The imaging conundrum of hepatic lymphoma revisited

Abstract

The imaging manifestations of hepatic lymphoma, both in its primary and secondary form, are extremely variable and overlap with a number of other more common hepatic diseases. However, in the appropriate clinical context, combining the imaging and laboratory features can aid in making the correct diagnosis. Since the management and prognosis of lymphomas are significantly different from other malignancies, early diagnosis and prompt commencement of therapy is of paramount importance. The various morphological appearances of hepatic lymphoma on imaging have been described here along with their possible differentials.Teaching points• Primary hepatic lymphoma is extremely rare.• Secondary liver involvement occurs in 50 % of patients with non-Hodgkin lymphoma.• The imaging manifestations of hepatic lymphoma are largely non-specific.• Some imaging features may be helpful in the appropriate clinical setting.• Management and prognosis of lymphoma is significantly different from other malignancies.

A Unique Case of Primary Hepatic CD30-Positive, CD15-Negative Classical Hodgkin’s Lymphoma Presenting as Fever of Unknown Origin and Acute Hepatic Failure

“…PHL can manifest radiographically in different ways. PHL can present as a solitary discrete lesion, which is the most common presentation of PHL, but can also present as multifocal lesions, diffuse infiltration, or as a periportal mass [14]. What makes our case challenging was that the only abnormality on imaging of the liver was hepatomegaly on the CT abdomen and pelvis.…”

Hypercalcemia due to Primary Hepatic Lymphoma

“…CT usually shows minimal to no enhancement on all phases likely due to the poor vascular supply. It is not uncommon to see a central hypodensity within the mass, commonly due to tissue necrosis [14]. Overall, there is no pathognomonic radiographic finding in PHL and therefore biopsy is considered the gold standard for the diagnosis of PHL.…”

Multimodality Imaging Spectrum of Extranodal Lymphoma: A Pictorial Review

“…Focal nodules commonly appear well-defined and hypoechoic on sonography, and hypoenhancing relative to the rest of the normal parenchyma on contrast-enhanced CT. Solitary, multifocal, or even miliary nodules can be seen in hepatosplenic lymphomatous involvement. 27,28 In cases of solitary hepatic lesion, the differentials of primary hepatic neoplasms (eg, hepatocellular carcinoma, intrahepatic cholangiocarcinoma, or focal nodular hyperplasia) and liver abscess should be considered. 27 Dedicated triphasic CT scan of the liver may help in differentiating other primary hepatic neoplasms from lymphoma by showing typical radiological features pertaining to the former entities.…”

“…27,28 In cases of solitary hepatic lesion, the differentials of primary hepatic neoplasms (eg, hepatocellular carcinoma, intrahepatic cholangiocarcinoma, or focal nodular hyperplasia) and liver abscess should be considered. 27 Dedicated triphasic CT scan of the liver may help in differentiating other primary hepatic neoplasms from lymphoma by showing typical radiological features pertaining to the former entities. For differentiation from liver abscess, absence of perilesional oedema and vascular thrombosis to suggest pylephlebitis, as well as presence of the "vessel penetration sign" with patent vessel traversing the lesion may suggest lymphoma.…”

“…For differentiation from liver abscess, absence of perilesional oedema and vascular thrombosis to suggest pylephlebitis, as well as presence of the "vessel penetration sign" with patent vessel traversing the lesion may suggest lymphoma. 27 In cases of multifocal lesions, important differential diagnoses are metastases and fungal abscesses. 25 Periportal lymphomatous spread is a distinctive pattern of hepatic lymphomatous involvement, likely because the majority of lymphatic drainage of liver occurs via the periportal lymphatic channels.…”