Percutaneous liver biopsy: retrospective study of primary and secondary hepatic lymphoma in twenty-one patients

CLINICAL AND PATHOLOGICAL CHARACTERIZATION OF HEPATIC LYMPHOMAS: A RETROSPECTIVE SINGLE-CENTER STUDY

BACKGROUND

The incidence of hepatic lymphoma has been increasing recently and diagnosis can be challenging as clinical presentation and radiological findings are usually variable and non-specific.

OBJECTIVE

The aims of this study were to describe their main clinical, pathological and imaging characteristics and identify poor prognostic factors.

METHODS

A retrospective study that included all patients with histological diagnosis of liver lymphoma over a 10-year period at our center was performed.

RESULTS

A total of 36 patients were identified, with mean age of 56.6 years and male predominance (58%). There were three patients with primary liver lymphoma (8.3%) and 33 with secondary liver lymphoma (91.7%). The most common histological type was diffuse large B-cell lymphoma (33.3%). The most common clinical manifestations included fever, lymphadenopathy, weight loss, night sweats and abdominal discomfort; three patients (11.1%) were asymptomatic. Computed tomography scan revealed heterogenous radiological patterns including a single nodule (26.5%), multiple nodules (41.2%) or diffuse infiltration (32.4%). The mortality rate during follow-up was 55.6%. Higher levels of C-reactive protein (P=0.031) and absence of treatment response (P<0.001) were significantly associated with higher mortality.

CONCLUSION

Hepatic lymphoma is a rare disease that may involve liver as part of a systemic disease or, less commonly, be confined to this organ. Clinical presentation and radiological findings are often variable and non-specific. It is associated with high mortality and poor prognostic factors include higher levels of C-reactive protein and absence of response to treatment.

Clinicopathologic Features of Lymphoproliferative Neoplasms Involving the Liver

Background and Objectives: Primary hepatic lymphoproliferative neoplasms (PHL) are uncommon. This retrospective study is aimed to present the clinicopathological characteristics of PHL and compare to secondary hepatic lymphoproliferative neoplasms (SHL). Materials and Methods: Patients who were diagnosed with lymphoproliferative neoplasms involving the liver between January 2004 and December 2018 at a tertiary medical center in central Taiwan were included. The demographic and clinical data, radiological results and histopathological findings were reviewed and summarized. Results: We analyzed 36 patients comprising 6 PHL patients and 30 SHL patients. The median age at diagnosis tended to be younger in PHL than in SHL (59 vs. 63 years old, p = 0.349). Both entities had a small male predominance. The PHL patients tended to have higher levels of aspartate aminotransferase, alanine transaminase and serum albumin and lower levels of alkaline phosphatase, total bilirubin, γ-glutamyl transferase and lactate dehydrogenase compared with SHL, but there was no significant difference. Multiple mass lesions were the most common radiological finding in both groups. Diffuse large B-cell lymphoma was the predominant subtype in both groups (67% in PHL and 40% in SHL). The PHL patients had a longer median survival than the SHL patients (not reached vs. 3 months, p = 0.003). Conclusions: Although there was no significant difference between PHL and SHL in clinical, laboratory and radiological features, the SHL patients had very poor outcomes with a median survival time of 3 months. Effective therapies are urgently required for these patients.

ACR Appropriateness Criteria® Liver Lesion-Initial Characterization

Incidental liver masses are commonly identified on imaging performed for other indications. Since the prevalence of benign focal liver lesions in adults is high, even in patients with primary malignancy, accurate characterization of incidentally detected lesions is of paramount clinical importance. This document reviews utilization of various imaging modalities for characterization of incidentally detected liver lesions, discussed in the context of several clinical scenarios. For each clinical scenario, a summary of current evidence supporting the use of a given diagnostic modality is reported. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Hepatic involvement by T-cell neoplasms: a clinicopathologic study of 40 cases

Hepatic involvement by a T-cell neoplasm is rare and often challenging to diagnose in liver biopsies. We collected 40 cases of T-cell neoplasms diagnosed in the liver from five large academic institutions to assess the clinicopathologic features. The patients included 11 women and 29 men, with a median age of 54 (range: 2-75) years and a high mortality rate (31/37, 83.8%). Fourteen (35%) patients were diagnosed with hepatosplenic T-cell lymphoma (HSTCL), 13 (32.5%) peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS), and 13 (32.5%) other types of T-cell neoplasms. Patients with HSTCL were much younger and had worse survival than PTCL-NOS and other T-cell neoplasms (P < 0.05). On imaging studies, 20 cases (50%) showed abnormalities, including 10 with mass lesions that correlated with normal or cholestatic pattern enzyme elevation. Histomorphological analysis revealed four main patterns; with the exception of mass forming lesions (pattern 4; n = 8), cases with sinusoidal predominant (pattern 1; n = 12), portal predominant with sinusoidal infiltrates (pattern 2; n = 13) or lobular aggregates (pattern 3; n = 5) demonstrated small to medium lymphocytes resembling a reactive/inflammatory process. In addition, we described two cases of T-cell large granular lymphocytic leukemia that mimicked HSTCL, and a case of aggressive post-transplant lymphoproliferative disorder that developed after chronic Epstein-barr virus (EBV) infection, suggesting the importance of EBV testing in some lymphoma cases. As the largest cohort of T-cell neoplasms in liver, our study provides critical data on disease frequency, distribution, and clinicopathologic features that are essential for accurate diagnosis.

Is Ultrasound-Guided Core Biopsy as Safe as Fine-Needle Aspiration, and Does It Add Significantly to the Diagnosis of Suspected Peritoneal Malignancy?

OBJECTIVES

We undertook this retrospective review to compare the safety and diagnostic yield of core biopsy (CB) compared to fine-needle aspiration (FNA) in patients with suspected peritoneal malignancy.

METHODS

This retrospective study included 35 patients who underwent ultrasound (US)-guided percutaneous biopsy of a peritoneal mass. Success rates of US-guided biopsy of these masses using the CB technique, FNA, or the combination of the two were compared. Outcomes of tissue adequacy, the final pathologic diagnosis, and complications were recorded. The binary outcome variable was adequate tissue obtained.

RESULTS

Adequate specimens were obtained in 94% (33 of 35) of the cases. There were 19 CBs, with 100% of samples sufficient for diagnosis (19 of 19). Thirty-one FNAs were performed, of which 7 were insufficient, with a diagnostic yield of 77% (24 of 31). There was a statistically significant difference between FNA and CB in providing more adequate tissue for diagnosis in our population (P = .035). There were no significant complications in either group.

CONCLUSIONS

The use of the CB technique when performing US-guided percutaneous biopsy of peritoneal masses provides better tissue for diagnosis compared to FNA. Additional benefits of CB, including genomic testing and tumor subtyping, make this technique a good addition to FNA, without significant complications.

Primary Hodgkin's lymphoma of liver in HIV-a case report and review of literature

Primary hepatic lymphoma (PHL) is a lymphoma presenting with predominant liver involvement at presentation in the early stage of lymphoma. It accounts to less than 0.4% of all extranodal lymphomas and usually occurs in immunocompromised states. It is more commonly of the non-Hodgkin's lymphoma of B cell variety. Hodgkin's lymphoma presenting as PHL has not been reported before. We report a 55-year-old HIV positive male presenting with an SOL in left lateral segments of liver having typical imaging characteristics of fibrolamellar HCC with normal serum AFP levels. Surgical resection was done and the histopathological analysis and immunohistochemistry of the specimen revealed it to be a Hodgkin's lymphoma. The patient was started on chemotherapy (ABVD regimen) along with highly active antiretroviral therapy (HAART). Primary lymphoma of liver can mimic HCC on imaging. Hence, in the background of an immunocompromised state like HIV with normal serum AFP levels, PHL should be suspected and liver biopsy can clinch the diagnosis.