Primary non-Hodgkin lymphoma of liver

Primary non-Hodgkin lymphoma (NHL) of liver is a very rare malignancy. Here, we report the case of a 65-year-old man who presented with constipation and right groin pain of 2 months' duration. A computed tomography (CT) scan of the abdomen incidentally detected multiple hypodense nodules in both lobes of the liver. Diagnosis of primary NHL of liver was made using ultrasound-guided biopsy. Extensive investigations--which included bone marrow biopsy; fluorescence in situ hybridization; flow cytometry; CT scan of chest, abdomen, and pelvis; and whole-body positron-emission tomography--showed no involvement of bone marrow, lymph nodes, spleen, or any other organ. The patient is currently being treated with a CHOP-R (cyclophosphamide-doxorubicin-vincristine-prednisolone/rituximab) regimen. The case has many unique features, including normal liver function tests, especially that for lactate dehydrogenase; no type B symptoms; and negative serology for viruses. The case demonstrates that primary hepatic lymphoma should be considered in the differential diagnosis of space-occupying liver lesions in presence of normal levels of alpha-fetoprotein and carcinoembryonic antigen. The literature is extensively reviewed.