Resende Vivian, Oliveira Tatiane S, Gomes Rafael T, Laboissière Renato Santos, Tavares-Junior Wilson Campos, de Melo Couto Osvaldo Flávio
Department of Surgery, School of Medicine, The Federal University of Minas Gerais, Belo Horizonte, Brazil.
Int J Surg Case Rep. 2013;4(12):1165-8. doi: 10.1016/j.ijscr.2013.10.003. Epub 2013 Oct 17.
Primary hepatic lymphoma is a rare malignancy which misdiagnosis and mistreatment is very frequent. Differential diagnosis of the hepatic lesion, based on the noninvolvement of blood vessels, includes: fatty infiltration, cirrhosis, amyloid infiltration, primary hepatomas, and metastatic neoplasms.
We describe a case of a 69-year-old man who presented with 15% weight loss and general fatigue over the previous 9 months. Physical examination revealed hepatomegaly without lymphadenopathy or splenomegaly. Magnetic resonance imaging showed a 13cm×9cm×11cm tumor on the right liver associated with normal levels of alpha-fetoprotein (AFP) and carcinoembryonic antigen (CEA). After two negatives ultrasonography-guided needle liver biopsies, the third one showed diffuse infiltration of large sized lymphoid cells. Immunohistochemical findings demonstrated the B-lymphocyte lineage of the tumor. The patient received R-CHOP therapy (cyclophosphamide, doxorubicin, vincristine, prednisone, and rituximab) with good response.
It is important to recognize PHL because it responds favorably to chemotherapy and may have a better prognosis than hepatocellular carcinoma or metastatic disease of the liver. When imaging findings on CT scans and MRI are nonspecific, a biopsy is needed not only for a definitive diagnosis but also for identifying the immunophenotype of the PHL. This type of lesion is highly chemosensitive and early aggressive chemotherapy may result in sustained remission.
This case emphasizes the importance of effective recognition of PHL considering its good response to chemotherapy and the possibility of sustained remission if early aggressive treatment is implemented.
原发性肝淋巴瘤是一种罕见的恶性肿瘤，误诊和误治情况非常常见。基于血管未受累对肝脏病变进行鉴别诊断，包括：脂肪浸润、肝硬化、淀粉样浸润、原发性肝癌和转移性肿瘤。
我们描述了一例69岁男性患者，在过去9个月中体重减轻了15%，并伴有全身乏力。体格检查发现肝脏肿大，无淋巴结肿大或脾肿大。磁共振成像显示右肝有一个13cm×9cm×11cm的肿瘤，甲胎蛋白（AFP）和癌胚抗原（CEA）水平正常。在两次超声引导下经皮肝穿刺活检结果为阴性后，第三次活检显示有大淋巴细胞的弥漫性浸润。免疫组织化学检查结果证实肿瘤为B淋巴细胞谱系。患者接受了R-CHOP治疗（环磷酰胺、阿霉素、长春新碱、泼尼松和利妥昔单抗），反应良好。
认识原发性肝淋巴瘤很重要，因为它对化疗反应良好，预后可能比肝细胞癌或肝转移性疾病更好。当CT扫描和MRI的影像学表现不具有特异性时，不仅需要进行活检以明确诊断，还需要确定原发性肝淋巴瘤的免疫表型。这种类型的病变对化疗高度敏感，早期积极化疗可能导致持续缓解。
该病例强调了有效识别原发性肝淋巴瘤的重要性，考虑到其对化疗反应良好，以及如果实施早期积极治疗可能实现持续缓解。
