Diagnostic and Therapeutic Quandaries in a Patient with Primary Hepatic Lymphoma and Concurrent Hepatitis C Infection

Abstract

Primary hepatic lymphoma (PHL) is a very rare sub-type of non-Hodgkin's lymphoma and hepatitis C infection may be a contributory factor. The association of hepatitis C infection and PHL causes difficulties in management since safety of rituximab in such situations is unclear due to lack of evidence. The role of anti-viral therapy in combination with chemotherapy is also uncertain. We describe the diagnostic and therapeutic challenges posed by a patient who was diagnosed with PHL and concurrent hepatitis C infection.

Complete response to comprehensive treatment of a primary hepatic diffuse large B cell lymphoma: A case report

“…The etiology of PHL remains unknown; however, HCV and human immunodeficiency virus have been found to be implicated ( 7 , 8 , 13 ). HCV infection is detected in 40–60% of patients with PHL ( 8 – 10 ). The frequent association with HCV indicates that this virus may be involved in the pathogenesis of PHL ( 14 , 15 ).…”

“…The etiology of PHL remains unclear, however, certain viruses, including hepatitis C virus (HCV), human immunodeficiency virus (HIV) and Epstein-Barr virus (EBV) may be involved. HCV infection is detected in 40–60% of patients with PHL ( 8 – 10 ). The pathogenesis of PHL remains unclear and may be associated with hepatitis C virus, human immunodeficiency virus, epstein-barr virus, or human T-lymphotropic virus infections, liver cirrhosis, systemic lupus erythematosus, and immunosuppressive therapy ( 8 ).…”

Primary hepatic lymphoma: is it a disease entity?

“…The following description of these modalities is mainly based on the results from retrospective studies. [34] Ultrasound is the most sensitive of image modalities to find liver lymphoma showing hypoechoic liver lesion with irregular margins. When contrast is used, the tumor is inhomogeneously hyperenhanced in the arterial phase and hypoenhanced in the portal and late phases, similar to the images of hepatocellular carcinoma.…”

Primary hepatic lymphoma mimicking hepatocellular carcinoma: case report and review of literature

“…9 Proposed etiological factors include preexisting chronic hepatitis, cirrhosis, Ebstein Barr Virus (EBV), Hepatitis B and C and those on immunosuppressives. [10][11][12][13][14] Radiologically predominantly hypodense solitary lesion is the most common presentation, although multiple lesions and diffuse infilterative forms with variable enhancement patterns are known. 2 In the present case report the tumor presented as a solitary lesion with faint enhancement and FNAC suggestive of hepatocellular carcinoma, that led to the misdiagnosis.…”