Hepatic Mucosa-Associated Lymphoid Tissue Lymphoma and Hepatocellular Carcinoma in a Patient With Hepatitis B Virus Infection

Abstract

Primary hepatic mucosa-associated lymphoid tissue (MALT) lymphoma is an extremely rare disease. A 65-year-old female patient with chronic hepatitis B presented with multiple solid masses in segment (S) 4, S5, and S6 of the liver. The nodule in S5 was diagnosed preoperatively as hepatocellular carcinoma by computed tomography, magnetic resonance imaging, and angiography. The nodule in S4 was initially interpreted as lymphoid follicles by needle biopsy. Segmentectomy of S5 and partial resection of S6 were performed. Microscopic examination of the S5 nodule revealed moderately differentiated hepatocellular carcinoma. The nodule from S6 showed nodular proliferation of atypical intermediate to medium-sized lymphoid cells in the portal area and lymph epithelial lesions of bile ducts. The atypical lymphoid cells were positive for LCA, L-26 and bcl-2 and negative for UCHL-1. These features were consistent with the diagnosis of MALT lymphoma. This is the first case report of synchronous hepatic MALT lymphoma and hepatocellular carcinoma associated with chronic hepatitis B.

Primary hepatic mucosa-associated lymphoid tissue lymphoma and hemangioma with chronic hepatitis B virus infection as an underlying condition

“…Whether HCV infection can lead to hepatic MALT lymphoma or not remains unclear. There are only 2 reported cases of MALT lymphoma (15,16) with HBV infection. The correlation between HBV and hepatic MALT lymphoma remains unclear, although hepatic MALT lymphoma is thought to be associated with specific immune reactions or autoimmune disorders.…”

Simultaneous Hepatic Relapse of Non-Hodgkin’s Lymphoma and Hepatocellular Carcinoma in a Patient with Hepatitis C Virus-Related Cirrhosis

“…Talamo et al[ 3] were the first to report a case of simultaneous occurrence of primary hepatic lymphoma and HCC. Takeshima et al [4 ]reported a patient with hepatic occurrence of mucosa-associated lymphoid tissue lymphoma together with HCC. These 2 cases showed no evidence of extrahepatic involvement by lymphoma, and they are considered to represent primary hepatic lymphoma, defined as confined to the liver with no evidence of lymphomatous involvement in the spleen, bone marrow, or other lymphoid structures.…”

“…According to the report on the focal liver lesions detected by imaging techniques in 414 patients with non-Hodgkin’s lymphoma (NHL) [2], only 1 case presented with simultaneous coexistence with NHL and HCC. We know of only four previously reported similar cases [3,4,5,6], all associated with hepatitis B virus (HBV) infection. How HBV and development of lymphoma are related is not known, although some reports have suggested a possible pathogenetic role of HBV in the development of hematologic malignant diseases [7, 8].…”

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

“…There is ample evidence that direct effects of HCV on hepatocytes, as well as chronic inflammation, contribute to the evolution of HCC. In spite of the putative etiologic role of HCV in both HCC and lymphoma, and the primary localization of HCV infection in the liver, there are few case reports of the simultaneous occurrence of hepatic lymphoma and HCC [2,3,4,5,6,7]. Of the 6 previously reported cases, 3 were associated with hepatitis B virus, 1 with HCV, 1 with neither and 1 was not specified.…”

“…The strongest link between HCV and lymphoma has been shown in splenic marginal zone lymphoma, but other lymphoma subtypes have also been associated with HCV. Six cases of concurrent hepatic lymphoma and HCC have been reported [2,3,4,5,6,7]. The lymphoma subtypes reported included diffuse large B-cell and mucosa-associated lymphoid tissue.…”