Imaging of primary non-Hodgkin's lymphoma of the liver

Clinicopathological features of primary liver lymphoma and its surgical therapy

AIM: To study clinicopathological features of primary liver lymphoma (PLL) and its diagnostic as well as therapeutic methods.

METHODS: Seven cases of primary liver lymphoma, diagnosed and treated at our hospital during 1975 and 2008, were retrospectively studied. The etiology, clinical presentations, morphology (detected by light microscopy, electron microscopy, or immunohistochemistry), serological tests of alpha fetal protein (AFP), carcinoma embryonic antigen (CEA), hepatitis B surface antigen (HBsAg), and lactate dehydrogenase (LDH), as well as therapeutic results were systematically analyzed.

RESULTS: Of the 7 patients, 4 patients presented with epigastric pain and fever, and 3 patients had fever, night sweats, and loss of weight. Five patients were complicated with chronic hepatitis or cirrhosis. Histopathological findings showed that 5 patients were B cell phenotype with positive staining of CD20 and CD79α. Electron microscopy of B cell lymphoma revealed an abundance of blood capillaries among tumor cells and organelles in cytoplasm. The other 2 patients belonged to T cell phenotype with positive expression of CD3 and CD45RO. Scant cytoplasm and few of organelles were prominent ultrastructural characteristics of T cell lymphoma. Serological test showed that 5 patients were negative for AFP and CEA, and HBsAg was positive in 5 patients. LDH level was elevated (range: 675.54 U/L-1246.5 U/L). The longer survival time was achieved in the 3 patients treated by surgical resection plus biochemotherapy (average survival: 23 months), compared with the 4 patients receiving surgical resection plus chemotherapy (average survival: 9.5 months).

CONCLUSION: Hepatitis B virus (HBV) infection is prevalent in PLL patients. The major clinicopathological features of PLL include B symptoms, space-occupying lesion in the liver, and elevated LDH level. Surgical resection plus biochemotherapy is a more effective approach, which prolongs survival time of PLL patients.

Linfoma não-Hodgkin apresentando-se como massa hepática única

OBJETIVO: Descrever as principais características de imagem do linfoma não-Hodgkin apresentando-se como massa hepática única. MATERIAIS E MÉTODOS: Realizamos estudo retrospectivo mediante análise de casos de pacientes com massa hepática única aos exames de ultrassonografia, tomografia computadorizada e ressonância magnética, com diagnóstico histológico de linfoma não-Hodgkin. Esses exames foram analisados por dois examinadores em consenso. RESULTADOS: Identificamos três pacientes, todos do sexo masculino, na quinta década de vida, com quadro clínico inespecífico e que apresentavam massa hepática única e com diagnóstico de linfoma não-Hodgkin. Na ultrassonografia a lesão hepática apresentava-se como massa com aspecto "em alvo" nos três casos estudados. Na tomografia computadorizada observou-se massa hipodensa e heterogênea, com realce anelar em todos os casos. Na ressonância magnética as lesões apresentavam-se heterogêneas, hipointensas em T1 e hiperintensas em T2, e também com realce anelar após a injeção do contraste. Nenhum paciente apresentava linfonodomegalia ou comprometimento de outras vísceras sólidas no momento do diagnóstico. CONCLUSÃO: Na presença de massa hepática solitária e com aspecto "em alvo" deve-se considerar, entre as hipóteses, o diagnóstico de linfoma.

Imaging features of primary extranodal lymphomas

Lymphomas are generally considered tumours of lymph nodes, but up to 40% arise extranodally. This group shows distinctive pathological, radiological, and clinical features. Different subtypes of extranodal lymphoma may show sufficiently specific radiological features to be of significant value in both establishing a diagnosis of lymphoma and ascertaining the exact subtype. Rapidly evolving lymphoma classifications and emergence of new entities have, however, hampered the accurate description of these features in the literature. In this review, we discuss the radiological appearances, using a variety of imaging methods, of the full spectrum of primary extranodal lymphomas, categorized according to the current World Health Organisation classification.

Imaging of focal hepatic lesions: self-assessment module

Focal hepatic lesions are one of the diagnostic challenges in daily practice. This article focuses on the imaging features of focal hepatic lesions on different imaging modalities, including sonography, CT, and MRI.

Primary hepatic Burkitt lymphoma

Primary hepatic lymphomas are exceedingly rare in children, with less than a dozen cases described to date. The authors present an 8.5-year-old boy with Burkitt lymphoma of the liver who had isolated multifocal liver lesions that exhibited a multilayered progressive enhancing pattern on MRI. Diagnosis was achieved after laparotomy and incisional biopsy that failed to detect disease outside the liver. The patient received short, intensive multiagent chemotherapy. He is currently well 22 months after the end of chemotherapy. This case illustrates that clinical judgment in conjunction with unusual imaging findings may contribute to the diagnosis of common tumors in rare locations.

Sonographic features of liver involvement by lymphoma

OBJECTIVE

The liver is one of the most frequent extranodal locations of non-Hodgkin lymphoma and Hodgkin disease. Nevertheless, lymphoma constitutes only 6% to 8% of focal lesions of the liver. Few studies have evaluated the sonographic patterns of lymphoma with liver involvement. The purpose of this study was to describe the sonographic features and to evaluate the accuracy of sonography for the diagnosis of lymphoma with liver infiltration.

METHODS

The abdominal sonographic findings of 23 consecutive patients with histologically proven diagnosis of lymphoma with liver involvement were reviewed.

RESULTS

The most prevalent sonographic features were hepatomegaly and splenomegaly. Abdominal lymphoadenopathies were identified in 34.8% of cases. Liver nodules were seen in half of patients, and the most frequent sonographic appearance was as multiple small focal lesions. Differences in sonographic patterns between high- and low-grade non-Hodgkin lymphoma were not seen. None of the patients with Hodgkin disease had liver nodules. Concordance between sonography and computed tomography for the diagnosis of focal liver lesions was observed.

CONCLUSIONS

Sonography may contribute to the diagnosis of liver infiltration by lymphoma. The presence of multiple focal liver lesions associated with splenomegaly and lymphoadenopathies should make us consider the diagnosis of lymphoma with liver involvement. Nevertheless, the low specificity of these findings requires histologic confirmation of lymphomatous infiltration of the liver.

[Primary non-Hodgkin lymphoma of the liver: case report and review of the literature]

Purpose was to describe the clinical, radiological and therapeutic features in primary liver lymphoma. We report the case of a 54-year-old patient, who is followed since the age of 20 years for neutropenia associated with mediastinal adenopathy. Systematical ultrasound find a mass of the left liver confirmed by Computed tomography (CT). Histological examination of laparoscopic liver biopsy specimens confirmed diffuse large-cell non-Hodgkin's lymphoma. The disease was confined to the liver without any evidence of extrahepatic involvement. The serology of Epstein Barr virus was highly positive. PET-scan show increased FDG uptake at the site of hepatic lesion and the mediastin. The patient received chemotherapy followed by radiation therapy of the left liver at the dose of 31 Gy. The patient was alive and free of disease 20 months after the diagnosis of primary liver lymphoma. The primary hepatic lymphoma is a rare malignancy, which classically affects 50-year-old patients with a male preponderance. The incidence is increased in immunosuppressed patients and some authors have suggested an association with hepatitis B or C infection, and with the Epstein Barr virus. The imaging studies including ultrasound, CT, magnetic resonance imaging (MRI) and now PET-scan help to establish the diagnosis and to the following. Treatment options are surgery, radiation, chemotherapy, or a combination.

Maligne Lymphome in der Leber

Primary hepatic lymphomas represent rare neoplasms, which are partly observed in association with chronic viral hepatitis, immunosuppression and autoimmune diseases. In contrast, secondary hepatic lymphomas are much more frequent and represent disseminated disease. Lymphomas involving the liver include, with decreasing frequency, diffuse large B-cell lymphoma, small lymphocytic lymphoma, Hodgkin's lymphoma, peripheral T-cell lymphoma, follicular lymphoma and extranodal marginal zone B-cell lymphoma. Many B-cell lymphomas in the liver reveal a characteristic infiltration pattern allowing a rapid and cost-effective diagnosis based on focused immunohistochemical analyses. In contrast, most T-cell lymphomas show a more diverse morphology, which is sometimes difficult to differentiate from a reactive condition. Therefore, additional molecular analyses are frequently necessary. The differential diagnosis includes hepatitis and inflammatory bile duct diseases, undifferentiated carcinoma, inflammatory myofibroblastic tumor as well as histiocytic and dendritic cell neoplasms.

[Anicteric cholestasis: imaging and diagnostic strategy]

Cholestasis is due to abnormal biliary secretion, from hepatic or extra hepatic causes. The diagnostic strategy of anicteric cholestasis will be discussed, defining hepatic biologic abnormalities, and the role and sequence of imaging techniques based on clinical and biological findings. Main causes will be emphasized and illustrated with different radiological techniques (US, CT and MRI).

Liver Metastases on Serial Contrast-enhanced Multidetector Computed Tomography Examinations

OBJECTIVE

To verify the earliest detectability of liver metastases in patients who underwent serial multidetector computed tomography (MDCT) examinations.

METHODS

We selected 12 patients with known primary cancer who underwent 4 or more contrast-enhanced, 4-detector MDCTs. When metastases had been reported, an evaluation of the preceding MDCT was done to define whether the lesion was detectable, detectable only by minimal signs, undetectable, or detected but misdiagnosed as a benign lesion (MBL).

RESULTS

Eighty-eight lesions were analyzed. Evaluating the preceding examination, we defined detectable (n=8), detectable only by minimal signs (n=5), undetectable (n=74), and MBL (n=1). The group with minimal signs was composed of 4 small hypodense foci and 1 calcification. The MBL was a non-Hodgkin lesion first misdiagnosed as a hemangioma.

CONCLUSION

Approximately 15% of liver metastases were prospectively missed, 9% of them being retrospectively detectable, 6% being retrospectively visible as minimal signs, whereas only 1% of liver metastases were misdiagnosed as a benign lesion.

Primary liver lymphoma in a patient with chronic hepatitis C

Primary liver lymphoma is a very rare disease and is frequently overlooked as a possible diagnosis. We report the case of an asymptomatic middle-aged man with chronic hepatitis C who developed primary liver lymphoma (PLL). A large solitary tumor in the left lobe of the liver was incidentally detected on routine ultrasound examination. Imaging studies showed mixed iso- and hypoechogenicity with hypoechoic rim, hypodense in the pre-contrast phase and thick wall enhancement in the post-contrast phase on computed tomographic study, hypointensity on T1WI, and hyperintensity of the central portion and slightly higher intensity in the peripheral wall on T2WI. These pictures were different from focal nodular hyperplasia, hepatocellular carcinoma, cholangiocarcinoma or metastases. Atypical hepatectomy was performed and the pathology of the hepatic tumor revealed non-Hodgkin's lymphoma. Systemic staging revealed no evidence of nodal or bone marrow involvement, so PLL was diagnosed. There was no tumor recurrence more than 4 years after operation and chemotherapy. PLL should be included in the differential diagnosis of solitary hepatic tumor in patients who are hepatitis C virus-positive, and who have atypical imaging and no known malignancy or elevated tumor marker levels.

Le lymphome primitif du foie : à propos d’un cas pédiatrique

Primary non Hodgkin's lymphoma of the liver is a very rare entity, compared with secondary hepatic lymphomatous involvement. It is exceptional in children. The authors report the case of a 9 year-old boy, who presents a primary hepatic lymphoma and review the role of medical imaging for diagnosis and follow-up.

Primary non-Hodgkin's lymphoma of the liver

We review the literature on primary hepatic lymphoma (PHL). PHL is a rare malignancy, and constitutes about 0.016% of all cases of non-Hodgkin's lymphoma. It has been reported to occur with increased frequency in patients with chronic hepatitis C infection. Most patients with PHL present with abdominal pain, constitutional symptoms and have hepatomegaly on examination. Imaging studies reveal solitary, or less often, multiple masses in the liver. The predominant histology is B-cell lymphoma, most commonly diffuse large cell type. Most patients are treated with chemotherapy, with some physicians employing a multimodality approach incorporating surgery and radiotherapy with chemotherapy. The prognosis is variable, with good response to early aggressive combination chemotherapy.

Clinicopathological features of eight Korean cases of primary hepatic lymphoma

Primary hepatic lymphoma is very rare, accounting for less than 0.4% of extranodal lymphomas. Furthermore, hepatic lymphoma, either primary or metastatic, is infrequently confirmed histopathologically in needle biopsy specimens. The aim of the current study is to assess the clinicopathological characteristics of primary hepatic lymphomas in Korea, which is an endemic area of chronic B viral hepatitis. In total, 17 cases with liver needle biopsy specimens with involvement of malignant lymphoma, from whom eight cases met the criteria for primary hepatic lymphoma, were selected. The clinicopathological features were reviewed. Five of eight (62.5%) cases were T cell lymphoma, including three cases (37.5%) of hepatosplenic T cell lymphoma. Three cases (37.5%) were diffuse large B cell lymphomas. Seven patients had follow-up data from 25 days to 50 months that was available for evaluation. The partial remission was present in two of seven patients (28.6%) and five patients (71%) died of disease 25 days to 7 months after the diagnosis. The data indicate that the relatively high incidence of T-cell type in Korean cases of primary hepatic lymphoma may be related to its aggressive behavior and poor prognosis despite combination chemotherapy.

[A case of primary hepatic lymphoma successfully treated by THP-COP therapy]

A 65-year-old woman was admitted due to epigastralgia. The presence of a tumor mass in the umbilical portion of the liver was recognized by abdominal ultrasonography and computed tomography scan. Needle biopsy of the tumor showed non Hodgkin's lymphoma (diffuse large B cell type) by histology and histoimmunology. She was treated by the THP-COP protocol, and complete remission was achieved after the third cycle. Primary hepatic lymphoma is so infrequent that standard treatments are not established yet. Most cases of primary hepatic lymphoma are treated by surgical resection in Japan; however our conservative approach to remission is considered as very helpful for discussing how to treat primary hepatic lymphoma.

Extranodal imaging manifestations of non-Hodgkin's lymphoma

A series of imaging features of extranodal, multi-systemic involvements in Non-Hodgkin's lymphoma (NHL) were investigated. The clinical data and imaging findings of 16 patients with pathologically proved NHL were retrospectively analyzed. The related literatures were reviewed. Of the 16 cases of NHL, skeletal involvement was found in 4, nasal cavity and nasal sinuses were involved in 4, too. Lesion in the thorax was seen in 3 patients, hepatic involvement occurred in one case, cerebral ventricle was affected in 3 cases, mesentery was involved in one case. Even though extranodal involvement of NHL exhibited extremely variable patterns, there were some relatively typical imaging findings. Emphasized in this report were the relatively specific imaging manifestations of different systems, which may mimic infectious or other neoplasms of different sites. The importance of imaging studies lies in the availability for diagnosis, staging and follow-up of NHL. Combined with the clinical and other related information, the diagnostic accuracy can be further improved, thus, providing reliable evidence in guiding clinical management.

Computed tomography and magnetic resonance imaging evaluation of liver cancer

Focal liver lesions occur commonly and with varying histology, each requiring radically different management. There are a multitude of imaging modalities currently being used for detecting and characterizing focal liver neoplasms. The primary modalities include ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and rarely, angiography. CT and MRI have benefited from rapid technologic advances, and MRI, in particular, from the advent of new contrast agents.