doiSerbia

A case of primary hepatic lymphoma and a review of the literature

Mašulović Dragan (Clinical center of Serbia, Center for radiology and MR imaging, Belgrade, Serbia + University of Belgrade, Faculty of Medicine, Belgrade, Serbia), draganmasulovic@yahoo.com
Filipović Aleksandar (Clinical center of Serbia, Center for radiology and MR imaging, Belgrade, Serbia + University of Belgrade, Faculty of Medicine, Belgrade, Serbia)
Zakošek Miloš (Clinical center of Serbia, Center for radiology and MR imaging, Belgrade, Serbia)
Bulatović Dušan (Clinical center of Serbia, Center for radiology and MR imaging, Belgrade, Serbia)
Stojadinović Milica (Clinical center of Serbia, Center for radiology and MR imaging, Belgrade, Serbia)

Introduction. Primary hepatic lymphoma (PHL) is a rare disease and represents lymphoproliferative disorder confined to the liver parenchyma. This condition is difficult to distinguish from other liver diseases. Histopathology is essential and confirms the diagnosis. Treatment options for PHL include surgery, chemotherapy, radiation, or combinations of these modalities. The objective of this this report is to present a case of PHL and to discuss disease features and treatment options in order to facilitate diagnostics and therapy. Case outline. A 72-year-old female was presented with abdominal pain, nausea, weight loss, and fatigue. Computed tomography (CT) revealed hypoattenuating solitary lesion in liver segment VIII. The detected liver lesion showed elevated 2-[fluorine 18] fluoro-2-deoxy-D-glucose uptake on positron emission tomography/CT examination. Extrahepatic disease was not detected. The tumor board opted for surgery, and atypical resection of liver segments VII and VIII was performed. Pathohistological examination of the resected tumor demonstrated liver infiltration with non-Hodgkin’s lymphoma, diffuse large B-cell type. Postoperative recovery was complicated by fluid collections in the right subphrenic space, successfully managed by percutaneous drainage. Subsequently, the patient was treated with chemotherapy and attained a complete remission documented by negative CT findings. Conclusion. PHL can easily be misdiagnosed as another more frequent primary liver tumor due to its non-specific clinical manifestations, laboratory and imaging findings, and therefore should be considered in the differential diagnosis of a hepatic lesion.

Keywords: chemotherapy, drainage, liver, operative, tumor