Longerich T, Schirmacher P, Dienes H P, Stein H, Loddenkemper C
Pathologisches Institut, Universitätsklinikum, Im Neuenheimer Feld 220/221, 69120, Heidelberg.
Pathologe. 2006 Jul;27(4):263-72. doi: 10.1007/s00292-006-0838-x.
Primary hepatic lymphomas represent rare neoplasms, which are partly observed in association with chronic viral hepatitis, immunosuppression and autoimmune diseases. In contrast, secondary hepatic lymphomas are much more frequent and represent disseminated disease. Lymphomas involving the liver include, with decreasing frequency, diffuse large B-cell lymphoma, small lymphocytic lymphoma, Hodgkin's lymphoma, peripheral T-cell lymphoma, follicular lymphoma and extranodal marginal zone B-cell lymphoma. Many B-cell lymphomas in the liver reveal a characteristic infiltration pattern allowing a rapid and cost-effective diagnosis based on focused immunohistochemical analyses. In contrast, most T-cell lymphomas show a more diverse morphology, which is sometimes difficult to differentiate from a reactive condition. Therefore, additional molecular analyses are frequently necessary. The differential diagnosis includes hepatitis and inflammatory bile duct diseases, undifferentiated carcinoma, inflammatory myofibroblastic tumor as well as histiocytic and dendritic cell neoplasms.
原发性肝淋巴瘤是罕见的肿瘤,部分病例与慢性病毒性肝炎、免疫抑制及自身免疫性疾病相关。相比之下,继发性肝淋巴瘤更为常见,代表播散性疾病。累及肝脏的淋巴瘤,按发病率递减依次为弥漫性大B细胞淋巴瘤、小淋巴细胞淋巴瘤、霍奇金淋巴瘤、外周T细胞淋巴瘤、滤泡性淋巴瘤及结外边缘区B细胞淋巴瘤。肝脏中的许多B细胞淋巴瘤呈现特征性浸润模式,基于针对性免疫组化分析可实现快速且经济高效的诊断。相反,大多数T细胞淋巴瘤形态更为多样,有时难以与反应性病变相鉴别。因此,常常需要进行额外的分子分析。鉴别诊断包括肝炎和炎症性胆管疾病、未分化癌、炎性肌纤维母细胞瘤以及组织细胞和树突状细胞瘤。