Maehara Naoki, Chijiiwa Kazuo, Makino Ichiro, Ohuchida Jiro, Kai Masahiro, Kondo Kazuhiro, Moriguchi Sayaka, Marutsuka Kousuke, Asada Yujiro
Department of Surgery 1, University of Miyazaki, School of Medicine, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
Surg Today. 2006;36(11):1019-23. doi: 10.1007/s00595-006-3286-6.
We report a case of reactive lymphoid hyperplasia (RLH) of the liver in a 72-year-old woman without any symptoms. To our knowledge, only 11 other cases of this disease have ever been reported. The lesion was found incidentally during a medical examination, as a hypoechoic mass in segment 3 of the liver on ultrasonography. The findings of computed tomography, magnetic resonance imaging, and angiography suggested a malignancy. Frozen section diagnosis of an intraoperative needle biopsy suggested malignant lymphoma, so we performed lateral segmentectomy of the liver. Macroscopically, the tumor was well defined, white, and firm. Microscopically, there was polymorphous lymphoplasmacytic infiltration, with various-sized and -shaped lymphoid follicles. Lymphocytic infiltration was also observed in the portal tracts around the nodular lesion. Immunohistochemical study revealed polyclonality, confirming a pathological diagnosis of RLH of the liver. We discuss the clinicopathologic characteristics of this unusual disease.
我们报告一例72岁无症状女性的肝脏反应性淋巴组织增生(RLH)病例。据我们所知,此前仅报告过11例该疾病。病变是在一次体检中偶然发现的,超声检查显示肝脏3段有一个低回声肿块。计算机断层扫描、磁共振成像和血管造影的结果提示为恶性肿瘤。术中针吸活检的冰冻切片诊断提示为恶性淋巴瘤,因此我们进行了肝脏左外叶切除术。大体上,肿瘤边界清晰,呈白色,质地坚硬。显微镜下,有多种形态的淋巴细胞和浆细胞浸润,伴有大小和形状各异的淋巴滤泡。在结节性病变周围的门静脉区域也观察到淋巴细胞浸润。免疫组织化学研究显示为多克隆性,证实了肝脏RLH的病理诊断。我们讨论了这种罕见疾病的临床病理特征。