Primary hepatic lymphoma: A rare disease

Abstract

like HCC is a very rare form, which have been described only twice before in literature. We present the case of a 72 years-old man, otherwise in good health, known for a nonactive HCV infection. On routine follow-up, two hepatic lesions were found, in segment 8 (S8) and segment 2 (S2). A 4 cm lymph node was found in the coeliac region, retrospectively present since 3 years on previous imaging. Biopsy of the S8 lesion showed a classical trabecular HCC; while in the coeliac lymph node showed carcinoma cells. PET scan showed an important captation of lymph node and S2 lesion, while no captation was found in the S8 lesion. Considering the patient's good health, the presence of two different lesions, a possible low morbidity approach, a non-completely evidence-based minimally invasive treatment was decided, with chemoembolization of the S8 HCC lesion while the S2 lesion was resected laparoscopically with left lobectomy and complete lymphadenectomy of the hepatic pedicle and coeliac trunk. Final pathologic analysis revealed a medullary-like HCC pT1, pN1. A B-cell lymphoma of the marginal zone was found in hepatic pedicle and coeliac trunk nodes. In this patient we found three different tumours, of which one was a medullary-like HCC. This is the third case described in literature to our knowledge. Because of its unknown biological behaviour, a surgical approach seems reasonably justified in this particular case.