Shiozawa Kazue, Watanabe Manabu, Ikehara Takashi, Matsukiyo Yasushi, Kikuchi Yoshinori, Kaneko Hironori, Okubo Yoichiro, Shibuya Kazutoshi, Igarashi Yoshinori, Sumino Yasukiyo
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokyo, Japan.
Division of Gastroenterological Surgery, Toho University Medical Center, Omori Hospital, Tokyo, Japan.
Case Rep Oncol. 2015 Feb 3;8(1):50-6. doi: 10.1159/000375118. eCollection 2015 Jan-Apr.
Primary hepatic marginal zone B-cell malignant lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) is extremely rare. We present a case in which a lesion was diagnosed as 2 contiguous tumors (MALT lymphoma and hemangioma) using contrast-enhanced ultrasonography (US) with sonazoid. There has been no previous case of contiguous hepatic MALT lymphoma and hemangioma. The present case was a female with no medical history. We detected a snowman-like appearance, which was a tumor of 15 mm in diameter with hypo- and hyper-echogenicities in the lateral and medial parts, respectively, in the Couinaud's segment (S6) of the liver on US. The tumor appeared as a single lesion with a low-density area in the unenhanced phase and prolonged enhancement in the equilibrium phases on dynamic CT. On MRI, the whole lesion showed a low-intensity signal on T1-weighted imaging, but isointensity in the lateral part and high intensity in the medial part were seen on T2-weighted imaging. On contrast-enhanced US, the lateral hypoechoic region was homogenously hyperenhanced in the early vascular phase, and the contrast medium was washed out after about 30 s; in contrast, the medial hyperechoic region was gradually stained from the margin toward the central region. The tumor showed a defect in both hypo- and hyperechoic regions in the postvascular phase. Hemangioma was suspected for the medial part based on the typical image findings, but the lateral part was not given a diagnosis. Thus, surgical resection was performed. The medial part was a hemangioma, and the lateral part was a MALT lymphoma by histopathological findings.
原发性肝黏膜相关淋巴组织边缘区B细胞恶性淋巴瘤（MALT淋巴瘤）极为罕见。我们报告一例使用声诺维增强超声检查诊断为两个相邻肿瘤（MALT淋巴瘤和血管瘤）的病例。此前尚无相邻的肝MALT淋巴瘤和血管瘤病例。该病例为一名无病史的女性。超声检查发现肝脏Couinaud段（S6）有一个雪人样肿物，直径15 mm，外侧部分为低回声，内侧部分为高回声。动态CT显示该肿物在平扫期为低密度区，平衡期强化延长，表现为单个病灶。MRI检查显示，整个病灶在T1加权成像上呈低信号，在T2加权成像上外侧部分呈等信号，内侧部分呈高信号。增强超声检查显示，外侧低回声区在早期血管期均匀性高增强，约30秒后造影剂消退；相比之下，内侧高回声区从边缘向中央区域逐渐染色。血管后期，肿物的低回声和高回声区域均显示充盈缺损。根据典型的影像表现，内侧部分怀疑为血管瘤，但外侧部分未明确诊断。因此，进行了手术切除。组织病理学检查结果显示，内侧部分为血管瘤，外侧部分为MALT淋巴瘤。
