Intrahepatic Reactive Lymphoid Hyperplasia: A Case Report and Review of the Literature

Abstract

Introduction Reactive lymphoid hyperplasia (RLH) is a rare and benign lesion found in organs of the gastrointestinal tract, skin, lung, orbit, and more rarely in the liver. Due to its similar appearance on imaging, it is hard to differentiate from primary liver malignancies. The following is a case report of a patient presenting with a suspicious liver lesion found to be RLH associated with primary biliary cirrhosis (PBC), after surgical resection. Presentation of Case A 54-year-old woman presented with nonspecific abdominal pain, and her workup included axial imaging of the abdomen that showed a suspicious lesion in her liver. After an extensive workup, which included a percutaneous biopsy, failed to confirm a diagnosis, a laparoscopic surgical resection was recommended. Discussion RLH is a rare condition of the liver, presenting in a suspicious fashion and raising concerns for a primary liver malignancy. RLH should be considered in the differential diagnosis of small hepatic lesions in middle-age females in the absence of any significant risk factors for hepatocellular carcinoma (HCC). RLH tends to be associated with PBC of the liver. Conclusion RLH of the liver is a rare, hard to diagnose, benign lesion. When intrahepatic, it cannot be easily differentiated from primary liver tumors and frequently requires surgical resection for pathological diagnostic confirmation.

Reactive Lymphoid Hyperplasia of the Liver Incidentally Found in a 55-Year-Old Woman with a History of Ulcerative Colitis

“…RLH predominately occurs in middle-aged women, with some type of autoimmune disease in about 40% of the cases [2]. Many patients have no symptoms, and they are often found incidentally on imaging study [2]. In our case, CT was performed to investigate the cause of abdominal pain happened to reveal a mass in the liver.…”

“…RLH, also known as pseudolymphoma or nodular lymphoid lesion, is a benign disease characterized by the proliferation of non-neoplastic polyclonal lymphocytes that form follicles with reactive germinal centers; it rarely occurs in the liver [1,2]. RLH predominately occurs in middle-aged women, with some type of autoimmune disease in about 40% of the cases [2]. Many patients have no symptoms, and they are often found incidentally on imaging study [2].…”

“…Reactive lymphoid hyperplasia (RLH), also known as pseudolymphoma or nodular lymphoid lesion [1,2], is a benign disease that occurs in various organs, such as the lungs, the orbits, the skin, and the gastrointestinal tract, however rarely occurring in the liver [1]. RLH is characterized by the proliferation of non-neoplastic polyclonal lymphocytes that form follicles with reactive germinal centers [2]. The first reported case of the RLH of the liver was by Snover et al in 1981 [3].…”

“…The first reported case of the RLH of the liver was by Snover et al in 1981 [3]. The true pathogenesis is unknown, but its occurrence is thought to be associated with reactive immune phenomenon to various immune stimulators, such as chronic viral hepatitis, autoimmune disease, and malignant tumor [2,3]. No cases occurring in patients with inflammatory bowel disease have been reported to date.…”

Hepatic Reactive Lymphoid Hyperplasia and Primary Hepatic Lymphoma: Ultrasound Features and Differentiation Diagnosis

“…Table 4 The results of EBER analysis, reticulum fiber staining, gene rearrangement and DC-FISH analysis In this study, HRLH and PHL lesions display many nonspecific features in the conventional ultrasound. Firstly, both of them are usually observed in the right lobe, and about 60% of the lesions are under the capsule, this may attribute to the lesion's growing along the terminals of blood vessels [13,17,18]. Secondly, the two kinds of lesions are generally hypoechoic and sometimes anechoic accompanied with posterior echo enhancement in the gray scale ultrasound images, the reason is that the nodules are composed of homogeneous lymphocytes which leads to small acoustic impedance difference and reduced acoustic attenuation [19][20][21][22].…”