Diffuse large B-cell lymphoma with secondary liver involvement

Case contributed by Marta Duczkowska

Presentation

New liver finding on abdominal ultrasound in a patient with a history of diffuse large B-cell lymphoma (DLBCL) treated with chemotherapy five years earlier. Renal failure.

Patient Data

Age: 80 years
Gender: Male

Heterogenous mass in left lobe of the liver.

  • Llrge hypoattenuating mass in segments 2 and 3 of the liver
    • the center of the mass shows delayed enhancement
  • small hemangioma in liver segment 7
  • enlarged lymph node in liver hilum
  • irregular lesions adjacent to aortic bifurcation and in the small bowel mesentery are likely related to previous chemotherapy
  • renal cysts
  • bilateral pleural effusions
  • small amount of peritoneal free fluid

On the unenhanced scan, the density of blood is lower than density of myocardium -  a finding suggestive of anemia.

Axial T2-weighted image demonstrates a well-defined, lobulated, mildly hyperintense lesion in the left liver lobe with a more hyperintense center. The lesion is hypointense on T1-weighted image and shows peripheral mild enhancement in the arterial and venous phase images. On the delayed phase there is retention of contrast within the central, fibrotic stroma. The mass shows peripheral diffusion restriction.

Case Discussion

Secondary involvement of the liver can occur in up to 50% of patients with non-Hodgkin lymphoma (NHL) 1. The imaging manifestations of hepatic lymphomas are largely non-specific.  Lymphomatous involvement of the liver may manifest as a focal liver mass or diffuse infiltrating disease 2. The highly cellular nature of lymphoma typically results in restricted diffusion.

The patient underwent a liver biopsy which confirmed the diagnosis of NHL.

The patient’s serum hemoglobin and hematocrit levels were 8.6 g/dL and 25.4%, respectively, consistent with anemia.

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Case information

rID: 82694
Published: 8th Oct 2020
Last edited: 8th Oct 2020
Inclusion in quiz mode: Included