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De Souza LM, Ismail M, Elaskandrany MA, Fratella-Calabrese A, Grossman IR. Primary Hepatic EBV-DLBCL Lymphoma in the Setting of COVID-19 Infection. ACG Case Rep J 2024; 11:e01276. [PMID: 38328768 PMCID: PMC10849344 DOI: 10.14309/crj.0000000000001276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/10/2024] [Indexed: 02/09/2024] Open
Abstract
This case study describes an instance of primary hepatic diffuse large B cell lymphoma (DLBCL) in a patient who had prolonged coronavirus disease 2019 (COVID-19). DLBCL rarely presents as a primary hepatic mass. The 53-year-old man sought emergency care because of fatigue and weight loss. Diagnostic tests showed mildly elevated liver enzymes and imaging pointed to several low-density liver lesions. A liver biopsy paired with immunohistochemical testing verified the DLBCL diagnosis. Notably, the patient had COVID-19 4 months before the liver-related symptoms. The link between COVID-19 and the emergence of solid tumor cancers is unclear, but this case underscores its potential significance and the need for further research. This report stresses the importance of recognizing and documenting instances where COVID-19 might influence the onset of solid tumor cancers, including primary hepatic DLBCL.
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Affiliation(s)
- Luisa Maria De Souza
- Department of Internal Medicine, Rutgers New Jersey Medical School University Hospital, Newark, NJ
| | - Mohamed Ismail
- Department of Internal Medicine, Rutgers New Jersey Medical School University Hospital, Newark, NJ
| | | | | | - I. Robert Grossman
- Department of Hematology and Oncology, Saint Barnabas Medical Center, NJ
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2
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Taiji R, Marugami N, Marugami A, Itoh T, Shimizu S, Nakano R, Hoda Y, Kunichika H, Tachiiri T, Minamiguchi K, Yamauchi S, Tanaka T. Multimodality Imaging of Primary Hepatic Lymphoma: A Case Report and a Literature Review. Diagnostics (Basel) 2024; 14:306. [PMID: 38337822 PMCID: PMC10855340 DOI: 10.3390/diagnostics14030306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
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.
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Affiliation(s)
- Ryosuke Taiji
- Department of Diagnostic and Interventional Radiology, Nara Medical University, 840 Shijo-cho, Kashihara-city, Nara 634-8522, Japan; (N.M.); (A.M.); (T.I.); (S.S.); (R.N.); (Y.H.); (H.K.); (T.T.); (K.M.); (S.Y.); (T.T.)
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3
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Koh HD, Choi JW, Kim EK, Park S, Kim MJ, Lee CK. Primary hepatic mucosa-associated lymphoid tissue lymphoma mimicking hepatocellular carcinoma in a patient with chronic hepatitis B: a case report. J Int Med Res 2023; 51:3000605231154399. [PMID: 36788763 PMCID: PMC9932769 DOI: 10.1177/03000605231154399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
Primary hepatic lymphoma is a rare disease, and primary hepatic mucosa-associated lymphoid tissue (MALT) lymphoma accounts for only 0.3% of all primary hepatic lymphomas. Herein, we report a case of primary hepatic MALT lymphoma in a male patient in his mid-40 s with chronic hepatitis B infection. The patient visited our department for further examination of a hepatic nodule initially visualized through abdominal pelvic computed tomography (CT). Based on imaging studies and elevated levels of tumor markers, the tumor was suspected to be hepatocellular carcinoma. A laparoscopic inferior sectionectomy (segment 5 and 6) was performed, and immunohistochemical staining revealed that the tumor was positive for CD20, B-cell lymphoma 2, pan-cytokeratin (CK), and CK19 markers. Pathological findings revealed it to be a primary hepatic MALT lymphoma. After surgery, bone marrow biopsies and fluorodeoxyglucose-positron emission tomography integrated with CT scanning confirmed that there was no other involvement. The patient did not receive chemotherapy, and there was no recurrence during the 24-month follow-up period. Hepatocellular carcinoma is the most common malignancy in patients with chronic hepatitis B, but rare tumors such as primary MALT lymphoma can also occur, so a careful approach is required for their differentiation.
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Affiliation(s)
- Hee Dong Koh
- Department of Internal Medicine, National Health Insurance
Service Ilsan Hospital, Goyang-shi, Republic of Korea
| | - Jong Won Choi
- Department of Internal Medicine, National Health Insurance
Service Ilsan Hospital, Goyang-shi, Republic of Korea,Jong Won Choi, Department of Internal
Medicine, National Health Insurance Service Ilsan Hospital, Baeksuk-1-dong 1232,
Ilsandong-ku, Goyang-shi 10444, Republic of Korea.
| | - Eun Kyung Kim
- Department of Pathology, National Health Insurance Service Ilsan
Hospital, Goyang-shi, Republic of Korea
| | - Sumi Park
- Department of Radiology, National Health Insurance Service Ilsan
Hospital, Goyang-shi, Republic of Korea
| | - Min Ji Kim
- Department of Internal Medicine, National Health Insurance
Service Ilsan Hospital, Goyang-shi, Republic of Korea
| | - Chun Kyon Lee
- Department of Internal Medicine, National Health Insurance
Service Ilsan Hospital, Goyang-shi, Republic of Korea
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Daniel T, Sweeney R, Haag A, Morrissey S. Diffuse Large B Cell Lymphoma Raising Suspicion for an Infection: A Case Report. Cureus 2023; 15:e34750. [PMID: 36909035 PMCID: PMC9998237 DOI: 10.7759/cureus.34750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 02/09/2023] Open
Abstract
Newly discovered liver lesions have a broad differential ranging from malignancy to infection. While tissue biopsy is the gold standard diagnostic modality, imaging can also aid in diagnosis. Hepatocellular carcinoma (HCC) can be diagnosed via imaging alone; however, masses suspicious for infection ultimately require biopsy and culture. We report a case of a 72-year-old male who presented with subjective fever, nausea, decreased appetite, dark urine, elevated liver function tests, and CT evidence of an exophytic liver mass. Differentials included infections such as hepatobiliary actinomycosis, abscess, solid malignancy, or lymphoma. Obtaining a definitive diagnosis with tissue biopsy endoscopically and percutaneously was quite difficult due to the location of the lesion around the porta hepatis. Subsequent laparoscopic biopsy revealed diffuse large B cell lymphoma (DLBCL).
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Affiliation(s)
- Tyrell Daniel
- Medicine Institute, Allegheny Health Network, Pittsburgh, USA
| | - Ryan Sweeney
- Medicine Institute, Allegheny Health Network, Pittsburgh, USA
| | - Aaron Haag
- Medicine Institute, Allegheny Health Network, Pittsburgh, USA
| | - Suzanne Morrissey
- Department of Gastroenterology and Hepatology, Allegheny Health Network, Pittsburgh, USA
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5
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Wang Q, Wu K, Zhang X, Liu Y, Sun Z, Wei S, Zhang B. Primary hepatopancreatobiliary lymphoma: Pathogenesis, diagnosis, and management. Front Oncol 2022; 12:951062. [PMID: 36110965 PMCID: PMC9469986 DOI: 10.3389/fonc.2022.951062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/08/2022] [Indexed: 11/28/2022] Open
Abstract
Primary hepatopancreatobiliary lymphoma (PHPBL) is extremely rare, which is defined as a lympho-proliferative disease confined to the hepatobiliary system and pancreas without any involvement of lymph nodes, bone marrow, or other organs. The clinical and imaging manifestations of PHPBL are variable and non-special, which are akin to those of tumors of the hepatobiliary and pancreatic systems. The overall prognosis and management of PHPBL differ from those of other tumors in the hepatobiliary system and pancreas. Proper diagnosis and prompt treatment are essential for improving clinical outcomes. Due to its rarity, the optimal treatment has not been issued. However, combination chemotherapy is considered as a standard treatment for them. This review provides an overview of the pathogenesis, diagnosis, pathology, and management of PHPBL and offers clinicians the diagnosis and management schedule for PHPBL.
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Affiliation(s)
- Qianwen Wang
- Department of Surgery, Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China
| | - Kangze Wu
- Department of Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xuzhao Zhang
- Department of Hematology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yang Liu
- Department of Surgery, Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China
| | - Zhouyi Sun
- Department of Surgery, Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China
| | - Shumei Wei
- Department of Pathology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Bo Zhang, ; Shumei Wei,
| | - Bo Zhang
- Department of Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Bo Zhang, ; Shumei Wei,
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Hai T, Zou LQ. Clinical management and susceptibility of primary hepatic lymphoma: A cases-based retrospective study. World J Clin Cases 2021; 9:9417-9430. [PMID: 34877277 PMCID: PMC8610872 DOI: 10.12998/wjcc.v9.i31.9417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/21/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The liver as a primary site of lymphoma is rarely seen, they are usually misdiagnosed as hepatocellular carcinoma, etc. In 2017, a review of primary hepatic lymphoma (PHL) was done in immunocompetent diffuse large B-cell lymphoma (DLBCL) patients. Yet questions that include treatment choosing or susceptibility of immunoincompetent patients remain disputable.
AIM To investigate the clinical characteristics of patients with PHL.
METHODS We collected PHL cases on PubMed, and extracted demographic and clinicopathological data to perform a systematic analysis. Survival analysis regarding age, lactate dehydrogenase (LDH), liver function abnormality (LFA), and treatment modalities were conducted. The Kaplan-Meier method and Cox regression were used to identify risk factors.
RESULTS Of 116 PHL patients with DLBCL (62.1%) as the most common subtype. Biopsy methods before surgery produced a 97% positive rate. Progression-free survival (PFS) was significantly shortened in patients with elevated LDH [Hazard ratio (HR): 3.076, 95% confidence interval (CI): 1.207-7.840, P = 0.018] or LFA (HR: 2.909, 95%CI: 1.135-7.452, P = 0.026). Univariate Cox regression analysis suggesting that LDH, liver function, B symptom, hepatosplenomegaly, and lesion were significantly associated with PHL patients survival (P < 0.05). Heavy disease burden was observed in deceased patients. A few PHL patients (3.4%) have slightly higher tumor markers.
CONCLUSION PHL patients with elevated LDH and LFA tend to have shorter PFS. Biopsy before treatment in undecided patients with no tumor markers exceeds upper limits has the most essential clinical significance, especially in immunoincompetent patients.
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Affiliation(s)
- Tao Hai
- Cancer Center, West China Hospital, Chengdu 610041, Sichuan Province, China
| | - Li-Qun Zou
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Nishikawa K, Katsuta K, Tanaka S, Fujibe K, Hattori A, Shiono Y, Oiwa M, Matsusaki S. Primary hepatic lymphoma diagnosed using endoscopic ultrasound-guided liver biopsy: a case report. J Med Case Rep 2021; 15:199. [PMID: 33896422 PMCID: PMC8073951 DOI: 10.1186/s13256-021-02791-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 03/16/2021] [Indexed: 12/29/2022] Open
Abstract
Background Because of the rarity of primary hepatic lymphomas, diagnosis of this disease entity may often be difficult, and performing a liver biopsy is the only way to establish a definitive diagnosis. Recently, endoscopic ultrasound-guided liver biopsy has emerged as a safe technique for obtaining liver tissue. However, there is no report on the use of endoscopic ultrasound-guided liver biopsy for diagnosing primary hepatic lymphomas. Case presentation An 85-year-old Asian man was admitted to our hospital because of multiple liver lesions without any identifiable primary tumor or extrahepatic lymphadenopathy. Serum tumor markers, including alpha-fetoprotein, were in the normal range. We provisionally diagnosed the patient with a cancer of unknown primary origin with liver metastases. An endoscopic ultrasound-guided fine needle liver biopsy of the tumor in the left lobe of the liver was performed using a transgastric approach, and histology revealed a primary hepatic lymphoma of a diffuse large B-cell lymphoma type. Conclusions Primary hepatic lymphomas are quite rare, and diagnosis is often difficult without performing a biopsy. Endoscopic ultrasound-guided liver biopsy is a useful diagnostic modality even in such cases.
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Affiliation(s)
- Kenichiro Nishikawa
- Department of Gastroenterology, Matsusaka Municipal Hospital, 1550, Tonomachi, Matsusaka, Mie, 515-8544, Japan.
| | - Koji Katsuta
- Department of Pathology, Matsusaka Municipal Hospital, 1550, Tonomachi, Matsusaka, Mie, 515-8544, Japan
| | - Syota Tanaka
- Department of Gastroenterology, Matsusaka Municipal Hospital, 1550, Tonomachi, Matsusaka, Mie, 515-8544, Japan
| | - Kodai Fujibe
- Department of Gastroenterology, Matsusaka Municipal Hospital, 1550, Tonomachi, Matsusaka, Mie, 515-8544, Japan
| | - Aiji Hattori
- Department of Gastroenterology, Matsusaka Municipal Hospital, 1550, Tonomachi, Matsusaka, Mie, 515-8544, Japan
| | - Yasunori Shiono
- Department of Gastroenterology, Matsusaka Municipal Hospital, 1550, Tonomachi, Matsusaka, Mie, 515-8544, Japan
| | - Michiaki Oiwa
- Department of Gastroenterology, Matsusaka Municipal Hospital, 1550, Tonomachi, Matsusaka, Mie, 515-8544, Japan
| | - Shimpei Matsusaki
- Department of Gastroenterology, Suzuka General Hospital, 1275-53, Yamanohana, Yasuzukacho, Suzuka, Mie, 513-8630, Japan
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Tsuji H, Yoshifuji H, Shindo T, Hishizawa M, Ishida A, Fujimoto M, Kitagori K, Akizuki S, Murakami K, Nakashima R, Hashimoto M, Tanaka M, Ohmura K. Primary hepatic lymphoma as other iatrogenic immunodeficiency-related lymphoproliferative disorders: a case report and review of the literature. Mod Rheumatol Case Rep 2021; 5:172-177. [PMID: 32985951 DOI: 10.1080/24725625.2020.1826627] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/04/2020] [Indexed: 06/11/2023]
Abstract
We report a case of 68-year-old man with stable polymyositis complicated with primary hepatic lymphoma (PHL) as other iatrogenic immunodeficiency-related lymphoproliferative disorders (OIIA-LPD). Multiple liver masses were diagnosed as diffuse large B-cell lymphoma (DLBCL) by biopsy. The LPD was associated with Epstein-Barr virus (EBV) reactivation, because EBV-DNA was detected in peripheral blood, and EBV antigen was detected in the tumour. He presented with high fever, cytopenia and hyperferritinemia, suggesting hemophagocytosis. Only discontinuation of methotrexate and tacrolimus resulted in a dramatic regression of the liver masses and improvement of fever and cytopenia. We review six cases of OIIA-LPD localised in the liver. All cases were DLBCL; 4/6 cases (67%) were positive for EBV staining, and 2/6 cases (33%) were improved after the discontinuation of immunosuppressants. Screening for EBV in blood and liver tumour is important, when a patient in immunosuppressive status presented with liver masses.
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Affiliation(s)
- Hideaki Tsuji
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hajime Yoshifuji
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takero Shindo
- Department of Hematology/Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masakatsu Hishizawa
- Department of Hematology/Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ayami Ishida
- Department of Diagnostic Pathology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masakazu Fujimoto
- Department of Diagnostic Pathology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koji Kitagori
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuji Akizuki
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kosaku Murakami
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ran Nakashima
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Motomu Hashimoto
- Department of the Control for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masao Tanaka
- Department of the Control for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koichiro Ohmura
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Abstract
Hepatic abnormalities in patients with lymphoproliferative disorders are common and can occur from direct infiltration by abnormal cells, bile duct obstruction, paraneoplastic syndrome, hemophagocytic syndrome, drug-induced liver injury, opportunistic infections, and reactivation of viral hepatitis. Hepatic involvement by lymphoma is often in association with systemic disease and rarely seen as a primary hepatic lymphoma. Vanishing bile duct syndrome is a well-known complication of Hodgkin disease. Antiviral prophylaxis for hepatitis B virus (HBV) reactivation is recommended for all HBsAg+ patients undergoing chemotherapy and all resolved HBV patients undergoing rituximab therapy and stem cell transplantation.
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Affiliation(s)
- Chalermrat Bunchorntavakul
- Division of Gastroenterology and Hepatology, Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Rajavithi Road, Ratchathewi, Bangkok 10400, Thailand; Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - K Rajender Reddy
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Park JE, Lee KM, Choi HY, Ahn SE, You MW. Methotrexate-associated primary hepatic lymphoma and cranial neuropathy in a patient with rheumatoid arthritis: A case report with clinical follow-up over a 7-year period. Medicine (Baltimore) 2019; 98:e14997. [PMID: 31027052 PMCID: PMC6831240 DOI: 10.1097/md.0000000000014997] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
RATIONALE Rheumatoid arthritis (RA) shows a variable clinical expression in patients. Articular disease is common manifestation, but patients may rarely present with extra-articular manifestation such as cranial neuropathy. Also, primary hepatic lymphoma (PHL) has rarely been reported in patient treated with immunosuppressive drug such as methotrexate (MTX) for RA. We herein describe a case of cranial neuropathy and MTX-related PHL in a woman receiving MTX for RA. PATIENT CONCERNS A 73-year-old women received MTX treatment for more than 5 years, presented with recurrent cranial neuropathies. During therapy of cranial neuropathies, liver enzyme levels were elevated. DIAGNOSES The patient was diagnosed as RA by laboratory examination. A series of examinations had been launched to evaluate any possible cause of the extra-articular manifestation of the patient including ultrasound, computed tomography, magnetic resonance image (MRI) and positron emission tomography of the liver and MRI of the brain. Finally, the patient diagnosed as MTX-associated PHL and cranial neuropathy. INTERVENTIONS The patient underwent 4-year MTX therapy for RA at first with prednisolone. After that, she had been treated with cyclophosphamide therapy for cranial neuropathy. The liver biopsy was performed for hepatic lesion. OUTCOMES MTX was discontinued, but no improvement of PHL and elevated liver enzyme was observed during the 3 weeks. The patient received 6 cycles of chemotherapy for 3 months and achieved complete remission including PHL and cranial neuronal lesion with symptom. No instances of relapse have occurred in 2 years of follow-up. LESSONS The present case is the extremely rare case in which MTX-related PHL and cranial neuropathy were involved together in the RA patient. It is necessary to examine long-term follow up hepatic and neurologic examinations that patient had a long history of receiving MTX therapy for RA.
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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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12
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Bao C, Wei J, Zhao X, Lin L, Chen D, Liu K, Qian W, Anas JM, Zhao K. Prognostic value of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography in primary hepatic mucosa-associated lymphoid tissue lymphoma: A case report and review of the literature. Medicine (Baltimore) 2018; 97:e9877. [PMID: 29517697 PMCID: PMC5882437 DOI: 10.1097/md.0000000000009877] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Primary hepatic mucosa-associated lymphoid tissue (MALT) lymphoma is extremely rare and we herein report a case of a patient suffering from primary hepatic MALT lymphoma with concomitant hepatitis B virus infection. DIAGNOSTIC MODALITIES AND OUTCOME Double masses were found in a 59-year-old Chinese female patient. We reported the laboratory results, computed tomography (CT) and fluorine-18-fluorodeoxyglucose (F-FDG) positron emission tomography (PET)/CT images among other findings. As far as we know, only 9 cases have been reported till now using F-FDG PET/CT imaging. Our patient's lesions were found to conform to standard uptake values of FDG. CONCLUSION It indicates that hepatic MALT lymphoma can be studied with F-FDG PET/CT like other F-FDG-avid lymphomas. It was also noted that delayed-time-point FDG PET imaging may further improve the detection of the MALT lymphoma in liver. Although the patient in this case refused further treatment, potential management options, including rituximab, which is also discussed in this review.
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Affiliation(s)
- Changqian Bao
- Lymphoma center, the First Affiliated Hospital
- Program in Clinical Medicine, School of Medicine, Zhejiang University, Zhejiang, China
| | - Juyin Wei
- Lymphoma center, the First Affiliated Hospital
| | - Xin Zhao
- PET center, the First Affiliated Hospital, Medical School of Zhejiang University
| | - Lili Lin
- PET center, the First Affiliated Hospital, Medical School of Zhejiang University
| | - Donghe Chen
- PET center, the First Affiliated Hospital, Medical School of Zhejiang University
| | - Kanfeng Liu
- PET center, the First Affiliated Hospital, Medical School of Zhejiang University
| | - Wenbin Qian
- Lymphoma center, the First Affiliated Hospital
| | - Jhurry Muhummad Anas
- Program in Clinical Medicine, School of Medicine, Zhejiang University, Zhejiang, China
| | - Kui Zhao
- PET center, the First Affiliated Hospital, Medical School of Zhejiang University
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Kang N, Kuo Y, Wu H, Chen W, Huang C, Chuang S, Feng Y. Primary hepatic diffuse large B-cell lymphoma with favorable response to immunochemotherapy. Journal of Cancer Research and Practice 2017; 4:139-142. [DOI: 10.1016/j.jcrpr.2017.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Abstract
Background and Aims: Non-Hodgkin lymphoma (NHL) of the liver is a rare lymphoid malignancy, accounting for less than 1% of extranodal lymphomas. Methods: I conducted an analysis of the U.S Surveillance, Epidemiology, and End Results (SEER) database to evaluate the histological subtypes and the survival outcomes of 785 cases with hepatic NHL between 1973 and 2012. Results: There were 785 of 312 459 cases with NHL had a first primary hepatic NHL (0.25%). Of the total 785 cases, the median age at diagnosis was 61 years (range 3-95 years) and male-female ratio of 1.7:1. The most common subtype was diffuse large B cell lymphoma (63.2%). In all patients, the median overall survival (OS) was 33 months (95%CI, 22-48 months). The 5-year OS rate for indolent B-cell NHLs was 62%, compared with 44% for an aggressive B-cell NHLs and 42% for T-cell NHLs. The median OS improved from 19 months in patients diagnosed in a period 1996-2000 to 60 months when diagnosed between 2006 and 2012 (p < .001). In a multivariable Cox regression analysis, the age ≥80 years (adjusted hazard ratio [aHR] 3.21, p < .001), male gender (aHR 1.26, p = .02), Black race (aHR, 1.70, p < .001), and T-cell NHL variants (aHR 1.73, p = .03) were unfavourable prognostic factors. Conclusion: NHL of the liver comprises about 0.3% of all NHLs and survival was improved in the recent calendar period.
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Affiliation(s)
- Mohamed Abd El-Fattah
- *Correspondence to: Mohamed Abd El-Fattah, Department of Internal Medicine, Faculty of Medicine, Suez Canal University, Ring Road, Ismailia City, Ismailia 41522, Egypt. Tel: +20-122-759-7912, +20-64-3215166, E-mail:
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15
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Liao SH, Chen YK, Yu SC, Wu MS, Wang HP, Tseng PH. An unusual case of primary hepatic lymphoma with dramatic but unsustained response to bendamustine plus rituximab and literature review. SAGE Open Med Case Rep 2017; 5:2050313X17709190. [PMID: 28596829 PMCID: PMC5448865 DOI: 10.1177/2050313x17709190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 04/17/2017] [Indexed: 12/18/2022] Open
Abstract
Objectives: Primary hepatic lymphoma is an uncommon cause of hepatic space-occupying lesions. Methods: We describe the case of a 73-year-old man with primary hepatic lymphoma, who presented with a low-grade fever and lower limb weakness which had progressed in the past 2 months. Results: Abdominal ultrasound and computed tomography showed multiple small hepatic tumors. Echo-guided biopsy of the hepatic tumor demonstrated primary hepatic diffuse large B cell lymphoma. Moreover, bone marrow was uninvolved, but the bone marrow smear disclosed hemophagocytosis, which is uncommon in diffuse large B cell lymphoma. Chemotherapy with bendamustine and rituximab treatment was initiated with a dramatic response: hepatic tumors markedly shrank in size shown by follow-up computed tomography and the patient returned to his normal life. Nevertheless, the response was sustained for only 8 months. Finally, the disease resisted further chemotherapy and this patient died of a severe Klebsiella pneumoniae infection. Conclusion: Chemotherapy with bendamustine and rituximab has shown a dramatic, but not durable, response in the present case with old age and multiple comorbidities.
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Affiliation(s)
- Sih-Han Liao
- National Taiwan University Cancer Center, Taipei, Taiwan
| | - Yin-Kai Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shan-Chi Yu
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ping-Huei Tseng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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16
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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] [What about the content of this article? (0)] [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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17
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Ugurluer G, Miller RC, Li Y, Thariat J, Ghadjar P, Schick U, Ozsahin M. Primary Hepatic Lymphoma: A Retrospective, Multicenter Rare Cancer Network Study. Rare Tumors 2016; 8:6502. [PMID: 27746888 PMCID: PMC5064304 DOI: 10.4081/rt.2016.6502] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 03/13/2016] [Indexed: 12/14/2022] Open
Abstract
Primary hepatic lymphoma (PHL) is a rare malignancy. We aimed to assess the clinical profile, outcome and prognostic factors in PHL through the Rare Cancer Network (RCN). A retrospective analysis of 41 patients was performed. Median age was 62 years (range, 23-86 years) with a male-to-female ratio of 1.9:1.0. Abdominal pain or discomfort was the most common presenting symptom. Regarding B-symptoms, 19.5% of patients had fever, 17.1% weight loss, and 9.8% night sweats. The most common radiological presentation was multiple lesions. Liver function tests were elevated in 56.1% of patients. The most common histopathological diagnosis was diffuse large B-cell lymphoma (65.9%). Most of the patients received Chop-like (cyclophosphamide, doxorubicin, vincristine, and prednisone) regimens; 4 patients received radiotherapy (dose range, 30.6-40.0 Gy). Median survival was 163 months, and 5- and 10-year overall survival rates were 77 and 59%, respectively. The 5- and 10-year disease-free and lymphoma-specific survival rates were 69, 56, 87 and 70%, respectively. Multivariate analysis revealed that fever, weight loss, and normal hemoglobin level were the independent factors influencing the outcome. In this retrospective multicenter RCN study, patients with PHL had a relatively better prognosis than that reported elsewhere. Multicenter prospective studies are still warranted to establish treatment guidelines, outcome, and prognostic factors.
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Affiliation(s)
- Gamze Ugurluer
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA; Department of Radiation Oncology, Acibadem Adana Hospital, Acibadem University, Adana, Turkey
| | - Robert C Miller
- Department of Radiation Oncology, Mayo Clinic, Rochester , MN, USA
| | - Yexiong Li
- Department of Radiation Oncology, Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing, China
| | - Juliette Thariat
- Department of Radiation Oncology, Center Antoine-Lacassagne , Nice, France
| | - Pirus Ghadjar
- Department of Radiation Oncology, Berlin Inselspital, Bern University Hospital and University of Bern, Charité Universitätsmedizin Berlin , Germany
| | - Ulrike Schick
- Department of Radiation Oncology, University Hospital , Brest, France
| | - Mahmut Ozsahin
- Department of Radiation Oncology, Lausanne University Hospital and University of Lausanne , Lausanne, Switzerland
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18
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Matsumoto R, Numata K, Doba N, Hara K, Chuma M, Fukuda H, Nozaki A, Tanaka K, Ishii Y, Maeda S. A case of multiple hepatic lesions associated with methotrexate-associated lymphoproliferative disorder. J Med Ultrason (2001) 2016; 43:545-51. [PMID: 27577564 DOI: 10.1007/s10396-016-0740-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 08/05/2016] [Indexed: 12/14/2022]
Abstract
Patients receiving methotrexate (MTX) for the treatment of autoimmune disease are at a high risk of developing lymphoproliferative disorders (LPD), the so-called methotrexate-associated lymphoproliferative disorders (MTX-LPD). We recently performed abdominal ultrasonography (US) in a patient with rheumatoid arthritis (RA) who had developed hepatic dysfunction during the course of MTX therapy; the examination revealed multiple well-demarcated hepatic tumors with slightly irregular borders, the largest one measuring 9 cm in diameter. In view of the finding of portal and hepatic veins perforating the tumor, we suspected a diagnosis of malignant lymphoma and performed a hepatic tumor biopsy. Histopathological examination of the biopsy specimens revealed a diagnosis of diffuse large B-cell lymphoma, and we made a final diagnosis of MTX-LPD. MTX treatment was discontinued, which resulted in rapid resolution of the lesions. Resolution of MTX-LPD can be obtained just by discontinuation of MTX treatment. In patients receiving MTX therapy who are found to have hepatic tumors perforated by the portal vein and/or hepatic vein on abdominal US, it is advisable to perform hepatic tumor biopsy to facilitate differential diagnosis of MTX-LPD and enable a definite diagnosis.
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Affiliation(s)
- Ruby Matsumoto
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.,Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Kazushi Numata
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
| | - Nobutaka Doba
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Koji Hara
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Makoto Chuma
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Hiroyuki Fukuda
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Akito Nozaki
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Katsuaki Tanaka
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Yoshimi Ishii
- Department of Hematology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Shin Maeda
- Division of Gastroenterology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
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19
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Liu Y, Jiang J, Wu Q, Zhang Q, Xu Y, Qu Z, Ma G, Wang X, Wang X, Jin W, Fang B. A Case of Primary Hepatic Lymphoma and Related Literature Review. Case Reports Hepatol 2016; 2016:6764121. [PMID: 27403354 DOI: 10.1155/2016/6764121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 04/30/2016] [Accepted: 05/22/2016] [Indexed: 01/30/2023] Open
Abstract
Objective. Primary hepatic lymphoma is a rare disease. And the clinical manifestations of this disease are nonspecific. The objective of this paper is to improve clinicians' understanding of this disease. Methods. We analyzed the clinical characteristics of a case of primary hepatic lymphoma in association with hepatitis B virus infection and reviewed the literature. Conclusion. The clinical manifestations of primary hepatic lymphoma are nonspecific. And it is easily misdiagnosed. Postoperative radiotherapy of patients with early stage was previously speculated to achieve favorable improvement. The application of targeted therapeutic drugs, chemotherapy, or combined local radiotherapy has become the first-line treatment strategy.
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20
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Kawashima K, Katakura K, Takahashi Y, Asama H, Fujiwara T, Kumakawa H, Ohira H. Primary rectal mucosa-associated lymphoid tissue lymphoma in a patient with previously identified primary biliary cirrhosis and secondary Sjögren's syndrome. Clin J Gastroenterol 2016; 9:124-8. [PMID: 27037914 PMCID: PMC4901106 DOI: 10.1007/s12328-016-0643-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 03/19/2016] [Indexed: 01/21/2023]
Abstract
An 83-year-old female began treatment with prednisolone and ursodeoxycholic acid at 62 years of age, following a diagnosis of primary biliary cirrhosis (PBC) and secondary Sjögren’s syndrome (SjS). With persisting bloody stools, the patient underwent colonoscopy at 83 years of age. Histopathological evaluation revealed mucosa-associated lymphoid tissue (MALT) lymphoma. The elevated rectal lesion resolved with rituximab treatment. We report this case because although patients with SjS are at increased risk of malignant lymphoma, primary rectal MALT lymphoma is very uncommon in association with PBC and secondary SjS.
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Affiliation(s)
- Kazumasa Kawashima
- Department of Gastroenterology, Public Soma General Hospital, Fukushima, Japan.,Department of Gastroenterology and Rheumatology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Kyoko Katakura
- Department of Gastroenterology and Rheumatology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
| | - Yuta Takahashi
- Department of Gastroenterology, Public Soma General Hospital, Fukushima, Japan
| | - Hiroyuki Asama
- Department of Gastroenterology, Public Soma General Hospital, Fukushima, Japan.,Department of Gastroenterology and Rheumatology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Tatsuo Fujiwara
- Department of Gastroenterology and Rheumatology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Hiromi Kumakawa
- Department of Gastroenterology, Public Soma General Hospital, Fukushima, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology and Rheumatology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
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21
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Gorodetskiy V, Klapper W, Probatova N, Vasilyev V. Primary Diffuse Large B-Cell Lymphoma of the Liver in a Patient with Sjogren Syndrome. Case Rep Oncol Med 2016; 2016:2053257. [PMID: 26998372 DOI: 10.1155/2016/2053257] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 11/25/2015] [Accepted: 12/30/2015] [Indexed: 12/05/2022] Open
Abstract
Sjögren's syndrome (SS) has the highest incidence of malignant lymphoproliferative disorders transformation among autoimmune diseases. We present a case of extranodal high grade lymphoma of the liver in a 52-year-old patient with long history of SS. Lymphoma manifested with sharp significant pain in the right hypochondrium, weakness, and profuse night sweats. Contrast-enhanced computed tomography scan (CT-scan) of the abdomen revealed multiple low density foci with homogeneous structure and clear contours in both lobes of the liver. Histologically, proliferation of medium sized lymphoma cells with round-oval and slightly irregular nuclei with fine chromatin was shown. Immunohistochemical and molecular features of the tumors allowed diagnosis of diffuse large B-cell lymphoma (DLBCL). To exclude secondary liver lesion by non-Hodgkin lymphoma, chest and small pelvis CT-scan, endoscopy of upper and lower gastrointestinal tract and study of bone marrow were performed. After 8 cycles of R-CHOP chemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone), the complete remission was achieved, which persists after 45 months of follow-up. Primary hepatic lymphomas are extremely rare, and previously only low-grade hepatic lymphomas have been described in SS. To our knowledge, the patient described here represents the first reported case of DLBCL with primary liver involvement in SS.
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22
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Tabata R, Tabata C, Ishikawa T, Yasumizu R. Extranodal non-Hodgkin's lymphoma with multiple vertebral and hepatic lesions without involvement of lymph nodes. Spine J 2015; 15:e13-4. [PMID: 25982436 DOI: 10.1016/j.spinee.2015.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 04/24/2015] [Accepted: 05/07/2015] [Indexed: 02/03/2023]
Affiliation(s)
- Rie Tabata
- Department of Hematology and Oncology, Hyogo Prefectural Tsukaguchi Hospital, 6-8-17 Minamitsukaguchi, Amagasaki, Hyogo, 661-0012 Japan
| | - Chiharu Tabata
- Hyogo College of Medicine Cancer Center, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501 Japan
| | - Takami Ishikawa
- Department of Orthopedics, Hyogo Prefectural Tsukaguchi Hospital, 6-8-17 Minamitsukaguchi, Amagasaki, Hyogo, Japan
| | - Ryoji Yasumizu
- Department of Pathology, Hyogo Prefectural Tsukaguchi Hospital, 6-8-17 Minamitsukaguchi, Amagasaki, Hyogo, Japan
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23
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Gorodetskiy VR, Probatova NA, Vasilyev VI, Vardaev LI, Ipatkin RV, Gabunia ZR, Petukhova SV, Ivannikov IO. [Primary hepatic lymphoma in a female patient with Sjögren's disease: A case report and literature review]. TERAPEVT ARKH 2015; 87:90-94. [PMID: 26155625 DOI: 10.17116/terarkh201587590-94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The paper describes a case of primary hepatic diffuse large B-cell lymphoma in a 52-year-old woman with a 27-year history of Sjögren's disease. It gives the data available in the literature on the etiology, diagnosis, and morphological characteristics of primary hepatic lymphoma and touches upon the issues of differential diagnosis.
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Affiliation(s)
- V R Gorodetskiy
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - N A Probatova
- N.N. Blokhin Russian Cancer Research Center, Moscow, Russia
| | - V I Vasilyev
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - L I Vardaev
- N.A. Semashko Central Clinical Hospital Two, OAO 'RZhD', Moscow, Russia
| | - R V Ipatkin
- N.A. Semashko Central Clinical Hospital Two, OAO 'RZhD', Moscow, Russia
| | - Z R Gabunia
- N.A. Semashko Central Clinical Hospital Two, OAO 'RZhD', Moscow, Russia
| | - S V Petukhova
- Central Clinical Hospital with Polyclinic, Department for Presidential Affairs of the Russian Federation, Moscow, Russia
| | - I O Ivannikov
- Central Clinical Hospital with Polyclinic, Department for Presidential Affairs of the Russian Federation, Moscow, Russia
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24
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Kawahara A, Tsukada J, Yamaguchi T, Katsuragi T, Higashi T. Reversible methotrexate-associated lymphoma of the liver in rheumatoid arthritis: a unique case of primary hepatic lymphoma. Biomark Res 2015; 3:10. [PMID: 25964853 PMCID: PMC4426646 DOI: 10.1186/s40364-015-0035-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 04/28/2015] [Indexed: 12/14/2022] Open
Abstract
Primary hepatic lymphoma (PHL) is an extremely rare disease, frequently associated with viruses such as hepatitis B virus (HBV), hepatitis C virus (HCV), and human immune deficiency virus (HIV). On the other hand, an increased risk of lymphoproliferative disorders (LPD) has been demonstrated in patients treated with immunosuppressive drugs such as methotrexate (MTX) for rheumatoid arthritis (RA). The role of Epstein-Barr virus (EBV) has been discussed in the pathogenesis of the immunodeficiency-associated LPDs. We here describe a RA patient, who developed PHL during RA treatment. The patient was a 64 year-old Japanese male with a 2-year history of RA, who had been treated with MTX at weekly dose of 8–14 mg for 2 years and infliximab (IFX) for 7 months. He presented with a 2 month history of generalized malaise, right hypochondrium pain and fever. Contrast-enhanced computed tomography (CECT) of the abdomen showed multiple irregular and nodular liver masses with a maximum of 13 cm in diameter on the right liver. Biopsy specimens demonstrated CD20-positve diffuse large B-cell lymphoma (DLBCL), but EBV was not identified by EBV-encoded RNA in situ hybridization. Serology for HBV, HCV, human T-cell leukemia virus I (HTLV-I), and HIV was negative. His symptoms disappeared following discontinuation of RA treatment including MTX. A drastic regression of the tumor masses was further obtained without cytotoxic chemotherapy. In addition, although the patient had no past history of liver dysfunction before MTX therapy, persistent elevation of liver enzymes has been observed during MTX treatment. These findings show a causative role of MTX in the development of reversible PHL in the patient.
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Affiliation(s)
- Ai Kawahara
- Hematology, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8556 Japan
| | - Junichi Tsukada
- Hematology, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8556 Japan
| | - Takahiro Yamaguchi
- Hematology, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8556 Japan
| | - Takefumi Katsuragi
- Hematology, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8556 Japan
| | - Takehiro Higashi
- Hematology, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8556 Japan
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25
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Zhang KJ, Chen S, Chen JL, Dong LH. Complete response to comprehensive treatment of a primary hepatic diffuse large B cell lymphoma: A case report. Oncol Lett 2015; 9:1557-1560. [PMID: 25789000 PMCID: PMC4356420 DOI: 10.3892/ol.2015.2920] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 12/16/2014] [Indexed: 01/20/2023] Open
Abstract
Primary hepatic lymphoma (PHL) is an uncommon lymphoid tumor with varied clinical features and treatment outcome. In the present study, the case of a 56-year-old patient with PHL and no clinical presentation was reported. During a routine physical examination, multiple hypodense nodules were incidentally detected in right lobes of the liver and hepatic portal in an abdominal computed tomography scan. A liver biopsy revealed the presence of a non-Hodgkin's lymphoma diffuse large B cell type that was CD20-positive, followed by the diagnosis of a PHL. The patient was treated with R-CHOP, radiotherapy and R-Hyper-CVAD/R-HD MTX-ara-C, and complete remission was achieved.
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Affiliation(s)
- Kai Jing Zhang
- Department of Hematology, Taizhou Central Hospital, Taizhou, Zhejiang 380000, P.R. China
| | - Sai Chen
- Department of Hematology, Taizhou Central Hospital, Taizhou, Zhejiang 380000, P.R. China
| | - Jian Lin Chen
- Department of Hematology, Taizhou Central Hospital, Taizhou, Zhejiang 380000, P.R. China
| | - Li Hua Dong
- Department of Hematology, Henan Provincial Tumor Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan 450008, P.R. China
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26
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Tatsumi G, Ukyo N, Hirata H, Tsudo M. Primary hepatic lymphoma in a patient with rheumatoid arthritis treated with methotrexate. Case Rep Hematol. 2014;2014:460574. [PMID: 25610674 PMCID: PMC4290657 DOI: 10.1155/2014/460574] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 12/12/2014] [Indexed: 12/13/2022] Open
Abstract
Primary hepatic lymphoma (PHL) has rarely been reported in patients with immunosuppression. We herein describe a case of Epstein-Barr virus- (EBV-) positive PHL in a 67-year-old Japanese woman receiving methotrexate (MTX) treatment for rheumatoid arthritis (RA). The patient, who had been receiving MTX therapy for more than 6 years, presented with low-grade fever and abdominal pain. Initial laboratory tests showed mildly elevated liver enzymes with normal levels of alpha-fetoprotein and carcinoembryonic antigen, and computed tomography scans revealed multiple hepatic tumors with no lymph-node swelling. Examination of liver specimens obtained via ultrasonography-guided needle biopsy indicated EBV-positive diffuse large B cell lymphoma; therefore, she was diagnosed with PHL. MTX was discontinued, and she was carefully monitored thereafter owing to the prolonged history of MTX administration for RA. Rapid progression of PHL was observed; therefore 10 days after the PHL diagnosis, she received 6 cycles of R-THP-COP (rituximab, cyclophosphamide, pirarubicin, vincristine, and prednisolone) therapy and achieved complete remission for more than 1 year. Although MTX-associated lymphoproliferative disorders often show remission after withdrawal of MTX, early diagnosis and treatment are essential for PHL in patients with RA treated with MTX, because of the aggressive nature of the disease.
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27
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Swadley MJ, Deliu M, Mosunjac MB, Gunthel CJ, Nguyen MLT, Hanley KZ. Primary and secondary hepatic lymphomas diagnosed by image-guided fine-needle aspiration: a retrospective study of clinical and cytomorphologic findings. Am J Clin Pathol 2014; 141:119-27. [PMID: 24343745 DOI: 10.1309/ajcpe58escqdzfkx] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES To explore the diagnosis of hematolymphoid malignancies of the liver (hepatic lymphoma [HeL]) by image-guided fine-needle aspiration (FNA), which can often be difficult due to a low index of suspicion and nonspecific patient presentations, especially in the rare cases where the liver is the only site of disease (primary HeL [PHeL]). Understanding the clinical setting in which such lesions arise, as well as the cytomorphologic findings, may assist cytopathologists in making an accurate diagnosis and triaging samples for ancillary studies. METHODS In this retrospective study of 32 patients with HeL, the largest such study to our knowledge, we review the clinical and diagnostic features of HeL. RESULTS HeL and especially PHeL most commonly show a diffuse large B-cell lymphoma phenotype and have a poor prognosis (median survival of seven months). PHeL is strongly associated with human immunodeficiency virus infection (12/16 patients). CONCLUSIONS Image-guided FNA with immediate evaluation is a reliable means to obtain diagnostic material and triage for ancillary tests.
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Affiliation(s)
- Matthew J. Swadley
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, GA
| | - Matea Deliu
- Department of Pathology, Grady Memorial Hospital, Atlanta, GA
| | - Marina B. Mosunjac
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, GA
- Department of Pathology, Grady Memorial Hospital, Atlanta, GA
| | | | | | - Krisztina Z. Hanley
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, GA
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28
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Mastoraki A, Stefanou MI, Chatzoglou E, Danias N, Kyriazi M, Arkadopoulos N, Smyrniotis V. Primary hepatic lymphoma: dilemmas in diagnostic approach and therapeutic management. Indian J Hematol Blood Transfus 2013; 30:150-4. [PMID: 25114399 DOI: 10.1007/s12288-013-0263-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Accepted: 04/19/2013] [Indexed: 02/05/2023] Open
Abstract
Primary hepatic lymphoma (PHL) is a very rare malignancy and is characterized by liver involvement at presentation with no affectation of the spleen, lymph nodes, peripheral blood, bone marrow, or other tissues until at least 6 months after diagnosis. PHL should be considered in the differential diagnosis in a patient with space-occupying liver lesions and normal levels of alpha-fetoprotein and CEA. A computed tomography (CT) scan is the commonly used modality for staging lymphomas. The widespread use of positron emission tomography/CT results in the improvement in the accuracy of detecting the extent of disease, response evaluation, and prognostication. The liver biopsy, due to its pleomorphic appearances in the needle biopsy specimen, can be very challenging. Current literature favors the combination of chemotherapy as the frontline treatment for its least invasiveness and improved survival. Favorable prognosis of PHL can be obtained by early surgery combined with chemotherapy in strictly selected patients. However, the optimal therapy is still unclear and the outcomes are uncertain.
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Affiliation(s)
- Aikaterini Mastoraki
- 4th Department of Surgery, Athens University, Medical School, ATTIKON University Hospital, 1 Rimini Str., 12462 Chaidari, Athens, Greece ; Gr. Lambraki 112-114, Piraeus, Athens, Greece
| | - Maria Ioanna Stefanou
- 4th Department of Surgery, Athens University, Medical School, ATTIKON University Hospital, 1 Rimini Str., 12462 Chaidari, Athens, Greece
| | - Evangelos Chatzoglou
- 4th Department of Surgery, Athens University, Medical School, ATTIKON University Hospital, 1 Rimini Str., 12462 Chaidari, Athens, Greece
| | - Nikolaos Danias
- 4th Department of Surgery, Athens University, Medical School, ATTIKON University Hospital, 1 Rimini Str., 12462 Chaidari, Athens, Greece
| | - Maria Kyriazi
- 4th Department of Surgery, Athens University, Medical School, ATTIKON University Hospital, 1 Rimini Str., 12462 Chaidari, Athens, Greece
| | - Nikolaos Arkadopoulos
- 4th Department of Surgery, Athens University, Medical School, ATTIKON University Hospital, 1 Rimini Str., 12462 Chaidari, Athens, Greece
| | - Vasilios Smyrniotis
- 4th Department of Surgery, Athens University, Medical School, ATTIKON University Hospital, 1 Rimini Str., 12462 Chaidari, Athens, Greece
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Somaglino C, Pramaggiore P, Polastri R. Primary hepatic lymphoma in a patient with chronic hepatitis B and C infection: diagnostic pitfalls and therapeutic challenge. Updates Surg 2014; 66:89-90. [PMID: 23529561 DOI: 10.1007/s13304-013-0208-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 03/16/2013] [Indexed: 10/27/2022]
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30
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Haws B, Zhang D, Damjanov I, Forster J, Cui W. Diffuse large B cell lymphoma (DLBCL) presenting as a spindle cell tumor of the liver: a case report. J Hematop 2013. [DOI: 10.1007/s12308-012-0174-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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31
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Murakami J, Shimizu Y. Hepatic manifestations in hematological disorders. Int J Hepatol 2013; 2013:484903. [PMID: 23606974 DOI: 10.1155/2013/484903] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 02/11/2013] [Accepted: 02/11/2013] [Indexed: 12/17/2022] Open
Abstract
Liver involvement is often observed in several hematological disorders, resulting in abnormal liver function tests, abnormalities in liver imaging studies, or clinical symptoms presenting with hepatic manifestations. In hemolytic anemia, jaundice and hepatosplenomegaly are often seen mimicking liver diseases. In hematologic malignancies, malignant cells often infiltrate the liver and may demonstrate abnormal liver function test results accompanied by hepatosplenomegaly or formation of multiple nodules in the liver and/or spleen. These cases may further evolve into fulminant hepatic failure.
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32
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De Re V, Caggiari L, Garziera M, De Zorzi M, Repetto O. Molecular signature in HCV-positive lymphomas. Clin Dev Immunol. 2012;2012:623465. [PMID: 22952554 PMCID: PMC3431075 DOI: 10.1155/2012/623465] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 06/29/2012] [Accepted: 07/03/2012] [Indexed: 12/12/2022]
Abstract
Hepatitis C virus (HCV) is a positive, single-stranded RNA virus, which has been associated to different subtypes of B-cell non-Hodgkin lymphoma (B-NHL). Cumulative evidence suggests an HCV-related antigen driven process in the B-NHL development. The underlying molecular signature associated to HCV-related B-NHL has to date remained obscure. In this review, we discuss the recent developments in this field with a special mention to different sets of genes whose expression is associated with BCR coupled to Blys signaling which in turn was found to be linked to B-cell maturation stages and NF-κb transcription factor. Even if recent progress on HCV-B-NHL signature has been made, the precise relationship between HCV and lymphoma development and phenotype signature remain to be clarified.
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33
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Ko HM, Hernandez-Prera JC, Zhu H, Dikman SH, Sidhu HK, Ward SC, Thung SN. Morphologic features of extrahepatic manifestations of hepatitis C virus infection. Clin Dev Immunol. 2012;2012:740138. [PMID: 22919404 PMCID: PMC3420144 DOI: 10.1155/2012/740138] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 06/28/2012] [Indexed: 12/18/2022]
Abstract
Cirrhosis and hepatocellular carcinoma are the prototypic complications of chronic hepatitis C virus infection in the liver. However, hepatitis C virus also affects a variety of other organs that may lead to significant morbidity and mortality. Extrahepatic manifestations of hepatitis C infection include a multitude of disease processes affecting the small vessels, skin, kidneys, salivary gland, eyes, thyroid, and immunologic system. The majority of these conditions are thought to be immune mediated. The most documented of these entities is mixed cryoglobulinemia. Morphologically, immune complex depositions can be identified in small vessels and glomerular capillary walls, leading to leukoclastic vasculitis in the skin and membranoproliferative glomerulonephritis in the kidney. Other HCV-associated entities include porphyria cutanea tarda, lichen planus, necrolytic acral erythema, membranous glomerulonephritis, diabetic nephropathy, B-cell non-Hodgkin lymphomas, insulin resistance, sialadenitis, sicca syndrome, and autoimmune thyroiditis. This paper highlights the histomorphologic features of these processes, which are typically characterized by chronic inflammation, immune complex deposition, and immunoproliferative disease in the affected organ.
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