Tanaka Taro, Saito Kazuhiro, Yunaiyama Daisuke, Matsubayashi Jun, Nagakawa Yuichi, Tanigawa Maki, Nagao Toshitaka
Department of Radiology, Tokyo Medical University, Tokyo 1600023, Japan.
Department of Anatomic Pathology, Tokyo Medical University, Tokyo 1600023, Japan.
World J Clin Cases. 2020 Nov 6;8(21):5313-5319. doi: 10.12998/wjcc.v8.i21.5313.
Reactive lymphoid hyperplasia (RLH) of the liver is a rare liver lesion. It is considered difficult to differentiate radiologically from hepatocellular carcinoma, metastatic liver tumor and other pathologies.
A 54-year-old woman presented to our hospital with RLH of the liver. The patient had a diagnosis of metastatic carcinoma of the liver from an unknown origin and subsequently underwent partial hepatectomy. However, histopathological analysis revealed RLH. The lesion showed perinodular enhancement in the arterial phase on contrast-enhanced computed tomography and magnetic resonance imaging. On diffusion-weighted imaging (DWI), we encountered linear hyperintensity along the portal tract consecutive to the liver lesion, which is a new characteristic radiologic finding. This finding corresponded to the lymphoid cell infiltration of the portal tract. Furthermore, there was strongly restricted diffusion on the apparent diffusion coefficient map. We used these characteristic radiologic findings to diagnose the lesion as a lymphoproliferative disease.
The linear hyperintensity consecutive to the liver lesion on DWI provided additional valuable diagnostic information.
肝脏反应性淋巴样增生(RLH)是一种罕见的肝脏病变。其在放射学上被认为难以与肝细胞癌、肝转移瘤及其他病变相鉴别。
一名54岁女性因肝脏RLH就诊于我院。该患者最初被诊断为来源不明的肝转移癌,随后接受了部分肝切除术。然而,组织病理学分析显示为RLH。在对比增强计算机断层扫描和磁共振成像中,病变在动脉期表现为结节周围强化。在扩散加权成像(DWI)上,我们在与肝脏病变相连的门静脉周围遇到线性高信号,这是一种新的特征性放射学表现。这一表现与门静脉周围的淋巴细胞浸润相对应。此外,在表观扩散系数图上存在强烈的扩散受限。我们利用这些特征性放射学表现将病变诊断为淋巴增殖性疾病。
DWI上与肝脏病变相连的线性高信号提供了额外有价值的诊断信息。