Concurrent and Apposed Hepatocellular Carcinoma and Small Lymphocytic Lymphoma/Chronic Lymphocytic Leukemia in a Patient with Hepatitis C Virus

Abstract

A patient with chronic hepatitis C virus (HCV) presented to our clinic with a hepatic mass as well as lymphocytosis. Biopsy of the hepatic mass revealed apposed hepatocellular carcinoma (HCC) and small lymphocytic lymphoma (SLL)/chronic lymphocytic leukemia (CLL). Dramatic examples of lymphoma regression during treatment with antiviral medication in chronic HCV patients have suggested an etiologic role for HCV in lymphomagenesis. A growing body of research seeks to clarify the details of the interaction between HCV and B-cell lymphomas. This case of adjacent SLL/CLL and HCC is the first published diagnosis of these two diseases in the liver at one time, and the only published example of the physical apposition of any lymphoma and HCC. The case is provocative in light of recent evidence that local interactions between HCV-infected hepatocytes and B cells may contribute to lymphomagenesis.

Hepatocellular Carcinoma With Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma in the Absence of Cirrhosis

“…All case reports to date showing a link between HCC and CLL have been in a background of chronic liver disease before HCC. 3,4,6 It is noteworthy that our patient lacked a background liver disease including viral hepatitis or hepatic fibrosis before diagnosis of HCC.…”

“…2 There are a few case reports on development of HCC in patients with chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL). Some of them have detailed concurrent HCC and CLL/SLL in people with preexisting liver damage from hepatitis C. 3,4 Only 2 reports to date have described this phenomenon in patients without preexisting liver damage, with CLL/SLL diagnosed a substantial time before HCC in both cases. 5,6 To the best of our knowledge, we present the first case of HCC without chronic liver disease or hepatic fibrosis where coexisting CLL/SLL was not clinically apparent before the diagnosis of HCC.…”

Concurrent CD5-negative small lymphocytic lymphoma (SLL) and CD5-positive metastatic carcinoma of unknown primary in a lymph node biopsy

“…In addition, patients with CLL/SLL may have increased risk for developing a secondary malignancy [12]. Although identifying CLL/SLL and concurrent metastatic carcinoma in a lymph node biopsy has been reported before [13][14][15][16], the incidental finding of a metastatic carcinoma of unknown primary in a lymph node biopsy for lymphoma workup is relative uncommon.…”