A Case of Contiguous Primary Hepatic Marginal Zone B-Cell Lymphoma and Hemangioma Ultimately Diagnosed Using Contrast-Enhanced Ultrasonography

Abstract

Primary hepatic marginal zone B-cell malignant lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) is extremely rare. We present a case in which a lesion was diagnosed as 2 contiguous tumors (MALT lymphoma and hemangioma) using contrast-enhanced ultrasonography (US) with sonazoid. There has been no previous case of contiguous hepatic MALT lymphoma and hemangioma. The present case was a female with no medical history. We detected a snowman-like appearance, which was a tumor of 15 mm in diameter with hypo- and hyper-echogenicities in the lateral and medial parts, respectively, in the Couinaud's segment (S6) of the liver on US. The tumor appeared as a single lesion with a low-density area in the unenhanced phase and prolonged enhancement in the equilibrium phases on dynamic CT. On MRI, the whole lesion showed a low-intensity signal on T1-weighted imaging, but isointensity in the lateral part and high intensity in the medial part were seen on T2-weighted imaging. On contrast-enhanced US, the lateral hypoechoic region was homogenously hyperenhanced in the early vascular phase, and the contrast medium was washed out after about 30 s; in contrast, the medial hyperechoic region was gradually stained from the margin toward the central region. The tumor showed a defect in both hypo- and hyperechoic regions in the postvascular phase. Hemangioma was suspected for the medial part based on the typical image findings, but the lateral part was not given a diagnosis. Thus, surgical resection was performed. The medial part was a hemangioma, and the lateral part was a MALT lymphoma by histopathological findings.

Primary hepatic extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue type

“…[22,24] Meanwhile, distinctive radiological features were absent. Ultrasound studies showed majority of the hepatic MALT lymphomas as hypoechoic masses, [7,15,16,22,26,29,31,40,43] which was in agreement with a previous study of liver lymphomas. [51] On contrast-enhanced CT, primary hepatic MALT lymphoma had been described as low-density mass, which was not enhanced, [16,17,31,39] or faint enhanced, [15,36,40] or enhanced peripherally in the early arterial phase.…”

“…Ultrasound studies showed majority of the hepatic MALT lymphomas as hypoechoic masses, [7,15,16,22,26,29,31,40,43] which was in agreement with a previous study of liver lymphomas. [51] On contrast-enhanced CT, primary hepatic MALT lymphoma had been described as low-density mass, which was not enhanced, [16,17,31,39] or faint enhanced, [15,36,40] or enhanced peripherally in the early arterial phase. [29] MRI was characterized by low signal intensity on T1-weighted images and moderately high signal intensity on T2-weighted images, and the enhancement pattern was similar to that of CT. [15,22,35,36,40,43] Our case also had these radiological features.…”

“…[51] On contrast-enhanced CT, primary hepatic MALT lymphoma had been described as low-density mass, which was not enhanced, [16,17,31,39] or faint enhanced, [15,36,40] or enhanced peripherally in the early arterial phase. [29] MRI was characterized by low signal intensity on T1-weighted images and moderately high signal intensity on T2-weighted images, and the enhancement pattern was similar to that of CT. [15,22,35,36,40,43] Our case also had these radiological features. Accordingly, the imaging features were similar to that of hepatocellular carcinoma, intrahepatic cholangiocellular carcinoma, or metastatic tumor, so the diagnosis was commonly misjudged.…”

The AFSUMB Consensus Statements and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound using Sonazoid

“…Lymphoma shows homogeneous hypoechogenicity on baseline US. On Sonazoid CEUS, lymphomas show early homogenous hyperenhancement and early wash-out in the vascular phase and defect in the postvascular phase [105].…”

Primary Hepatic Mucosa-Associated Lymphoid Tissue Lymphoma: A Case Report

“…On CT scans, the hepatic MALT lymphoma is enhanced peripherally in the arterial phase and low attenuat- ed in the delayed phase, according to an earlier report (4). Another study indicated that hepatic MALT lymphoma shows prolonged enhancement in the delayed phase on dynamic CT and is enhanced in the arterial phase with persisting enhancement in the portal phase on dynamic MRI (9). Similarly, in our case, enhancement was evident in the arterial phase; however, unlike previous reports, our case showed iso-attenuation in the delayed phase and undistorted vessels traversing the liver mass (6).…”