Pseudolymphoma of the liver: Report of a case and review of the literature

Abstract

We report a case of pseudolymphoma of the liver in a 49-year-old woman without an underlying disease except for liver hemangioma. A 20-mm nodule was incidentally found in segment 2 of the liver by abdominal ultrasonography during a regular follow-up of the hepatic hemangioma. After a series of radiological examinations, a left lateral sectionectomy was performed because malignant hepatic tumor could not be excluded. The patient was discharged uneventfully 7 days after the operation. The pathology examination revealed a pseudolymphoma. No recurrence of the tumor was found 5½ years after the operation. To the best of our knowledge, only 46 cases of pseudolymphoma of the liver have been reported to date. A review of the literature showed that pseudolymphomas occur predominantly in females (89.4%), usually occur as a single tumor (80.4%), are no more than 20 mm in size (90.6%), and are frequently associated with either autoimmune disease or chronic liver disease. Because an accurate diagnosis is difficult to establish, vigilant follow-up is indicated, and surgical intervention is the choice of treatment once the suspiciousness of malignancy has been raised.

Hepatic Pseudolymphoma with an Occult Hepatitis B Virus Infection

“…Although the etiopathogenesis of pseudolymphoma is unknown, it can develop due to mechanical stimulation in patients with extrahepatic autoimmune disease, such as Sjogren syndrome, Hashimoto thyroiditis, Takayasu arteritis, and antiphospholipid syndrome, or chronic liver disease such as primary biliary cirrhosis, viral hepatitis, and nonalcoholic steatohepatitis. Pseudolymphomas have been reported to develop after interferon treatment for chronic hepatitis that supports the inflammatory nature of the lesion ( 2 ). Although the etiopathogenesis of hepatic pseudolymphoma remains unclear, 27% of the patients had chronic liver diseases including HBV- or HCV-related liver cirrhosis, and 23% had autoimmune disorders in the liver, such as primary biliary cholangitis (PBC), or in extrahepatic organs ( 5 ).…”

“…Pseudolymphoma is also called reactive lymphoid hyperplasia (RLH) or a nodular lymphoid lesion. It was first described in the lung as a lymphocytic tumor associated with inflammation and with no evidence of systemic dissemination in 1963 ( 2 ). Pseudolymphoma can occur in various locations, including the skin, orbit, thyroid, breast, lung, and gastrointestinal tract; but it rarely occurs in the liver.…”

“…There have been 4 reports of pseudolymphoma in association with HBV infection ( 2 ). Our case had an occult HBV infection, and uninvolved liver tissue in the resected specimen showed mild fibrosis and mild lymphocytic infiltration on histopathology.…”

Contrast‐Enhanced Ultrasound Features of Hepatic Reactive Lymphoid Hyperplasia: Correlation With Histopathologic Findings

“…This kind of manifestation on contrast‐enhanced MRI was consistent with that on CEUS imaging in this study. However, some reports mentioned that HRLH showed peripheral rim enhancement in the arterial phase and subsequent wash‐out in the portal phase on contrast‐enhanced computed tomography and MRI without referring to entirely homogeneous hyperenhancement in the early arterial phase. These imaging features may cause a misdiagnosis of liver metastasis or cholangiocarcinoma according to previously published guidelines .…”

“…Histopathologically, it is characterized by a marked proliferation of non‐neoplastic polyclonal lymphocytes without atypia and mitosis, in which lymphoid follicles of various sizes and shapes with germinal centers can be detected . Until now, no more than 100 cases have been reported in the English literature . Follow‐up or a conservative strategy should be undertaken instead of surgery if a definite diagnosis is made .…”