Extensive hepatic granulomas associated with peripheral T-cell lymphoma

A case of T-cell lymphoma presenting with marked hepatosplenomegaly and extensive hepatic granulomas is described. A 55-yr-old female experienced long-term liver damage showing histological triaditis with atypical lymphoid cell infiltration and erythrophagocytosis. The patient developed marked hepatosplenomegaly and eventually died of respiratory failure. Neither systemic lymphadenopathy nor hematological disorder was noted until her death. Autopsy revealed small atypical lymphoid cells positive for T-cell marker, as well as extensive infiltration of generalized organs, including the liver, spleen, and lungs. As a result of diffuse proliferation of atypical lymphoid cell admixed with variable reactive cells, mainly at the T-zone, the lymph nodes underwent effacement of normal architecture; however, the peripheral sinuses and the fibrous capsule remained relatively well preserved. These histological features were consistent with a diagnosis of peripheral T-cell lymphoma (PTL). It is interesting to note that there were numerous epithelioid granulomas admixed with a small number of atypical lymphoid cells within the hepatic parenchyma. The atypical lymphoid cells may be responsible for the granulomatous reaction in the liver. To our knowledge, there have been no other reported cases of PTL that presented with numerous epithelioid granulomas confined to the liver.