Lee Ji Yeon, Lee Jaejun, Sung Pil Soo
Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
Int J Mol Sci. 2025 May 18;26(10):4823. doi: 10.3390/ijms26104823.
Isolated intrahepatic lymphoid follicles (ILFs), also referred to as reactive lymphoid hyperplasia, are rare benign lymphoid proliferations that can closely mimic hepatocellular carcinoma (HCC) on imaging. This case highlights the diagnostic complexity of hepatic mass lesions in chronic hepatitis B patients, particularly when radiologic and serologic features raise concern for malignancy. A 60-year-old man with chronic hepatitis B presented with a liver mass, elevated alpha-fetoprotein levels, and imaging findings of heterogeneous arterial enhancement, all suggestive of HCC. Despite initial treatment with atezolizumab plus bevacizumab, the lesion progressed, leading to an extended left hepatectomy. Histopathological examination revealed well-formed lymphoid follicles with reactive germinal centers, without evidence of malignancy or granulomatous inflammation. Serum IgG was elevated, and ANA was positive, supporting the possibility of an underlying immune-mediated process. The patient showed clinical and serologic improvement following corticosteroid therapy, with no evidence of recurrence at 10-month follow-up. This case underscores the importance of histopathological confirmation in hepatic masses with atypical features and highlights the need to consider benign immune-related mimickers in the differential diagnosis, particularly in the era of immunotherapy.
孤立性肝内淋巴滤泡（ILFs），也称为反应性淋巴组织增生，是罕见的良性淋巴增殖性病变，在影像学上可酷似肝细胞癌（HCC）。本病例突出了慢性乙型肝炎患者肝脏占位性病变的诊断复杂性，尤其是当放射学和血清学特征引发对恶性肿瘤的担忧时。一名患有慢性乙型肝炎的60岁男性出现肝脏肿块、甲胎蛋白水平升高以及动脉期不均匀强化的影像学表现，所有这些都提示为HCC。尽管最初接受了阿替利珠单抗加贝伐单抗治疗，但病变仍进展，最终进行了扩大左肝切除术。组织病理学检查显示有形成良好的淋巴滤泡及反应性生发中心，无恶性肿瘤或肉芽肿性炎症证据。血清IgG升高，抗核抗体阳性，支持潜在免疫介导过程的可能性。患者在接受皮质类固醇治疗后临床和血清学情况改善，10个月随访时无复发迹象。本病例强调了对具有非典型特征的肝脏肿块进行组织病理学确诊的重要性，并突出了在鉴别诊断中考虑良性免疫相关模仿病变的必要性，尤其是在免疫治疗时代。
