Primary hepatic mucosa-associated lymphoid tissue lymphoma in a patient with no chronic liver disease: Case report

Abstract

Extramarginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) is a non-Hodgkin lymphoma of low-grade malignancy. The most common localization is the stomach, and the common nongastric sites are salivary glands, the skin, orbits, the conjunctiva, the lung, breasts, upper airways, other gastrointestinal sites, and the liver. Primary hepatic MALT lymphoma is a rare disease and the diagnostic can be challenging. The clinical presentation is nonspecific and may range from no symptoms to end-stage liver disease. The radiological aspect of hepatic lymphoma may indicate this diagnosis; however, the final diagnosis is made by hepatic biopsy. We report the case of a 47-year-old woman with no chronic liver disease, incidentally found with a focal liver mass at ultrasound examination. The only clinical symptom was fatigue. The blood tests were normal and tumoral markers were negative. Computed tomography and magnetic resonance imaging were performed. However, because the hepatic lesion was first described as a benign entity and, at second opinion, the suspicion of lymphoma was raised, the patient decided to undergo surgery first, without prior biopsy. The histopathologic analysis confirmed the diagnosis: hepatic MALT lymphoma positive for CD 20 and negative for CD 5, BCL6, cyclin D1, and CD 23. No lymph node involvement was noted and follow-up imaging with positron emission tomography-computed tomography did not show any other site of disease, thus confirming the diagnosis of primary hepatic MALT lymphoma. The aim of this paper was to highlight the imagistic features of primary hepatic lymphoma to contribute to the early diagnosis of this rare disease entity.

Primary hepatic mucosa-associated lymphoid tissue lymphoma

“…The hepatic MALT lymphomas appeared to be hypoechoic masses in 8 cases (ultrasound studies), [7–9,11,20,27,28,31] hypodense lesions in another 8 cases (CT findings), [6,7,11,17,30,31] and slightly enhanced in 5 cases (with contrast administration). [6,17,20,28,29] The MRI revealed the masses appearing as low density T1-weighted images in 8 cases, [9,11,17,27,28] as high-density T2-weighted images in 9 cases, [7,9,11,13,17,27,28] and with restricted diffusion on diffusion-weighted imaging in 1 case. [7] Our patient also showed these radiologic features on CT and MRI.…”

Primary hepatic extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue

“…Although the incidence of primary hepatic MALT lymphoma is extremely rare, some unique clinical characteristics were reported in the literatures (Table 1) [6][7][8][9][10][11][12][13][14][15]. Most of primary hepatic MALT lymphoma cases occurred in elderly people and were presented with incidentally detected liver masses without specific symptoms [6,7].…”

“…In this case, the patient was initially misdiagnosed with HCC by CT and MRI studies. Betianu et al [8] states that there are no characteristic radiological findings of PHL. After contrast administration, more than 50% of PHLs showed no enhancement, 30% showed patchy enhancement and 15% showed a ring enhancement.…”

“…After contrast administration, more than 50% of PHLs showed no enhancement, 30% showed patchy enhancement and 15% showed a ring enhancement. On MRI, PHL is hypo-or isointense on T1 and hyperintense on T2 [8]. Thus, when suspected malignant liver masses are seen in imaging studies without elevation of tumor markers, lymphoma should be a differential diagnosis and liver biopsy could be an option.…”

Primary hepatic mucosa‐associated lymphoid tissue lymphoma with hepatocellular carcinoma: A case report and literature review

“…Since the first report of four hepatic MALT lymphoma cases in 1995, 14 about 70 cases have been reported worldwide. [15][16][17][18][19] Due to the limited cases, little is known about the clinical characteristics, treatment and prognosis of this disease. It mostly occurs in elderly individuals with a median age of 62-64 years, with a roughtly same sex ratio.…”