images in haematology
Diffuse large B-cell lymphoma resembling a metastatic liver tumour
A 53-year-old man who was regularly reviewed at our hospital for chronic hepatitis C infection was admitted in November 2012 with severe upper abdominal pain. Ultrasonography and computerized tomography showed multiple liver nodules with hepatomegaly. On magnetic resonance imaging, there were multiple T2 high-intensity nodular lesions, which were interpreted as metastatic liver tumours (upper panel). Upper and lower endoscopy was subsequently performed to identify a primary lesion, but none was found. Liver biopsy, however, showed diffuse large B-cell lymphoma (DLBCL) [lower left: haematoxylin-eosin staining (9100); lower right: CD20 immunohistochemical staining (9100)]. 18 F-fluorodeoxyglucose positron emission tomography revealed multiple lesions with a high maximum standardized uptake value (SUVmax; 10–23) in the lungs, liver and bones, and treatment with the R-CHOP regimen (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone) was commenced. The patient received eight courses of
ª 2014 John Wiley & Sons Ltd British Journal of Haematology, 2015, 168, 1
R-CHOP therapy; he achieved complete remission, which has been maintained to date. Primary hepatic DLBCL can be classified into three morphological patterns: solitary liver mass, multiple focal nodules and diffuse infiltrative disease. The first two patterns are the most common. Imaging studies showing a solitary space-occupying lesion or multiple heterogeneous lesions in the liver are usually interpreted as hepatocellular carcinoma or metastatic cancer. Our patient had multiple focal nodules resembling metastatic liver tumours. Our experience demonstrates that when a patient with multiple nodular lesions of the liver is encountered, the possibility of malignant lymphoma should be considered. Yuu Saitoh, Moritaka Gotoh, Seiichiro Katagiri and Kazuma Ohyashiki Department of Haematology, Tokyo Medical University, Tokyo, Japan. E-mail: [email protected]
First published online 14 October 2014 doi: 10.1111/bjh.13163
Diffuse large B-cell lymphoma resembling a metastatic liver tumour
A 53-year-old man who was regularly reviewed at our hospital for chronic hepatitis C infection was admitted in November 2012 with severe upper abdominal pain. Ultrasonography and computerized tomography showed multiple liver nodules with hepatomegaly. On magnetic resonance imaging, there were multiple T2 high-intensity nodular lesions, which were interpreted as metastatic liver tumours (upper panel). Upper and lower endoscopy was subsequently performed to identify a primary lesion, but none was found. Liver biopsy, however, showed diffuse large B-cell lymphoma (DLBCL) [lower left: haematoxylin-eosin staining (9100); lower right: CD20 immunohistochemical staining (9100)]. 18 F-fluorodeoxyglucose positron emission tomography revealed multiple lesions with a high maximum standardized uptake value (SUVmax; 10–23) in the lungs, liver and bones, and treatment with the R-CHOP regimen (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone) was commenced. The patient received eight courses of
ª 2014 John Wiley & Sons Ltd British Journal of Haematology, 2015, 168, 1
R-CHOP therapy; he achieved complete remission, which has been maintained to date. Primary hepatic DLBCL can be classified into three morphological patterns: solitary liver mass, multiple focal nodules and diffuse infiltrative disease. The first two patterns are the most common. Imaging studies showing a solitary space-occupying lesion or multiple heterogeneous lesions in the liver are usually interpreted as hepatocellular carcinoma or metastatic cancer. Our patient had multiple focal nodules resembling metastatic liver tumours. Our experience demonstrates that when a patient with multiple nodular lesions of the liver is encountered, the possibility of malignant lymphoma should be considered. Yuu Saitoh, Moritaka Gotoh, Seiichiro Katagiri and Kazuma Ohyashiki Department of Haematology, Tokyo Medical University, Tokyo, Japan. E-mail: [email protected]
First published online 14 October 2014 doi: 10.1111/bjh.13163
