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Okura K, Seo S, Shimizu H, Nishino H, Yoh T, Fukumitsu K, Ishii T, Hata K, Haga H, Hatano E. Primary hepatic extranodal marginal zone B-cell mucosa-associated lymphoid tissue lymphoma treated by laparoscopic partial hepatectomy: a case report. Surg Case Rep 2023; 9:29. [PMID: 36843127 PMCID: PMC9968672 DOI: 10.1186/s40792-023-01613-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/15/2023] [Indexed: 02/28/2023] Open
Abstract
BACKGROUND Primary hepatic extranodal marginal zone B-cell mucosa-associated lymphoid tissue (MALT) lymphoma is very rare, so it is difficult to diagnose preoperatively. And there is no established treatment for hepatic MALT lymphoma. We report herein a case of primary hepatic MALT lymphoma treated by laparoscopic partial hepatectomy, and discuss the usefulness of laparoscopic hepatectomy for a rare liver tumor. CASE PRESENTATION This patient was a woman in her 60s, who was diagnosed preoperatively as having synchronous liver metastasis from sigmoid colon cancer; therefore, laparoscopic partial hepatectomy was performed. She had a good course after the operation and was discharged on postoperative day 12. However, she was diagnosed pathologically as having primary hepatic MALT lymphoma. A bone marrow biopsy was also performed, and then she was finally diagnosed as having limited-stage primary hepatic MALT lymphoma. She received no postoperative treatment and showed no recurrence for 4 years postoperatively. CONCLUSIONS We experienced the good result of the patient with limited-stage primary MALT lymphoma treated by laparoscopic partial hepatectomy. Liver tumors are sometimes misdiagnosed by imaging examinations alone. Laparoscopic hepatectomy has been widespread recently as a minimally invasive procedure, and it may be useful for both diagnosis and treatment.
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Affiliation(s)
- Keisuke Okura
- grid.258799.80000 0004 0372 2033Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoru Seo
- Department of Surgery, Kyoto Katsura Hospital, 17 Yamadahirao-cho, Nishikyo-ku, Kyoto, 615-8256, Japan.
| | - Hironori Shimizu
- grid.258799.80000 0004 0372 2033Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroto Nishino
- grid.258799.80000 0004 0372 2033Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomoaki Yoh
- grid.258799.80000 0004 0372 2033Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ken Fukumitsu
- grid.258799.80000 0004 0372 2033Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takamichi Ishii
- grid.258799.80000 0004 0372 2033Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koichiro Hata
- grid.258799.80000 0004 0372 2033Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hironori Haga
- grid.258799.80000 0004 0372 2033Department of Diagnostic Pathology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Etsuro Hatano
- grid.258799.80000 0004 0372 2033Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Lau WY, Ho K, Chan FK, Lam S, Cheng K. Primary hepatic mucosa‐associated lymphoid tissue lymphoma: Case report and literature review. SURGICAL PRACTICE 2022. [DOI: 10.1111/1744-1633.12539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Wing Yu Lau
- Department of Surgery Kwong Wah Hospital Yau Ma Tei Hong Kong
| | - Kit‐Man Ho
- Department of Surgery Kwong Wah Hospital Yau Ma Tei Hong Kong
| | | | - Shi Lam
- Department of Surgery Kwong Wah Hospital Yau Ma Tei Hong Kong
| | - Kai‐Chi Cheng
- Department of Surgery Kwong Wah Hospital Yau Ma Tei Hong Kong
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Xie H, Lv J, Ji Y, Du X, Yang X. Primary hepatic mucosa-associated lymphoid tissue lymphoma: A case report and literature review. Medicine (Baltimore) 2019; 98:e15034. [PMID: 30921228 PMCID: PMC6456129 DOI: 10.1097/md.0000000000015034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
RATIONALE Primary hepatic mucosa-associated lymphoid tissue (MALT) lymphoma is a rare disease, and there is no consensus yet on the treatment modalities. Here, we report a new case of MALT lymphoma and review the current literature on this disease. PATIENT CONCERNS A 73-year-old man was admitted to our department following the incidental finding of a solitary 1.8-cm diameter mass in the liver. DIAGNOSIS Microscopic findings identified the mass as a tumor with infiltration of diffuse atypical B lymphocytes. Immunohistochemical analysis showed positivity for CD20 and CD79a, and negativity for CD3 and CD5. These collective data led to the diagnosis of primary hepatic MALT lymphoma. INTERVENTIONS The tumor was removed by surgical resection. The patient refused additional treatment after the surgery. OUTCOMES At the time of writing this report, the patient has been disease free for 6 months postsurgery. LESSONS Review of the previously published case reports on this rare tumor type indicates that in addition to chronic liver inflammation due to infection or other reasons, genetic aberrations can also contribute to the development of hepatic MALT lymphoma. Additionally, IgH rearrangement is a good genetic hallmark of this tumor. Owing to no specific clinical or radiologic features to define the disease profile for diagnosis, surgery may be a good choice for both diagnosis and therapy if the patient's condition permits.
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Abstract
Systemic hematopoietic disorders may present on liver biopsy, and rare cases of primary hepatic lymphoma (PHL) may be encountered. Hepatopathologists must be familiar with the full spectrum of hematopoietic disorders involving the liver and be prepared to exclude benign mimics. PHL, which is confined to the liver without extrahepatic involvement, can present as solitary or multiple nodules, raising consideration for carcinoma on imaging, or may mimic benign inflammatory conditions, posing a diagnostic challenge. This article describes clinical, morphologic, and immunophenotypic features of some of the most common hematopoietic neoplasms involving the liver, along with differential diagnosis and recommended ancillary testing.
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Dong S, Chen L, Chen Y, Chen X. Primary hepatic extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue type: A case report and literature review. Medicine (Baltimore) 2017; 96:e6305. [PMID: 28353562 PMCID: PMC5380246 DOI: 10.1097/md.0000000000006305] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
RATIONALE Primary hepatic mucosa-associated lymphoid tissue (MALT) lymphoma is an extremely rare disease. To the best of our knowledge, only 67 cases had been reported in 39 English literatures to date. The aim of this study was to add a new case of this disease to the literature and to review the current literature. PATIENT CONCERNS A 50-year-old man was incidentally identified with a solitary mass of 5 cm in diameter in the left lobe of the liver. DIAGNOSES Based on the results of imaging studies, intrahepatic cholangiocellular carcinoma was suspected, and then surgery was performed. Microscopic findings showed that the tumor was a hepatic MALT lymphoma, and immunohistochemical analysis revealed that the lymphoma cells were CD20+, CD79a+, BCL-2+, CD3-, and CD5-. INTERVENTIONS The patient received rituximab after surgery. OUTCOMES He was free of disease for 13 months at the time of this report. LESSONS Since previously published case reports and our case described nonspecific clinical features of this rare disease, it was usually misdiagnosed before histological confirmation and surgery resection may be a good choice for both diagnosis and local therapy.
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Primary hepatic mucosa-associated lymphoid tissue lymphoma: a case report and literature review. Surg Case Rep 2015; 1:87. [PMID: 26435907 PMCID: PMC4580714 DOI: 10.1186/s40792-015-0091-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 09/17/2015] [Indexed: 12/20/2022] Open
Abstract
Primary hepatic mucosa-associated lymphoid tissue (MALT) lymphoma is an extremely rare disease. We herein describe the findings in a 74-year-old man with elevated liver enzyme levels. Dynamic computed tomography showed focal biliary dilation and atrophy in the posterior segment, while dynamic magnetic resonance images revealed a small, highly enhanced small mass located at the root of posterior branch of the biliary ducts. As the mass was not detected on abdominal ultrasonography, a biopsy could not be performed. Cholangiocellular carcinoma was suspected, and surgery was performed. However, the surgically resected hepatic tumor was a nodule of aggregated lymphocytes that formed a lymphoepithelial lesion. Immunohistochemical analysis revealed that the lymphoma cells were positive for CD20 and CD79a, but negative for CD3. No other lymphoid lesions were found during additional postoperative examinations. Therefore, the patient was diagnosed with primary hepatic MALT lymphoma. He was also diagnosed with Helicobacter pylori infection, and thus, pylorus eradication was performed. At the time of this report, the patient was free of disease for 2 years without any additional treatment. The present case contributed to the diagnosis and management of this rare disease, as previously published case reports described varying imaging features; it also suggested that preoperative diagnosis was often difficult without biopsy.
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Kikuma K, Watanabe J, Oshiro Y, Shimogama T, Honda Y, Okamura S, Higaki K, Uike N, Soda T, Momosaki S, Yokota T, Toyoshima S, Takeshita M. Etiological factors in primary hepatic B-cell lymphoma. Virchows Arch 2012; 460:379-87. [PMID: 22395482 PMCID: PMC3320708 DOI: 10.1007/s00428-012-1199-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Revised: 01/08/2012] [Accepted: 01/19/2012] [Indexed: 12/26/2022]
Abstract
Sixty-four cases of malignant lymphoma involving the liver were examined. Of these, 20 cases were histologically confirmed to be primary hepatic B-cell lymphoma. Twelve of these 20 cases were diffuse large B-cell lymphoma (DLBCL) and eight cases were mucosa-associated lymphoid tissue (MALT) lymphoma. Of the 12 cases of DLBCL, six were immunohistologically positive for CD10 and/or Bcl6 (indicating a germinal center phenotype), six were positive for Bcl2, and five were positive for CD25. Eight of the 12 DLBCL cases (66.7%) and two of the eight MALT lymphoma cases (25%) had serum anti-hepatitis C virus (HCV) antibodies and HCV RNA. The incidence of HCV infection was significantly higher in the hepatic DLBCL cases than in systemic intravascular large B-cell cases with liver involvement (one of 11 cases, 9.1%) and T/NK-cell lymphoma cases (one of 19 cases, 5.3%) (p < 0.01 for both). Two hepatic DLBCL cases (16.7%) had rheumatoid arthritis treated with methotrexate, and four MALT lymphoma cases (50%) had Sjögren’s syndrome, primary biliary cirrhosis, or autoimmune hepatitis; one case in each of these two groups was complicated by chronic HCV-seropositive hepatitis. Although primary hepatic lymphoma is rare, persistent inflammatory processes associated with HCV infection or autoimmune disease may play independent roles in the lymphomagenesis of hepatic B cells.
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Affiliation(s)
- Kanta Kikuma
- Departments of Pathology and Internal Medicine, Faculty of Medicine, Fukuoka University, Nanakuma 7-45-1, Johnan-ku, Fukuoka, Japan
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Hayashi M, Yonetani N, Hirokawa F, Asakuma M, Miyaji K, Takeshita A, Yamamoto K, Haga H, Takubo T, Tanigawa N. An operative case of hepatic pseudolymphoma difficult to differentiate from primary hepatic marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue. World J Surg Oncol 2011; 9:3. [PMID: 21232116 PMCID: PMC3033353 DOI: 10.1186/1477-7819-9-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Accepted: 01/13/2011] [Indexed: 12/16/2022] Open
Abstract
Hepatic pseudolymphoma (HPL) and primary hepatic marginal zone B cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) are rare diseases and the differential diagnosis between these two entities is sometimes difficult. We herein report a 56-year-old Japanese woman who was pointed out to have a space occupying lesion in the left lateral segment of the liver. Hepatitis viral-associated antigen/antibody was negative and liver function tests including lactic dehydrogenase, peripheral blood count, tumor markers and soluble interleukin-2 receptor were all within normal limit. Imaging study using computed tomography and magnetic resonance imaging were not typical for hepatocellular carcinoma, cholangiocarcinoma, or other metastatic cancer. Fluorodeoxyglucose-positron emission tomography examination integrated with computed tomography scanning showed high standardized uptake value in the solitary lesion in the liver. Under a diagnosis of primary liver neoplasm, laparoscopic-assisted lateral segmentectomy was performed. Liver tumor of maximal 1.0 cm in diameter was consisted of aggregation of lymphocytes of predominantly B-cell, containing multiple lymphocyte follicles positive for CD10 and bcl-2, consistent with a diagnosis of HPL rather than MALT lymphoma, although a definitive differentiation was pending. The background liver showed non-alcoholic fatty liver disease/early non-alcoholic steatohepatitis. The patient is currently doing well with no sign of relapse 13 months after the surgery. Since the accurate diagnosis is difficult, laparoscopic approach would provide a reasonable procedure of diagnostic and therapeutic advantage with minimal invasiveness for patients. Considering that the real nature of this entity remains unclear, vigilant follow-up of patient is essential.
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Affiliation(s)
- Michihiro Hayashi
- Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan.
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Doi H, Horiike N, Hiraoka A, Koizumi Y, Yamamoto Y, Hasebe A, Ichikawa S, Yano M, Miyamoto Y, Ninomiya T, Ishimaru Y, Miyagawa M, Takamura K, Kawasaki H, Kozuka T, Maeda T, Yoshino T. Primary hepatic marginal zone B cell lymphoma of mucosa-associated lymphoid tissue type: case report and review of the literature. Int J Hematol 2008; 88:418-423. [PMID: 18807227 DOI: 10.1007/s12185-008-0153-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2008] [Revised: 06/22/2008] [Accepted: 07/04/2008] [Indexed: 12/12/2022]
Abstract
A primary hepatic marginal zone B cell lymphoma of mucosa-associated lymphoid tissue (MALT) is very rare. We found a solitary mass 27 mm in size in the left lobe of the liver of a 58-year-old Japanese man with a history of hepatitis-C infection. Based on the results of imaging studies, the tumor was diagnosed as a hepatocellular carcinoma (HCC). The left lobe of the liver was lobectomized and microscopic findings showed that the tumor was a hepatic MALT lymphoma, while immunohistochemistry showed it to be positive for CD20 and CD79a. In a fluorodeoxyglucose-positron emission tomography examination integrated with computed tomography scanning (FDG-PET CT) before surgery, the tumor was revealed to have a high standardized uptake value (SUV) for FDG. The patient received chemotherapy after surgery. To the best of our knowledge, 45 cases had been reported with a mean age for all patients of 61.4 years. The pathogenesis remains unclear, although half of the patients had a past history of chronic inflammatory liver disease. Surgical resection was performed in most cases and some patients received postoperative chemotherapy or radiotherapy. The clinicopathologic characteristics and management of this extremely rare disease are also discussed.
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Affiliation(s)
- Hirokazu Doi
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan.
| | - Norio Horiike
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan
| | - Atsushi Hiraoka
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan
| | - Yohei Koizumi
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan
| | - Yasunori Yamamoto
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan
| | - Aki Hasebe
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan
| | - Soichi Ichikawa
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan
| | - Makoto Yano
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan
| | - Yasunao Miyamoto
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan
| | - Tomoyuki Ninomiya
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan
| | - Yoshihiro Ishimaru
- Department of Radiology, Ehime Prefectural Central Hospital, Ehime, Japan
| | - Masao Miyagawa
- Department of Radiology, Ehime Prefectural Central Hospital, Ehime, Japan
| | - Kazuhito Takamura
- Department of Surgery, Ehime Prefectural Central Hospital, Ehime, Japan
| | - Hideki Kawasaki
- Department of Surgery, Ehime Prefectural Central Hospital, Ehime, Japan
| | - Teruhiko Kozuka
- Department of Hematology, Ehime Prefectural Central Hospital, Ehime, Japan
| | - Toshiharu Maeda
- Department of Medical Laboratory, Ehime Prefectural Central Hospital, Ehime, Japan
| | - Tadashi Yoshino
- Department of Pathology, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
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