Hodgkin's and non-Hodgkin's hepatic lymphoma: sonographic findings

Multimodality Imaging of Primary Hepatic Lymphoma: A Case Report and a Literature Review

Primary hepatic lymphoma (PHL) is a rare form of non-Hodgkin lymphoma primarily affecting the liver. We present a case of an 84-year-old man diagnosed with PHL, incidentally detected during abdominal ultrasonography. The ultrasonography showed a hypoechoic nodule. When examined by CEUS, the nodule showed hyperenhancement in the arterial phase and hypoenhancement in the portal and late phases. Conversely, CECT demonstrated hypoenhancement through all the phases. The patient declined a tumor biopsy and opted for follow-up care. Ten months later, the lobular mass had increased from 15 mm to 65 mm, presenting as hypoechogenic and demonstrating the "vessel-penetrating sign" on color Doppler imaging. CEUS revealed reticulated enhancement, indicating intratumoral vessels. The mass displayed hypoattenuation on plain CT, hypointensity in T1-weighted images, and hyperintensity in T2-weighted images and exhibited significant restriction in diffusion-weighted images. Both CECT and contrast-enhanced MRI exhibited hypoenhancement. The patient underwent a partial hepatic segmentectomy, and the mass was pathologically diagnosed as a diffuse large B-cell lymphoma. Subsequent postoperative radiological examinations revealed no other lesions, confirming the diagnosis of PHL. Our report highlights specific ultrasonographic signs of PHL observed from an early stage and presents a review of the relevant literature.

Curative intent treatment of late presented extragastrointestinal stromal tumor: two identical case reports with literature review

Gastrointestinal stromal tumors (GISTs) occurring outside the gastrointestinal tract are known as extragastrointestinal stromal tumors (EGIST). They share some common histopathologic and molecular characteristics. This report describes two female patients who were suspected of having a mesenteric GIST, but opted for surveillance rather than definitive treatment. Upon reassessment, both patients demonstrated increased tumor mass with no evidence of distant metastasis. The intraoperative findings confirmed the conclusion of clinical and imaging studies performed preoperatively and radical excisions were performed. Histopathological examination (spindle cell neoplasm) and immunohistochemistry (CD117) confirmed EGIST. Both patients underwent Imatinib therapy following surgery with no evidence of disease recurrence or metastasis upon follow up. Although sharing histologic features with GIST, EGIST frequently demonstrates distinct characteristics that facilitate the proper diagnosis and management of EGIST. Since it is a rare and aggressive disease with a poor outcome, early detection and curative surgical resection remains the mainstay of treatment.

Malignant Retroperitoneal Extra-Gastrointestinal Stromal Tumor: A Unique Entity

Extra-gastrointestinal stromal tumors (EGISTs) are a recently described group of tumors. A handful of less than 70 cases have been reported in English literature, so far, to the best of our knowledge. Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the alimentary canal. EGISTs are a unique entity, which require distinction from GISTs because, even though, they exhibit similar histology and immunohistochemistry to GISTs, they occur outside the gastrointestinal tract, i.e. in omentum, mesentery, retroperitoneum, etc. and have different behavior patterns as far as their prognosis and management are concerned. Retroperitoneal sub-group of EGISTs is extremely rare and we report such a case of primary malignant EGIST of the retroperitoneum which presented as a soft tissue mass on radiological evaluation. The tumor turned out to be a histopathological surprise, and could be distinctively labeled as EGIST only after morphological and immunohistochemical studies. It is imperative for radiologists, pathologists and oncologists, among other clinicians, to be able to recognize and understand the presentation of this group of tumors due to their rapid progression and poor prognosis, so that an early diagnosis and management may be able to improve the final disease outcome.

Necrotic lymphoma in a patient with post-transplantation lymphoproliferative disorder: ultrasonography and CT findings with pathologic correlation

Seventeen months after kidney transplantation for the treatment of nephrotic syndrome, a retroperitoneal mass was incidentally detected in a 30-year-old man during routine follow-up. Ultrasonography revealed a mass measuring 5.5 cm×4.3 cm located between the liver and the atrophic right kidney, which showed markedly heterogeneous internal echogenicity. Contrast-enhanced computed tomography displayed a mild degree of enhancement only at the periphery of the mass, while the center lacked perceivable intensification. The patient underwent surgical resection. The final pathological diagnosis was non-Hodgkin lymphoma (diffuse large B-cell lymphoma), and extensive necrosis was observed on microscopic examination. We found that the prominent heterogeneous echogenicity of the mass (an unusual finding of lymphoma) demonstrated on ultrasonography is a result of extensive necrosis, which may sometimes occur in patients with post-transplantation lymphoproliferative disorder.

Pitfalls in a sonographic diagnosis of liver abscess in children

BACKGROUND

The purpose of this article is to identify the pitfalls of sonography in the diagnosis of liver abscesses, hematomas, and hepatic tumors, which appear similar and therefore are difficult to differentiate from each other.

METHODS

Cases were collected at the China Medical University Hospital between January 2008 and January 2010. Liver abscesses were initially diagnosed by sonograph in selected patients who were younger than 18 years.

RESULTS

There were 15 patients in whom a liver mass was diagnosed by ultrasound, but 6 of them were excluded from further study because of failure to meet any of the screening criteria. Nine patients with a mean age of 11.3 years (range 5-17 years) were initially suspected to have liver abscesses by ultrasound and were enrolled in the study. These nine patients were identified as follows: five with liver abscess, one with liver hematoma, one with hepatic lymphoma, one with perihepatic abscess, and one with undifferentiated liver sarcoma. Ultrasonography alone was sufficient for diagnosis in five patients. Four patients required abdominal CT scanning to confirm final diagnosis.

CONCLUSION

Different liver lesions may present sonographic images similar to those of liver abscesses. Therefore, it is suggested that patients in whom liver abscesses were diagnosed by ultrasound undergo further evaluation if the clinical condition is less likely.

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.

Lymphoma presenting as an echogenic periportal mass: sonographic findings

Abdominal lymphoma usually appears as homogeneous, markedly hypoechoic masses on sonography. We report a case of primary lymphoma presenting as an extrahepatic and intrahepatic periportal echogenic mass encasing the hepatic vessels.

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 hepatic non-Hodgkin's lymphomas: case report and review of the literature

A 31-yr-old man presented with a 1-wk history of fever, chills, weakness, headaches, and a significant 20-lb weight loss over the preceding 2 months. His past medical history was relevant for liver amebiasis during childhood. Two days before admission, the patient noticed jaundice. He denied abdominal pain or other GI symptoms, and there was no history of alcohol intake, medications, or illicit drugs. His physical examination revealed generalized jaundice, hepatosplenomegaly, and bilateral leg edema. Neurologically, the patient was agitated, with periods of disorientation, and he had bilateral flapping. His blood tests revealed pancytopenia, renal failure, liver failure, and coagulopathy. Because the patient had a fever, hepatosplenomegaly, and pancytopenia, a further workup also included a bone marrow and liver biopsy. No conclusive diagnosis could be made from the above tests, and the patient died 5 days after admission. Postmortem evaluation, including flow cytometry and gene rearrangement in the tissue obtained from the liver, revealed large B cell lymphoma. This case illustrates an unusual presentation of hepatic non-Hodgkin's lymphoma. Current information regarding this entity is scant, mainly owing to its rarity. We present a review of the literature, including the incidence, presentation, treatment, and prognosis of primary hepatic lymphoma.

Acquired immunodeficiency syndrome (AIDS) of the abdominal organs: imaging features

The liver, spleen, biliary tract, pancreas, and kidneys are commonly affected by opportunistic infection, malignancy, and inflammatory disorders during the course of human immunodeficiency virus (HIV) infection. Clinical manifestations of solid abdominal visceral involvement are protean and usually nonspecific, but it is important to establish a specific diagnosis promptly in these often critically ill patients. This presentation reviews the cross-sectional imaging spectrum of HIV-associated lesions of these organs.

Diagnosis and treatment of hepatic disease in patients with HIV

Liver involvement with opportunistic infections and neoplasms is a well-recognized component of AIDS, affecting most patients. The cause of hepatic disease in these patients may be divided into hepatitis, granulomatous disease, mass lesions, vascular lesions, hepatotoxic drugs, and nonspecific findings. With a rational approach, most patients with AIDS and liver disease can be diagnosed and treated in a cost-effective manner with low morbidity.