 months. Physical examination revealed hepatomegaly without lymphadenopathy or splenomegaly. Magnetic resonance imaging showed a 13 cm × 9 cm × 11 cm tumor on the right liver associated with normal levels of alpha-fetoprotein (AFP) and carcinoembryonic antigen (CEA). After two negatives ultrasonography-guided needle liver biopsies, the third one showed diffuse infiltration of large sized lymphoid cells. Immunohistochemical findings demonstrated the B-lymphocyte lineage of the tumor. The patient received R-CHOP therapy (cyclophosphamide, doxorubicin, vincristine, prednisone, and rituximab) with good response.DISCUSSIONIt is important to recognize PHL because it responds favorably to chemotherapy and may have a better prognosis than hepatocellular carcinoma or metastatic disease of the liver. When imaging findings on CT scans and MRI are nonspecific, a biopsy is needed not only for a definitive diagnosis but also for identifying the immunophenotype of the PHL. This type of lesion is highly chemosensitive and early aggressive chemotherapy may result in sustained remission.CONCLUSIONThis case emphasizes the importance of effective recognition of PHL considering its good response to chemotherapy and the possibility of sustained remission if early aggressive treatment is implemented.

Currently neglected, physical examination maintains its clinical relevance

“…lymphoma, metastatic or less commonly primary, with which both US findings (hypoechogenic liver lesions) and clinical signs/symptoms of our patient (i.e. night sweats, weight loss, enlarged lymph nodes) were consistent [2]. 2. metastases from the overt/occult primary site, with which the US findings and the patient's weight loss were possibly plausible.…”

Primary hepatic lymphoma: is it a disease entity?

“…Since then, cases and case series have been accumulated reporting the characteristics of primary hepatic lymphoma and stating that this disease is extremely rare with the absence of lymphoproliferative disease outside the liver. [20,21] Some authors defined primary hepatic lymphoma as a very rare malignant tumor with the features of liver involvement and without involvement of other organs and tissues including bone marrow, lymph nodes, the spleen and peripheral blood until at least 6 months after diagnosis. [14,22] However, Caccamo's criteria which many authors have cited for the diagnosis of primary hepatic lymphoma were proposed in 1986 and based on the data of a single patient who was complicated with liver cirrhosis, Kaposi's sarcoma, and involvement of gastric mucosa and abdominal lymph nodes.…”

An unusual case of primary hepatic lymphoma with dramatic but unsustained response to bendamustine plus rituximab and literature review

“…Other clinical complaints are also non-specific, including nausea with vomiting, early satiety, weight loss, fatigue, difficulty in ambulation, limb weakness, and jaundice, often of short duration. 4,[13][14][15][16][17] Our case had an unusual presentation with bilateral lower limb weakness and low-grade fever. Physical examination may disclose hepatomegaly, palpable liver, and leg edema.…”