Takeuchi Nobuhiro, Naba Kazuyoshi
Department of Gastroenterology, Kawasaki Hospital, Kobe, Hyogo 652-0042, Japan.
Department of Laboratory Medicine, Kawasaki Hospital, Kobe, Hyogo 652-0042, Japan.
Case Rep Gastrointest Med. 2014;2014:925307. doi: 10.1155/2014/925307. Epub 2014 Mar 16.
An 82-year-old woman presented with a high-grade fever of 40°C and was admitted to our institution for intensive examination and treatment. Noncontrast abdominal computed tomography (CT) revealed low-density masses at segments 5 and 8, suggestive of a liver abscess. On further examination, a contrast-enhanced abdominal CT showed a 30 × 30 mm mass with an enhanced margin at segment 8 in the arterial phase; the contrast agents were washed out in the venous phase. In addition, a 63 × 52 mm mass with a density lower than that of liver parenchyma was observed at segment 8 in the portal phase. On the basis of these findings, either a liver abscess or hepatocellular carcinoma was suspected. To confirm the diagnosis, a fine needle biopsy was scheduled. Histopathological analysis of the biopsied specimens confirmed the diagnosis of diffuse large B-cell lymphoma. Chemotherapy was not indicated owing to the patient's age and poor performance status; thus, best supportive care was planned. On day 22 after admission, the patient died of pneumonia. We experienced a case of PHL that was difficult to discriminate from a liver abscess. Imaging alone is insufficient to diagnose PHL; therefore, fine needle biopsy is recommended for a definitive diagnosis.
一名82岁女性因40°C的高热入院，在我院接受强化检查和治疗。腹部非增强计算机断层扫描（CT）显示5段和8段有低密度肿块，提示肝脓肿。进一步检查发现，腹部增强CT显示动脉期8段有一个30×30mm的肿块，边缘强化；静脉期造影剂被廓清。此外，门脉期在8段观察到一个63×52mm的肿块，其密度低于肝实质。基于这些发现，怀疑是肝脓肿或肝细胞癌。为明确诊断，安排了细针活检。活检标本的组织病理学分析确诊为弥漫性大B细胞淋巴瘤。由于患者年龄和身体状况较差，不适合进行化疗；因此，计划给予最佳支持治疗。入院后第22天，患者死于肺炎。我们遇到了一例难以与肝脓肿鉴别的原发性肝淋巴瘤病例。仅靠影像学检查不足以诊断原发性肝淋巴瘤；因此，建议进行细针活检以明确诊断。
