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T-cell-rich B-cell lymphoma presenting as liver disease
S M Khan1, B J Cottrell, G H Millward-Sadler
1Department of Histopathology, Southampton General Hospital, Portsmouth, UK.
Histopathology
|September 1, 1993
Summary
T-cell-rich B-cell lymphoma is often misdiagnosed on liver biopsy, mimicking inflammatory or T-cell diseases. This under-recognized lymphoma subset presents atypically and has a poor prognosis, highlighting the need for accurate diagnosis.
Area of Science:
- Oncology
- Hepatology
- Pathology
Background:
- T-cell-rich B-cell lymphoma (TRBCL) is a subtype of non-Hodgkin's lymphoma.
- Accurate diagnosis of liver lymphomas is crucial for patient management.
- TRBCL can present with non-specific clinical and histological features.
Purpose of the Study:
- To describe the clinicopathological features of T-cell-rich B-cell lymphoma diagnosed on liver biopsy.
- To highlight diagnostic challenges and potential pitfalls in identifying TRBCL in the liver.
- To emphasize the importance of recognizing TRBCL as a distinct entity that can mimic primary liver disease.
Main Methods:
- Retrospective analysis of eight cases of T-cell-rich B-cell lymphoma diagnosed on liver biopsy over 15 years.
- Review of histological morphology and immunohistochemical profiles.
- Correlation of liver biopsy findings with clinical presentation and disease stage.
Main Results:
- Seven out of eight referred cases were initially misdiagnosed, often as inflammatory conditions or T-cell lymphoma.
- TRBCL cases exhibited a distinct lymphohistiocytic or granulomatous infiltrate, predominantly in portal tracts, with abundant T-cells and few B-cell blasts.
- All patients presented atypically, favoring non-neoplastic liver disease, and had a poor prognosis with no survivors beyond 15 months.
Conclusions:
- T-cell-rich B-cell lymphoma is an under-recognized entity in liver biopsies.
- Diagnostic errors are common due to its mimicry of inflammatory liver disease and T-cell lymphomas.
- Distinct morphological and immunohistochemical features should prompt consideration of TRBCL in liver biopsies, especially in atypical presentations.