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Chikamori F, Yorita K, Yoshino T, Ito S, Mizobuchi M, Ueta K, Mizobuchi K, Shimizu S, Nanjo K, Yukishige S, Iwabu J, Matsuoka H, Hokimoto N, Yamai H, Onishi K, Tanida N, Sharma N. Sarcoidosis-lymphoma syndrome with portal hypertension: diagnostic clues and approach. Radiol Case Rep 2021; 16:2192-2201. [PMID: 34178191 PMCID: PMC8213984 DOI: 10.1016/j.radcr.2021.05.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/14/2021] [Accepted: 05/15/2021] [Indexed: 11/16/2022] Open
Abstract
Sarcoidosis-lymphoma syndrome associated with portal hypertension is very rare. A 68-year-old female presented with a 5 kg weight loss in 6 months. Soluble interleukin-2 receptor activity was increased and total platelet count was decreased. Contrast-enhanced computed tomography showed the presence of hepatosplenomegaly and a 3 cm-sized tumor in segment 3 of the liver. The hepatic venous catheterization showed mild portal hypertension. On fluorodeoxyglucose-positron emission tomography/computed tomography, progressive malignant lymphoma was suspected. However, bone marrow biopsy showed multiple noncaseating granulomas. A laparoscopic liver biopsy revealed that the liver tumor had features of Hodgkin lymphoma. There were multiple noncaseating epithelioid granulomas in the portal tracts of the liver. Splenectomy for splenomegaly and partial hepatectomy for the liver tumor were performed. Pathological examination of the resected specimens revealed multiple noncaseating epithelioid granulomas in the liver and spleen. Histopathology of the liver tumor confirmed classic Hodgkin lymphoma with mixed cellularity. We conclude that hepatic venous catheterization, positron emission tomography/computed tomography, and pathological examinations of bone marrow, liver, and spleen are crucial for the diagnosis of sarcoidosis-lymphoma syndrome associated with portal hypertension.
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Affiliation(s)
- Fumio Chikamori
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Kenji Yorita
- Department of Diagnostic Pathology, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Tadashi Yoshino
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-ku, Okayama, Japan
| | - Satoshi Ito
- Department of Radiology, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Miki Mizobuchi
- Department of Internal Medicine, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Koji Ueta
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Kai Mizobuchi
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Shigeto Shimizu
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Kazumasa Nanjo
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Sawaka Yukishige
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Jun Iwabu
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Hisashi Matsuoka
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Norihiro Hokimoto
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Hiromichi Yamai
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Kazuhisa Onishi
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Nobuyuki Tanida
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Niranjan Sharma
- Department of Surgery, Adv Train Gastroint & Organ Transp Surgery, Dunedin, New Zealand
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