Primary hepatic lymphoma presenting as pyogenic liver abscess:A case report

BACKGROUND Primary hepatic lymphoma(PHL)is a lymphoproliferative disorder confined to the liver without peripheral lymph node involvement and bone marrow invasion.PHL is extremely rare in clinical practice.The etiology and pathogenesis of PHL are largely unknown.There are no common standard protocols or guidelines for the treatment of PHL.CASE SUMMARY We report the case of a 66-year-old man who presented with fever and abdominal pain for three weeks.Computed tomography and magnetic resonance imaging scans showed a pyogenic liver abscess.The patient underwent a right posterior hepatectomy.The surgical pathology revealed aggressive B-cell lymphoma,with a primary consideration of diffuse large B-cell lymphoma of non-germinal center origin.CONCLUSION This article reviews the characteristics,mechanism and treatment of PHL and provides insight into the diagnosis of PHL.

Diagnosis and surgical treatment of primary hepatic lymphoma

AIM: To assess the benefi ts and limits of surgery for primary hepatic lymphoma (PHL), and probability of survival after postoperative chemotherapy. METHODS: A retrospective analysis was undertaken to determine the results of surgical treatment of PHL over the past 8 years. Only nine patients underwent such treatment. The detailed data of diagnosis, treatment, and prognosis were carefully studied. RESULTS: All patients were mistaken as having α-fetoprotein-negative hepatic cancer before pathological diagnosis. The mean delay time between initial symptoms and final diagnosis was 26.8 d (range:14-47 d). Hepatitis B virus infection was noted in 33.3% of these patients. Most of the lesions were found to be restricted to a solitary hepatic mass. The surgical procedure performed was left hepatectomy in five cases, including left lateral segmentectomy in three. Right hepatectomy was performed in three cases and combined procedures in one. One patient died on the eighth day after surgery,secondary to hepatic insufficiency. The cumulative 6-mo, 1-year, and 2-year survival rates after hepatic surgery were, respectively, 85.7%,71.4%, and 47.6%. One patient survived for>5 years after surgery without any signs of recurrence until latest follow-up, who received routine postoperative chemotherapy every month for 2 years and then regular follow-up. By univariate analysis, postoperative chemotherapy was a significant prognostic factor that influenced survival (P=0.006). CONCLUSION: PHL is a rare entity that is often misdiagnosed, and has a potential association with chronic hepatitis B infection. The prognosis is variable, with good response to early surgery combined with postoperative chemotherapy in strictly selected patients.

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

BACKGROUND： Hepatic lymphoma （HL） is categorized as primary and secondary hepatic lymphoma （PHL and SHL）. This disorder can present as hepatic mass or mass-like lesion. Chemotherapy often is the first line treatment for patients with HL. Thus, an accurate pre-management histological diagnosis is essential to potentially improve clinical outcomes. The present study was to explore the prevalence of HL in ultrasound guided liver biopsies for hepatic mass or mass-like lesions, to investigate HL associated clinicopathological features, to raise the awareness of early recognition and proper diagnosis of this entity, and to assess specimen adequacy in needle core biopsy. METHODS： Twenty-one cases of HL were enrolled. Clinical and pathological characteristics were evaluated, quality of biopsies was assessed and pertinent literature was reviewed. RESULTS： HL was diagnosed in 0.94% of 2242 liver biopsy cases with ambiguous clinical presentation, laboratory tests and image studies. There were two cases of PHL （0.09%）, and nineteen cases of SHL （0.85%）. Histopathologically, diffuse large B-cell lymphoma was the most common type, followed by B-cell lymphoma not otherwise specified, T-ceU lymphoma, Hodgkin＇s lymphoma, and B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma. Additionally, three lym- phocytic infiltration patterns were documented microscopically. The nodular infiltration was the most common type. CONCLUSIONS： HL is a rare entity and histopathology along with ancillary tests remains the only way to make the diagnosis.Clinicians＇ awareness of this entity and early liver biopsy are essential in patient management.

^(18)F-fluorodeoxyglucose PET/CT findings of a solitary primary hepatic lymphoma:A case report

Primary hepatic lymphoma is extremely rare,and only a few cases have been described on positron emission tomography(PET) or PET/computed tomography(PET/CT) imaging in the English literature.We report a case of a 55-year-old woman who presented with low-grade fever and weight loss of three months.On CT scanning,a mass was identified which appeared to be a hypoattenuating lesion,on ultrasonographic imaging,the mass was hypoechoic,therefore,liver abscess or hepatic metastasis from a gastrointestinal primary was initially suspected.Tumor markers such as alpha-fetoprotein,carcinoembryonic antigen and carbohydrate antigen 19-9 were within normal limits.PET/CT demonstrated a large abnormal ring-like hypermetabolic focus in the right liver lobe.The lesion was resected and the histo-pathological findings were consistent with lymphoma.The patient was discharged two weeks after surgery and did not receive any further treatment.After 25 mo follow-up,she is in good health.18F-fluorodeoxyglucose PET/CT is useful in confirming the diagnosis of primary hepatic lymphoma by demonstrating no other foci with high uptake in other parts of the body.

Clinical management and susceptibility of primary hepatic lymphoma:A cases-based retrospective study

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.

Application of superb microvascular imaging in focal liver lesions

AIM To explore the ability of superb microvascular imaging(SMI) in differential diagnosis of focal liver lesions(FLLs) and to compare SMI morphology findings to those of color Doppler ultrasound and enhanced imaging.METHODS Twenty-four patients with 31 FLLs were included in our study,with diagnoses of hemangioma(HE)(n = 17),hepatocellular carcinoma(HCC)(n = 5),metastatic lesions(n = 5),primary hepatic lymphoma(n = 1),focal nodular hyperplasia(FNH)(n = 2),and adenoma(n = 1). Nine lesions were pathologically diagnosed,and 22 lesions were radiologically confirmed,all of which were evaluated by at least two types of enhanced imaging techniques. All patients had undergone SMI. Patients were divided into subgroups based on pathological and radiological diagnoses to analyze SMI manifestations. We also compared the SMI manifestations of the most common malignant FLLs(HCCs and metastatic lesions) with those of the most common benign FLLs(HEs).RESULTS HEs were classified into three SMI subgroups: diffuse dot-like type(n = 6),strip rim type(n = 8),and nodular rim type(n = 3). The sizes of the three types of HEs were significantly different(P = 0.00,< 0.05). HCCs were classified into two subgroups: diffuse honeycomb type(n = 2) and non-specific type(n = 3). Four of the metastatic lesions were the strip rim type,and the other metastatic lesion was the thick rim type,which is the same as that of lymphoma. FNH was described as a spoke-wheel type,and adenoma as a diffuse honeycomb type. The SMI types of HCCs and metastatic lesions were significantly different from those of HEs(P = 0.048,< 0.05).CONCLUSION SMI technology enables microvascular evaluation of FLLs without using any contrast agent. For HEs,lesion size may affect SMI performance. SMI is able to provide useful information for differential diagnosis of HCCs and metastatic lesions from HEs.

Non-Hodgkin Lymphoma of the Liver:A US Population-based Analysis

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 NHLvariants (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.