Primary hepatic diffuse large B-cell lymphoma

Case contributed by Dr Nadia Khan

Presentation

Patient presented to emergency room with right upper quadrant abdominal pain.

Patient Data

Age: 70 years
Gender: Female

Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.

Liver

Ultrasound

Patient had ultrasound of the right upper quadrant performed.

The liver is lobular in contour containing innumerable hypoechoic lesions throughout the parenchyma with diffuse flow on color Doppler interrogation. 

CT of the abdomen and pelvis with oral and intravenous was performed for further evaluation of liver lesions.

Contrast-enhanced images demonstrate lobular appearance of the liver with multiple hypo-attenuating lesions with faint peripheral enhancement. There is also enlargement of lymph nodes in the celiac axis.

PET/CT

Nuclear medicine

PET/CT was performed after CT-guided liver biopsy and established diagnosis of liver lymphoma.

PET/CT images demonstrate avid uptake of FDG-18 tracer throughout the liver from lymphomatous involvement.

Histology demonstrates tumor cells adjacent normal liver cells. 

Case Discussion

Patient underwent CT-guided liver biopsy which showed diffuse large B-cell lymphoma of unclear type. The pathology from liver lymph node was confirmed high grade non-germinal diffuse large B-cell lymphoma.  Flow cytometry of tumor cells was positive for CD19, CD20, Lambda, with variable expression of CD5.  Tumor cells were negative for CD10 and CD23.

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