Primary hepatic lymphoma misdiagnosed as hepatic hemangioma: a case report and domestic literature review / 第二军医大学学报

ABSTRACT

Objective To explore the characteristics of diagnosis, treatment and prognosis of primary hepatic lymphoma (PHL), so as to better understand the tumor. Methods The diagnosis and treatment of a patient with PHL misdiagnosed as hepatic hemangioma were reported, and the domestic literatures were reviewed from 1975 to 2019 to sum up the diagnosis, treatment and prognosis characteristics of PHL. Results This patient had no specific clinical manifestations, and was misdiagnosed as hepatic hemangioma in other hospital. Magnetic resonance imaging (MRI) examination in our hospital showed that the tumor had malignant features and vessel floating sign, suggesting the possibility of malignancy. The patient was treated with resection of multiple hepatic tumors +hepatoduodenal lymph node dissection +cholecystectomy. Postoperative pathological results showed that the tumor was composed of large patches of lymphoid cells with few cytoplasm and atypical nuclei; the tumor had no obvious envelope; and the peripheral liver tissues were infiltrated. Immunohistochemical staining showed that the cells in follicular zone were mostly CD20 (+), and the cells in germinal center were CD10 (+), Bcl-6 (+) and Bcl-2 (+), Ki-67 (80%). Primary hepatic B-cell non-Hodgkin lymphoma (B-NHL) was diagnosed finally. A total of 376 PHL patients were reported in 91 domestic literatures, with an average age of 48.8±9.6 years and a male-to female ratio of 1.691. The imaging was characterized by single lesion and vessel floating sign, lack of blood supply. The levels of lactic dehydrogenase were increased in 146 cases (38.8%). Totally 132 cases (35.1%) were misdiagnosed and the final diagnosis depended on pathological findings. Survival analysis results showed that the prognosis of B-NHL patients was significantly better than that of T-cell non-Hodgkin lymphoma (T-NHL) patients (median overall survival time 36.4 months vs 20.7 months, P=0.009); the prognosis of mucosa-associated lymphoid tissue lymphoma patients was significantly better than that of diffuse large B-cell lymphoma patients (52.0 months vs 30.0 months, P=0.049); and the prognosis of B-NHL patients treated with surgery combined with postoperative chemotherapy was significantly better compared with those treated with surgery alone and those treated with chemotherapy alone (45.6 months vs 23.9 months and 7.7 months, P=0.016). Conclusion Primary hepatic lymphoma is a rare tumor without characteristic clinical features, and its diagnosis needs to be combined with medical history, clinical manifestations, and imaging and laboratory examination. Once PHL is confirmed, it should be treated actively by surgery combined with chemotherapy or comprehensive chemotherapy..