Reactive Lymphoid Hyperplasia of the Liver: A Clinicopathological Study of 7 Cases

Abstract

Background. Reactive lymphoid hyperplasia (RLH) of the liver is a benign focal liver mass that may mimic a malignant liver tumor. Although rarely encountered in clinical practice, it often poses diagnostic and management dilemmas. Methods. Cases diagnosed as hepatic RLH between January 1996 and June 2011 were investigated in a retrospective study. Clinicopathological features as well as follow-up information of the cases were studied. Results. A total of seven cases of hepatic RLH were investigated, with a median age of 46 years (range: 33–76 years). Hepatic RLH was accompanied by concomitant diseases in some patients. The average size of hepatic lesions of our cases was 45 mm (range: 15–105 mm). All of the cases were not accurately diagnosed until confirmed by pathological findings, and surgical resections were performed for all. Postoperative course was uneventful for all of the patients during followup. Conclusions. RLH of the liver is a rare benign disease with a female predilection of unknown etiology. It is very difficult to correctly diagnose this disease without pathological results. Subtle differences on radiological findings of it may be helpful for differential diagnosis from other diseases. Curative resection of the lesion is suggested for the treatment of this disease.

Reactive lymphoid hyperplasia of the liver

“…In previous reviews, RLH is thought to be associated with an immune-mediated reactive phenomenon. Because one-third of the reported cases had various autoimmune disorders, such as Sjögren's syndrome, CREST syndrome (the limited cutaneous form of systemic scleroderma), autoimmune thyroiditis, primary biliary cirrhosis and primary immunodeficiency 1. Another one-third of the cases had a history of malignancies in various organs, as in our case (Table 1).…”

“…Since then, 41 cases of RLH in the liver have been reported in the English literature,1 including 2 cases of Korea 3,4. It is characterized by formation of follicles with polymorphic and polyclonal cell population and active germinal centers.…”

“…RLH of the liver may mimic a primary or metastatic hepatic malignancy radiologically, especially in patients with chronic hepatitis or internal malignancies. Fifteen cases out of 41 reported cases before the operation of hepatic RLH had most frequently been misdiagnosed as hepatocellular carcinoma (HCC) 1. Some authors described subtle differences in radiological findings between hepatic RLH and HCC.…”

“…Some authors described subtle differences in radiological findings between hepatic RLH and HCC. They have reported that hepatic RLH becomes unclear in the delayed phase on MRI scan with injection of contrast agents; while HCC is more hypodense in the delayed phase 1. Therefore, understanding of characteristic imaging of hepatic RLH will better direct the diagnosis.…”

“…RLH is thought to represent a reactive immunological response, and some cases may arise in association with malignancy and hepatitis 1. Radiologically, RLH of the liver may mimic a primary or metastatic hepatic malignancy.…”