Primary Hepatic Lymphoma Complicated by a Hepatic Inflammatory Pseudotumor and Tumor-Forming Pancreatitis

Abstract

Background: Hepatic inflammatory pseudotumor (IPT) is considered to be benign in biological behavior, and its malignant transformation is extremely rare. There has only been one published case of primary hepatic lymphoma complicated by hepatic IPT.Case presentation: A 73-year-old man presented with obstructive jaundice and a pancreatic head mass. Histology of the mass revealed chronic pancreatitis with lymphoid follicle formation, leading to a diagnosis of a suspicion of follicular pancreatitis. After a choledochojejunostomy, a hepatic tumor was detected, and a biopsy revealed lymphoplasmacytic infiltration. Immunohistochemistry confirmed the polyclonal nature of lymphoplasma cells, indicative of an IPT. The hepatic tumor disappeared during follow-up, but the patient exhibited a high fever related to tumor recurrence. A biopsy revealed the co-existence of a diffuse large B-cell lymphoma and an IPT. IgG4-related disease was excluded because storiform fibrosis, obliterative phlebitis, and a significant increase in IgG4-immunoreactive cells were absent in all investigated tissues. The tumor completely disappeared after chemotherapy.Conclusion: Careful observation is necessary in this kind of situation because the presence of a hepatic IPT may represent an increased risk of malignant transformation.Abbreviations: IPT: inflammatory pseudotumor; DLBCL: diffuse large B-cell lymphoma; CT: computed tomography; LDH: lactate dehydrogenase; sIL-2R: soluble interleukin-2 receptor; EBER: Epstein-Barr virus-encoded small RNA; R-CHOP: rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone

Follicular pancreatitis: A rare pancreatic inflammatory pseudotumor

“…Recurrence of follicular pancreatitis after resection has never been reported with follow up extending up to five years. Two cases reported spontaneous resolution after incomplete resection [16,10]. However, one of those cases reported the subsequent development of hepatic inflammatory pseudotumor and diffuse large B-cell lymphoma involving the liver at 46 and 102 months respectively after diagnosing follicular pancreatitis [10].…”

“…Two cases reported spontaneous resolution after incomplete resection [16,10]. However, one of those cases reported the subsequent development of hepatic inflammatory pseudotumor and diffuse large B-cell lymphoma involving the liver at 46 and 102 months respectively after diagnosing follicular pancreatitis [10]. Interestingly, one reported case of follicular pancreatitis was treated with steroids resulting in a 50% decrease in size [9] suggesting that follicular pancreatitis like autoimmune pancreatitis may be steroid responsive.…”

“…Of note, nonspecific chronic pancreatitis generally does not demonstrate focally elevated FDG uptake [41,42,43,44]. 18F-FDG PET/CT could help identify metastatic disease compatible with malignancy, although there are two case reports of hepatic lesions being associated with follicular pancreatitis [15,10]. Discriminating follicular pancreatitis from pancreatic adenocarcinoma based on SUVmax will probably be unreliable since distinguishing nonspecific focal chronic pancreatitis from pancreatic adenocarcinoma based on SUVmax is difficult [45].…”

“…Follicular pancreatitis is a very rare form of chronic pancreatitis and is usually mistaken for a pancreatic neoplasm. Only 13 cases have been reported in the literature to date [7,8,9,10,11]. However, 6 earlier case reports with diagnoses such as lymphoid hyperplasia or pseudolymphoma of the pancreas were also likely follicular pancreatitis cases [12,13,14,15,16,17].…”

Primary hepatopancreatobiliary lymphoma: Pathogenesis, diagnosis, and management

“…The typical B symptoms of fever and weight loss can be found in one-third of all cases ( 24 ). Other symptoms include fatigue, anorexia, nausea, jaundice, and vomiting ( 30 – 33 ). On the physical examination of abdomen, tenderness in the upper right quadrant and hepatomegaly are the common presenting features.…”