Primary Hodgkin’s lymphoma of liver in HIV—a case report and review of literature

Abstract

Primary hepatic lymphoma (PHL) is a lymphoma presenting with predominant liver involvement at presentation in the early stage of lymphoma. It accounts to less than 0.4% of all extranodal lymphomas and usually occurs in immunocompromised states. It is more commonly of the non-Hodgkin's lymphoma of B cell variety. Hodgkin's lymphoma presenting as PHL has not been reported before. We report a 55-year-old HIV positive male presenting with an SOL in left lateral segments of liver having typical imaging characteristics of fibrolamellar HCC with normal serum AFP levels. Surgical resection was done and the histopathological analysis and immunohistochemistry of the specimen revealed it to be a Hodgkin's lymphoma. The patient was started on chemotherapy (ABVD regimen) along with highly active antiretroviral therapy (HAART). Primary lymphoma of liver can mimic HCC on imaging. Hence, in the background of an immunocompromised state like HIV with normal serum AFP levels, PHL should be suspected and liver biopsy can clinch the diagnosis.

Hodgkin Lymphoma in People Living with HIV

“…Among PLWH, cHL often presents with unfavorable features at diagnosis, such as poorer performance status, advanced-stage, extranodal disease, and bone marrow involvement [9,14,19]. The presence of B symptoms is also more frequent than in the general population [14] and exclusive extranodal presentation has been reported in some sites such as bone marrow and liver [70,71]. In the cART era the median CD4 count at HL diagnosis is between 120 and 385 × 10 9 /L [6,9,14] (Table 1).…”

Hodgkin Lymphoma in People Living With HIV

“…Among PLWH, cHL often presents with unfavorable features at diagnosis, such as poorer performance status, advanced-stage, extranodal disease, and bone marrow involvement [9,14,19]. The presence of B symptoms is also more frequent than in the general population [14] and exclusive extranodal presentation has been reported in some sites such as bone marrow and liver [71,72]. In the cART era the median CD4 count at HL diagnosis is between 120 and 385 x 10 9 /L [6,9,14] (Table 1).…”