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Primary hepatic diffuse large B-cell lymphoma presenting unusual imaging features.

Kumi Ozaki1, Hiroshi Ikeno2, Kenji Koneri3

  • 1Departments of Radiology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan. ozakik-rad@umin.org.

Clinical Journal of Gastroenterology
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Summary

Primary hepatic lymphoma, a rare liver cancer, can be misdiagnosed. Early imaging recognition is crucial for effective treatment with chemotherapy and/or radiotherapy, avoiding surgery.

Keywords:
18F-fluorodeoxyglucoseApparent diffusion coefficientDiffuse large B-cell lymphomaPrimary hepatic lymphoma

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Area of Science:

  • Hepatobiliary imaging
  • Oncology
  • Radiology

Background:

  • Primary hepatic lymphoma is rare and often misdiagnosed due to non-specific symptoms.
  • Early diagnosis is vital as it is treatable with chemotherapy and/or radiotherapy, preventing unnecessary surgery.

Observation:

  • A 73-year-old woman presented with fever and elevated liver enzymes, showing a hypoechoic hepatic mass on ultrasound.
  • CT revealed an ill-defined mass with peripheral enhancement; MRI showed specific signal characteristics including low ADC and diffusion-weighted imaging hyperintensity.
  • FDG-PET/CT demonstrated doughnut-like uptake, raising suspicion for lymphoma over cholangiocarcinoma.

Findings:

  • Imaging findings, particularly low ADC and high FDG uptake, were suggestive of malignant lymphoma.
  • Percutaneous biopsy confirmed diffuse large B-cell lymphoma.
  • The mass resolved completely after radiochemotherapy with no recurrence at 3 years.

Implications:

  • This case highlights the importance of considering primary hepatic lymphoma in the differential diagnosis of liver masses.
  • Advanced imaging techniques like MRI and PET/CT play a crucial role in differentiating lymphoma from other hepatic malignancies.
  • Timely diagnosis and treatment can lead to favorable outcomes for patients with primary hepatic lymphoma.