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Case Reports
. 2018 Feb 27;10(2):e2242.
doi: 10.7759/cureus.2242.

An Unusual Presentation of Primary Hepatic Diffuse Large B-cell Lymphoma of the Liver

Rohit Dhingra  1 , Michael W Winter  2 , Osman H Yilmaz  3 , Sunny Jaiswal  4 , Mark Sterling  5
Affiliations
Case Reports

An Unusual Presentation of Primary Hepatic Diffuse Large B-cell Lymphoma of the Liver

Rohit Dhingra et al. Cureus. .

Abstract

This report describes a case of primary hepatic diffuse large B-cell lymphoma (DLBCL) in a 64-year-old male who presented with constitutional symptoms, jaundice, abdominal swelling, and right upper quadrant pain. The diagnosis was confirmed on percutaneous liver biopsy. Notably, there was no evidence of extra-hepatic involvement. The patient received methylprednisolone and cyclophosphamide with good response but was lost to follow-up upon being transferred. This case highlights the importance of considering primary hepatic DLBCL in patients with unexplained abnormal liver tests and atypical imaging without solitary or discrete lesions, as this rare malignancy can present furtively.

Keywords: diffuse large b cell lymphoma; hepatology; liver tumors; lymphoma.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Computed Tomography (CT) of the Abdomen with Intravenous contrast
Axial image at the level of the liver demonstrates a mildly enlarged liver without a discrete focal mass (arrow)
Figure 2
Figure 2. Magnetic Resonance Imaging (MRI) of the Abdomen without contrast
T2 weighted axial image at the same level of the liver demonstrates abnormal heterogeneous increased T2 signal predominately involving the left hepatic lobe (small arrow). There are small areas of normal liver seen (long arrow), suggesting an infiltrative process.
Figure 3
Figure 3. Liver Core Biopsy
Liver core biopsy extensively involved by lymphoid cells with sparse hepatic parenchyma (*)
Figure 4
Figure 4. Higher Magnification of Liver Biopsy
Higher magnification of this diffuse infiltrate (*) reveals frequent morphological characteristics of DLBCL including large sized lymphoid cells with irregular nuclei, vesicular chromatin, small nucleoli, and moderate amount of cytoplasm.
Figure 5
Figure 5. Liver Core Biopsy with CD-20 Immunohistochemical Staining
Immunohistochemical staining reveals the atypical lymphoid cells to be diffusely positive for CD20.
Figure 6
Figure 6. Liver Core Biopsy with bcl-6 Immunohistochemical Staining
Liver Core Biopsy with bcl-6 Immunohistochemical Staining
See this image and copyright information in PMC

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