Wu Fa-Zong, Chen Xiao-Xiao, Chen Wei-Yue, Wu Qiao-Hong, Mao Jian-Ting, Zhao Zhong-Wei
Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Hospital of Zhejiang University, Lishui 323000, Zhejiang Province, China.
World J Clin Cases. 2022 Oct 6;10(28):10130-10135. doi: 10.12998/wjcc.v10.i28.10130.
Primary liver cancer is one of the most common malignant tumours, while primary splenic lymphoma is a rare malignancy. Thus, cases of hepatocellular carcinoma (HCC) combined with splenic lymphoma are extremely rare.
We present a 62-year-old woman who was admitted to the Interventional Radiology Department with a lump in the spleen and liver as well as multiple enlarged lymph nodes visible by ultrasound. Contrast-enhanced computed of the abdomen revealed a circular, low-density, shallow mass (approximately 2.6 cm in diameter) in the left intrahepatic lobe and multiple round, low-density shadows in the spleen with clear boundaries (maximum diameter 7.6 cm). Based on the characteristic clinical symptoms and explicit radiological findings, the clinical diagnosis was HCC with metastasis to the liver portal, retroperitoneal lymph nodes, and spleen. After transcatheter arterial chemoembolization and sequential radiofrequency ablation, the -fetoprotein level returned to the normal range, and the hepatitis B cirrhosis improved. In addition, splenic tumour biopsy confirmed the diagnosis of primary malignant lymphoma, which went into remission after chemotherapy.
HCC with primary splenic non-Hodgkin lymphoma is extremely rare and easily misdiagnosed. Better understanding would facilitate early diagnosis, treatment and prognosis.
原发性肝癌是最常见的恶性肿瘤之一，而原发性脾淋巴瘤是一种罕见的恶性肿瘤。因此，肝细胞癌（HCC）合并脾淋巴瘤的病例极为罕见。
我们报告一名62岁女性，因脾脏和肝脏肿块以及超声可见多个肿大淋巴结入住介入放射科。腹部增强计算机断层扫描显示左肝内叶有一个圆形、低密度、浅肿块（直径约2.6 cm），脾脏有多个圆形、低密度阴影，边界清晰（最大直径7.6 cm）。根据特征性临床症状和明确的影像学表现，临床诊断为HCC伴肝门、腹膜后淋巴结及脾脏转移。经肝动脉化疗栓塞及序贯射频消融后，甲胎蛋白水平恢复正常范围，乙型肝炎肝硬化有所改善。此外，脾脏肿瘤活检确诊为原发性恶性淋巴瘤，化疗后缓解。
HCC合并原发性脾非霍奇金淋巴瘤极为罕见，易误诊。更好的了解将有助于早期诊断、治疗及预后。
