Tokuyama K, Wada T, Moriwaki S, Kobasi H, Mandai K
Dept. of Int. Med., Shikoku Cancer Center Hospital.
Gan No Rinsho. 1989 Jan;35(1):74-80.
Reported are two cases of a malignant lymphoma that presented a liver injury in which death was brought on by hepatic failure. In both instances on admission, liver injury and hepatomegaly were noticed. Abdominal ultrasonography and computerized tomography, however, showed no SOL in the liver or any clear lymph node mass, though a bright echo and a diffuse low density was observed in one of the patients (Case 1). In spite of treatment that included prednisolone, the liver injury in both patients progressed towards hepatic failure. Severe jaundice increased rapidly in Case 1, and a disseminated intravascular coagulopathy complicated by jaundice was observed in the other patient (Case 2). Both autopsies revealed severe lymphoma cell infiltration into the liver, mainly in Glisson's capsule, and diffuse hepatic cell necrosis. Diagnostic imaging of the diffuse lymphoma infiltration into the liver proved very difficult, so that it was necessary to rely on a differential diagnosis, employing laboratory tests and a liver biopsy.
报告了两例恶性淋巴瘤患者出现肝损伤并因肝衰竭死亡的病例。两例患者入院时均发现有肝损伤和肝肿大。然而，腹部超声检查和计算机断层扫描显示肝脏内无实体瘤或明显的淋巴结肿块，不过其中一名患者（病例1）观察到有明亮回声和弥漫性低密度影。尽管采用了包括泼尼松龙在内的治疗方法，但两名患者的肝损伤均进展为肝衰竭。病例1中严重黄疸迅速加重，另一例患者（病例2）出现了伴有黄疸的弥散性血管内凝血。两次尸检均显示肝脏有严重的淋巴瘤细胞浸润，主要在肝门管区，并有弥漫性肝细胞坏死。肝脏弥漫性淋巴瘤浸润的诊断性影像学检查非常困难，因此有必要依靠实验室检查和肝活检进行鉴别诊断。
