Hepatosplenic gamma/delta T-cell lymphoma masquerading as alcoholic hepatitis and methadone withdrawal

Abstract

Hepatosplenic gamma/delta T-cell lymphoma is a rare neoplasm of mature gamma/delta T-cells with sinusoidal infiltration of spleen, liver, and bone marrow. Patients are predominantly adolescent and young adult males and usually present with marked hepatosplenomegaly. Pancytopenia is another common finding. Despite an initial response to treatment, patients have a median survival of one to two years. In this report, we document a case of alcoholic hepatitis and methadone withdrawal masquerading unsuspected, hepatosplenic gamma/delta T-cell lymphoma with unusual CD20 positivity.

Keywords: Alcoholic hepatitis; CD20 positivity; Hepatosplenic gamma/delta T-cell lymphoma; Methadone withdrawal.

Fig. 1

Histopathology specimen showing diffuse infiltration of liver sinusoids (low-power-view, left) by intermediate sized lymphoid cells with irregular convoluted nuclear contours and associated with degenerated hepatocytes (high-power-view, right).

Fig. 2

Immunostains from liver biopsy demonstrating CD3 positivity (left column) and CD20 positivity (right column). Above: low-power view; below: high-power view.

Fig. 3

Immunostains from bone marrow aspirate demonstrating CD3 positivity (left) and CD20 positivity (right).