Came in for a prescription renewal for hypertension and benign prostatic hypertrophy. The general practitioner noticed a GGT of almost 200 IU/L and referred him for a liver ultrasound.
After a large hypoechoic hepatic mass was discovered, he was referred for a triphasic liver CT.

At ultrasound, the combination of a large hypoechoic mass with a central scar, central vessel and radiating septa, placed focal nodular hyperplasia at the top differential diagnosis list. At CT, however, the mass showed features most compatible with hepatic lymphoma, perhaps even primary, and a single retroperitoneal node.
An ultrasound-guided biopsy was obtained.

Histopathology report:

Macroscopic description
Two cylinders of tissue measuring 0.8 cm and 1.2 cm in length and 0.1 cm in diameter each.

Microscopic description
Diffuse large B-cell lymphoma.

Comment: cores of tissue infiltrated by a population of large atypical cells. The atypical cells are positive for CD20, CD10, CD79a, BCL6, and are negative for CD3,CD5, BCL2, c-Myc, cyclin D1, CD23 and pankeratin. Ki67 index: 70-80%.