Hepatic Lymphoma

Primary hepatic lymphoma (PHL) is a rare form of non-Hodgkin lymphoma (NHL) that primarily involves the liver, as opposed to a predominant lymph nodal or splenic involvement in other subtypes of NHL. The liver is the major reticuloendothelial organ, and hepatic involvement secondary to systemic NHL is common, such that 40% of patients with NHL have liver involvement. The majority of the patients with PHL report vague symptoms such as nausea, vomiting, upper abdominal pain or discomfort, and approximately one-third report constitutional symptoms including fever, myalgias, and weight loss. However, due to the low incidence with characteristically vague symptoms at the outset, patients with PHL often undergo extensive investigations before reaching up a definitive diagnosis. Diagnosis of PHL depends on a liver biopsy that should be compatible with the lymphoma and the absence of extrahepatic lymphoproliferative involvement. Primary hepatic lymphoma may often confound with other space-occupying liver lesions, namely hepatocellular carcinoma, hepatic adenoma, focal hyperplasia of the liver, and hepatic hemangioma. At times a hepatologist must address the rare possibility of PHL besides the common notably, hepatocellular carcinoma while approaching the space-occupying lesions of the liver.