Primary Hepatic Lymphoma Presenting as an Isolated Solitary Hepatic Cyst

Abstract

A 76-year-old Hispanic woman with a past medical history of diabetes, hypertension, hyperlipidemia, and paroxysmal atrial fibrillation presented with chronic right-sided chest and abdominal pain. She had no other symptoms, including fever, weight loss, or anorexia. A physical examination revealed an irregular cardiac rhythm, no lymphadenopathy, and a soft abdomen with mild tenderness to palpation in the right subcostal area with a palpable mass. Laboratory tests revealed a normocytic anemia with hemoglobin level of 10.4 mg/dL and a normal WBC count, liver-function tests, carcinoembryonic antigen, Ca19-9, and ␣-fetoprotein. A computed tomography scan demonstrated a 12-cm exophytic low-density cystic mass with peripheral nodularity in segment six of the liver (Fig 1). Radiographic characteristics were read as consistent with a biliary cystadenoma, biliary cystic adenocarcinoma, or a cystic hepatic carcinoma. Because of her symptoms, the patient underwent operative exploration and intraoperative ultrasound of the mass (Fig 2), which revealed a large complex cystic mass with solid components and mural nodularity concerning for a hepatobiliary malignancy. There was no ascites, extrahepatic masses, or intra-abdominal/retroperitoneal lymphadenopathy. The patient underwent an uncomplicated hepatic resection of the mass including segment VI of the liver. The specimen was cross-sectioned, which confirmed a complex cystic mass within the liver parenchyma and a grossly negative surgical margin (Fig 3). The patient had an uncomplicated postoperative course and complete resolution of her abdominal pain on postoperative follow-up.

Primary hepatic lymphoma presenting as pyogenic liver abscess: A case report

“…Currently, there are no common standard protocols or guidelines for the treatment of PHL. Treatment options include surgery, radiation therapy, chemotherapy, or combinations thereof[ 25 , 26 ]. PHL is generally chemo-sensitive, and the most common chemotherapy regimen used is R-CHOP[ 27 ].…”

“…The prognosis of most PHL cases is complete remission, with a 5-year survival rate approaching 87.1%[ 26 ]. Prognostic factors include age, general condition, lesion size, pathological subtype, elevated LDH, and concurrent underlying diseases such as cirrhosis, chronic active hepatitis, HIV infection, and immunodeficiency[ 28 ].…”

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

“…39 We searched case reports of primary hepatic diffuse large B cell lymphoma on "PubMed" from 2006 to 2015 (Table 3). 4,9,10,[13][14][15][16][17][18]22,24,26,[40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56] Among a total of 29 case reports (20 with bone marrow information), no hemophagocytosis has ever been reported. The differences with regard to survival, clinical, and pathologic characteristics between T-/NK-celland B-cell-associated HPS remain unclear.…”

Primary hepatopancreatobiliary lymphoma: Pathogenesis, diagnosis, and management

“…However, different immunophenotypes have their own characteristics, which are essential for the classification of PHL. In DLCBL, they are often positive for CD45, PAX5, and BCL-2 with a high Ki-67 index ( Figure 2I ) ( 30 , 75 , 76 ). Patients with DLBCL are always subclassified into the germinal center B-cell (GCB) group, expressing CD10 and/or BCL-6 without MUM-1, and the non-GCB group, expressing MUM-1 without CD10 and BCL-6 ( Figures 2J–L ) ( 37 , 64 ).…”