An operative case of hepatic pseudolymphoma difficult to differentiate from primary hepatic marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue

Abstract

Hepatic pseudolymphoma (HPL) and primary hepatic marginal zone B cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) are rare diseases and the differential diagnosis between these two entities is sometimes difficult. We herein report a 56-year-old Japanese woman who was pointed out to have a space occupying lesion in the left lateral segment of the liver. Hepatitis viral-associated antigen/antibody was negative and liver function tests including lactic dehydrogenase, peripheral blood count, tumor markers and soluble interleukin-2 receptor were all within normal limit. Imaging study using computed tomography and magnetic resonance imaging were not typical for hepatocellular carcinoma, cholangiocarcinoma, or other metastatic cancer. Fluorodeoxyglucose-positron emission tomography examination integrated with computed tomography scanning showed high standardized uptake value in the solitary lesion in the liver. Under a diagnosis of primary liver neoplasm, laparoscopic-assisted lateral segmentectomy was performed. Liver tumor of maximal 1.0 cm in diameter was consisted of aggregation of lymphocytes of predominantly B-cell, containing multiple lymphocyte follicles positive for CD10 and bcl-2, consistent with a diagnosis of HPL rather than MALT lymphoma, although a definitive differentiation was pending. The background liver showed non-alcoholic fatty liver disease/early non-alcoholic steatohepatitis. The patient is currently doing well with no sign of relapse 13 months after the surgery. Since the accurate diagnosis is difficult, laparoscopic approach would provide a reasonable procedure of diagnostic and therapeutic advantage with minimal invasiveness for patients. Considering that the real nature of this entity remains unclear, vigilant follow-up of patient is essential.

Spontaneously complete regression of pseudolymphoma of the remnant pancreas after pancreaticoduodenectomy

“…A low signal intensity mass on T1-weighted MRI and accumulation of 18 F-FDG PET were firstly demonstrated in the current case of pancreatic pseudolymphoma. In hepatic and pulmonary pseudolymphoma, similar MRI [4] and PET [5,6] findings have been reported.…”

Primary Hepatic Marginal Zone B Cell Lymphoma : A Case Report and Review of the Literature

“…These results were better than those previously reported, and it could have been due to strict patient selection and the use of postoperative chemotherapy in most patients [2]. Reported cases demonstrate that MALT lymphoma has a favorable prognosis compared with other subtypes of PHL [13]. Since our patient had stage IE disease according to the Ann Arbor staging system, and the pathologic type was marginal B-cell lymphoma (low-grade lymphoma, MALT lymphoma), we expect the prognosis to be favorable with adequate therapy.…”

“…Other histologic subtypes of PHL include high-grade tumors (lymphoblastic and Burkitt lymphoma, 17 %), follicular lymphoma (4 %), diffuse histiocytic lymphoma (5 %), marginal zone B-cell lymphoma (MALT lymphoma), anaplastic large-cell lymphoma, mantle cell lymphoma, and T-cell-rich B-cell lymphoma [6]. Primary hepatic marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue type (MALT lymphoma) is a rare entity with only 48 cases being reported in the worldwide literature since the first report by Isaacson et al, which accounts for 1.6-3 % of PHL [12,13].…”

“…Although our patient received the CHOP regimen only without any evidence of tumor recurrence after 15 months of follow-up, the addition of rituximab, a chimeric mouse-human monoclonal antibody targeting the pan-B-cell antigenic marker CD20 (the first monoclonal antibody licensed for use in the treatment of cancer), to the CHOP regimen, when given in 8 cycles, augments the complete response rate and prolongs event-free and overall survival in elderly patients with diffuse large Bcell lymphoma, without a clinically significant increase in toxicity [4]. With regard to hepatic MALT lymphomas, reported cases demonstrate that MALT lymphoma is usually limited to the liver and surgical resection cures the patient in most cases [13]. Also, when diagnosis is confirmed after needle biopsy, nonresection treatment procedures would be permitted, such as radiofrequency ablation instead of surgical resection [13].…”

“…With regard to hepatic MALT lymphomas, reported cases demonstrate that MALT lymphoma is usually limited to the liver and surgical resection cures the patient in most cases [13]. Also, when diagnosis is confirmed after needle biopsy, nonresection treatment procedures would be permitted, such as radiofrequency ablation instead of surgical resection [13].…”