Tammana Venkata S, Begum Rehana, Oneal Patricia, Karpurapu Hemamalini, Muley Amruta, Yeruva Sri Lakshmi Hyndavi, Dunmore-Griffith Jacquelyn, Mekonen Eyasu, Hasan Nabhani
Department of Internal Medicine, Howard University Hospital, 2041 Georgia Avenue, NW, Washington, DC 20060, USA.
Department of Radiation Oncology, Howard University Hospital, Washington, DC, USA.
Case Rep Gastrointest Med. 2014;2014:724256. doi: 10.1155/2014/724256. Epub 2014 Apr 29.
Lymphomas arising in the liver are extremely rare. Here, we describe a case of Hepatitis C virus infection with primary hepatic lymphoma (PHL) presenting with hyperbilirubinemia. A 45-year-old African American male presented with abdominal pain, pruritus, and itching for two days. CT of abdomen and pelvis with contrast showed numerous masses in the liver. The liver biopsy was consistent with diffuse large B cell lymphoma (DLBCL). Conventional chemotherapy was avoided initially because of hyperbilirubinemia. Hence, radiation therapy was given initially to reduce his bilirubin levels and tumor size. The patient was able to complete six cycles of rituximab combined with cyclophosphamide, adriamycin, vincristine, and prednisone (R-CHOP) chemotherapy and achieved a complete response verified by positron emission tomography-computed tomography (PET-CT). PHL should be considered when there are numerous space occupying liver lesions seen on imaging. Hyperbilirubinemia may be a reason for delay in treatment for some of these patients. Hence, the role of radiation therapy prior to treatment with R-CHOP is an alternative to management for stage IV diffuse large B cell lymphoma.
肝脏发生的淋巴瘤极为罕见。在此，我们描述一例丙型肝炎病毒感染合并原发性肝淋巴瘤（PHL）且伴有高胆红素血症的病例。一名45岁的非裔美国男性因腹痛、瘙痒两天前来就诊。腹部和盆腔增强CT显示肝脏有大量肿块。肝脏活检结果符合弥漫性大B细胞淋巴瘤（DLBCL）。由于高胆红素血症，最初避免了常规化疗。因此，最初给予放射治疗以降低其胆红素水平和肿瘤大小。该患者能够完成六个周期的利妥昔单抗联合环磷酰胺、阿霉素、长春新碱和泼尼松（R-CHOP）化疗，并通过正电子发射断层扫描-计算机断层扫描（PET-CT）证实达到完全缓解。当影像学检查发现肝脏有大量占位性病变时，应考虑PHL。高胆红素血症可能是部分此类患者治疗延迟的原因。因此，在使用R-CHOP治疗之前进行放射治疗，是IV期弥漫性大B细胞淋巴瘤治疗的一种替代方案。
