Muthukrishnan Srinivasan, Amudhan Anbalagan, Rajendran Shanmugasundaram
Department of Surgical Gastroenterology, Rajiv Gandhi Government General Hospital & Madras Medical College, Chennai 600003, India.
AME Case Rep. 2018 May 10;2:21. doi: 10.21037/acr.2018.04.08. eCollection 2018.
Primary hepatic lymphoma (PHL) is a lymphoma presenting with predominant liver involvement at presentation in the early stage of lymphoma. It accounts to less than 0.4% of all extranodal lymphomas and usually occurs in immunocompromised states. It is more commonly of the non-Hodgkin's lymphoma of B cell variety. Hodgkin's lymphoma presenting as PHL has not been reported before. We report a 55-year-old HIV positive male presenting with an SOL in left lateral segments of liver having typical imaging characteristics of fibrolamellar HCC with normal serum AFP levels. Surgical resection was done and the histopathological analysis and immunohistochemistry of the specimen revealed it to be a Hodgkin's lymphoma. The patient was started on chemotherapy (ABVD regimen) along with highly active antiretroviral therapy (HAART). Primary lymphoma of liver can mimic HCC on imaging. Hence, in the background of an immunocompromised state like HIV with normal serum AFP levels, PHL should be suspected and liver biopsy can clinch the diagnosis.
原发性肝淋巴瘤（PHL）是一种在淋巴瘤早期表现为主要累及肝脏的淋巴瘤。它占所有结外淋巴瘤的比例不到0.4%，通常发生在免疫功能低下的状态。它更常见的是B细胞型非霍奇金淋巴瘤。此前尚未有霍奇金淋巴瘤表现为PHL的报道。我们报告一例55岁HIV阳性男性，其肝脏左外侧段有一个占位性病变（SOL），具有纤维板层型肝癌的典型影像学特征，血清甲胎蛋白（AFP）水平正常。进行了手术切除，标本的组织病理学分析和免疫组化显示为霍奇金淋巴瘤。患者开始接受化疗（ABVD方案）以及高效抗逆转录病毒治疗（HAART）。肝脏原发性淋巴瘤在影像学上可模仿肝癌。因此，在像HIV这样的免疫功能低下状态且血清AFP水平正常的背景下，应怀疑PHL，肝脏活检可确诊。
