An Unusual Presentation of Primary Hepatic Lymphoma

Abstract

Primary hepatic lymphoma (PHL) is a rare disease that usually manifests as a heterogenous solitary intrahepatic mass, multiple lesions or a diffuse infiltrative form. PHL presenting as a small focal area of hepatic involvement and a large predominant extrahepatic component is uncommon. We report a histopathologically proven case of primary hepatic lymphoma that caused significant diagnostic dilemma on contrast-enhanced computed tomography due to its unusual imaging appearance as a hypo-enhancing intra-abdominal solid mass with relatively small area of hepatic parenchymal involvement and a large exophytic component.

An Uncommon Presentation of a Common Disease: Periportal Infiltrating Form of Hepatic Lymphoma

“…It constitute less than 1% of all non-Hodgkin's lymphoma cases. 2 Diffuse large B-cell lymphoma comprises the majority of cases of PHL. The most common imaging manifestation is a solitary discrete lesion seen in 60% of cases.…”

“…The latter variant manifests as linear ill-defined or circumscribed mass encasing the portal vein and may cause its attenuation or thrombosis; however, the incidence of venous involvement is significantly lower than in hepatocellular carcinoma. 2 Persistence of this periportal disease may suggest refractoriness to chemotherapy or disease exacerbation. 3 A variety of neoplastic as well as nonneoplastic condition can affect the periportal space, resulting in periportal hypodensity by either impending the lymphatic drainage or retrograde dissemination of malignant cells from the hilum.…”