Nishikawa Kenichiro, Katsuta Koji, Tanaka Syota, Fujibe Kodai, Hattori Aiji, Shiono Yasunori, Oiwa Michiaki, Matsusaki Shimpei
Department of Gastroenterology, Matsusaka Municipal Hospital, 1550, Tonomachi, Matsusaka, Mie, 515-8544, Japan.
Department of Pathology, Matsusaka Municipal Hospital, 1550, Tonomachi, Matsusaka, Mie, 515-8544, Japan.
J Med Case Rep. 2021 Apr 26;15(1):199. doi: 10.1186/s13256-021-02791-9.
Because of the rarity of primary hepatic lymphomas, diagnosis of this disease entity may often be difficult, and performing a liver biopsy is the only way to establish a definitive diagnosis. Recently, endoscopic ultrasound-guided liver biopsy has emerged as a safe technique for obtaining liver tissue. However, there is no report on the use of endoscopic ultrasound-guided liver biopsy for diagnosing primary hepatic lymphomas.
An 85-year-old Asian man was admitted to our hospital because of multiple liver lesions without any identifiable primary tumor or extrahepatic lymphadenopathy. Serum tumor markers, including alpha-fetoprotein, were in the normal range. We provisionally diagnosed the patient with a cancer of unknown primary origin with liver metastases. An endoscopic ultrasound-guided fine needle liver biopsy of the tumor in the left lobe of the liver was performed using a transgastric approach, and histology revealed a primary hepatic lymphoma of a diffuse large B-cell lymphoma type.
Primary hepatic lymphomas are quite rare, and diagnosis is often difficult without performing a biopsy. Endoscopic ultrasound-guided liver biopsy is a useful diagnostic modality even in such cases.
由于原发性肝淋巴瘤罕见，该疾病实体的诊断常常困难，而进行肝脏活检是确立明确诊断的唯一方法。近来，内镜超声引导下肝脏活检已成为获取肝脏组织的一种安全技术。然而，尚无关于使用内镜超声引导下肝脏活检诊断原发性肝淋巴瘤的报道。
一名85岁的亚洲男性因多发肝脏病变入院，未发现任何可识别的原发性肿瘤或肝外淋巴结病。包括甲胎蛋白在内的血清肿瘤标志物均在正常范围内。我们初步诊断该患者为原发性不明的癌症伴肝转移。采用经胃途径对肝脏左叶肿瘤进行了内镜超声引导下细针肝脏活检，组织学检查显示为弥漫性大B细胞淋巴瘤型原发性肝淋巴瘤。
原发性肝淋巴瘤相当罕见，不进行活检时诊断常常困难。即使在这种情况下，内镜超声引导下肝脏活检也是一种有用的诊断方式。
