Primary hepatic lymphoma with spindle cell components: a case report

Abstract

Diffuse large B-cell lymphoma (DLBCL) with spindle cell components is extremely rare and often misdiagnosed as carcinoma or sarcoma. Here, we present a case of primary DLBCL with spindle cell components arising in the liver, for which a preoperative diagnosis by needle biopsies was unsuccessful. The patient was a 70-year-old man with a continuous cough. Thoracic computed tomography incidentally detected a mass of 5 cm in diameter in his liver. The initial and second needle biopsies from the liver mass were pathologically diagnosed as suspicious for sarcomatoid hepatocellular carcinoma. He underwent an extended left hepatectomy. Histological examination revealed a diffuse or epithelioid arrangement of round and polygonal cells, mixed with the fascicles of spindle-shaped cells. Immunohistochemically, all the morphological types of tumor cells showed positive reactions for a lymphocytic marker (CD45RB) and B-cell markers (CD20 and CD79a). Double-immunostaining revealed that the spindle-shaped tumor cells expressed CD20, but never expressed alpha-smooth muscle actin. Malignant lymphoma with a spindle cell morphology is quite uncommon, and this variant can be a diagnostic pitfall, especially in tiny biopsy specimens. We emphasize that pathologists should be reminded of lymphoma as a differential diagnosis of spindle cell tumors.

A spindle cell variant of diffuse large B‐cell lymphoma is characterized by T‐cell/myofibrohistio‐rich stromal alterations: analysis of 10 cases and a review of the literature

“…Spindle cell features strongly suggest the evidence for non‐hematological diseases, but have been reported to be associated with a small minority of anaplastic large cell lymphoma and B‐cell lymphomas . Also, it is true that spindle‐like lymphoma cells with twisted, blunt‐ended nuclei can occasionally be seen when soft tissues are involved .…”

“…After that, the spindle cell variant of DLBCL (Sp‐DLBCL) was implicated as a morphologic variant that carries a risk of being misdiagnosed as carcinoma or sarcoma. As shown in Table , to date, the number of cases of Sp‐DLBCL reported in the literature exceeds twenty . Most of them presented as extranodal lesions (11 cases, skin; 3 cases, maxilla; 3 cases, soft tissue; 2 cases, vagina; 1 case, nasal mucosa; 1 case, uterine cervix; and 1 case, liver), with nodal lesions presenting in only three cases.…”

Linfoma hepático primario: Evolución favorable con quimioterapia combinada con rituximab

“…Para que un linfoma pueda ser considerado como primitivamente hepático (LHP), en el momento del diagnóstico los síntomas han de obedecer a la afectación de ese parénquima y no haber sido demostrada la afectación de bazo, ganglios linfáticos, sangre periférica, médula ósea u otros tejidos hasta al menos seis meses después. Según esos estrictos criterios de Caccamo (4), Lei identificó 90 casos entre 1981 y 1993 (5), Noronha describió 251 publicados entre 1981 y 2003, y nosotros hemos hallado otros 17 posteriores a 2003, en su gran mayoría no hodgkinianos (LNH) (6)(7)(8)(9)(10)(11)(12).…”

“…Actividad de protrombina 97% (70-120); tiempo de cefalina 27 segundos (25-34 s); fibrinógeno 506 mg/dl (200-400). Glucemia 103 mg/dl (70-105); creatinina 0,79 mg/dl (0,7-1,10); GOT 115 U/l ; GPT 126 U/l ; LDH 860 U/l (90-230); GGT 111 U/l (3-52); bilirrubina 0,98 (0,2-1,0) mg/dl; fosfatasa alcalina 393 U/l (98-295); proteínas totales 6,2 g/dl (6,(3)(4)(5)(6)(7)(8)0), con 3,46 g/dl de albúmina (3,2-5,5) y espectro electroforético normal; calcio 9,6 mg/dl (8,(4)(5)(6)(7)(8)(9)(10)2); fósforo 3,4 mg/dl (2,(3)(4)6); ácido úrico 5 mg/dl (2,2-7,0); colesterol 159 mg/dl (150-200); triglicéridos 65 mg/dl (50-170); sodio 141 mEq/l (136-145); potasio 4,3 mEq/l (3,2); sideremia 45 µg/dl (60-120); ferritina 282 ng/ml (30-400), transferrina 185 ng/dl (200-360). Marcadores tumorales: antígeno CA 15,3: 12 UI/ml (normal < 30), CA 54,9: 3 UI/ml (< 12), CA 125: 5 UI/ml (< 35), CA 19,9: 8 U/ml (< 37), antígeno carcinoembrionario: 3 U/ml (< 5) y tripsina: 180 ng/ml (140-400); β 2 microglobulina: 4,2 mg/l (1,2-2,8 mg/l).…”

Primary Cutaneous Spindle Cell B-Cell Lymphoma of Follicle Origin Mimicking Acne Rosacea

“…3 Rare cases involving extracutaneous organs including the vagina, uterus, and liver have also been reported. [4][5][6] Here, we report a rare case of spindle cell B-cell lymphoma mimicking lesions of acne rosacea in the cheek of a patient.…”