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Imaging findings for intravascular large B-cell lymphoma of the liver.

Bae J, Lim HK, Park HY - Clin Mol Hepatol (2015)

Bottom Line: Intravascular large B-cell lymphoma (IVLBCL) is a rare subtype of extranodal diffuse large B-cell lymphoma that most commonly involves the central nervous system and skin.To our knowledge, no state-of-the art imaging findings have been reported for hepatic IVLBCL in the English literature.We report the first case of hepatic involvement of IVLBCL along with a literature review.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT
Intravascular large B-cell lymphoma (IVLBCL) is a rare subtype of extranodal diffuse large B-cell lymphoma that most commonly involves the central nervous system and skin. To our knowledge, no state-of-the art imaging findings have been reported for hepatic IVLBCL in the English literature. We report the first case of hepatic involvement of IVLBCL along with a literature review.

No MeSH data available.


Related in: MedlinePlus

MRI findings for a 58-year-old man with IVLBCL of the liver. (A) Precontrast T1-weighted liver image showing ill-defined hypointense mass-like lesions (arrows) in both hepatic lobes. (B) These lesions appear as homogeneous hyperintense areas on a T2-weighted image (arrows). The small, hyperintense focal lesion (arrowhead) in the subcapsular area of liver segment VII is a known hemangioma. Dynamic MRI images after gadolinium-EOB-DTPA enhancement show little contrast enhancement during the hepatic arterial (C), portal venous (D), or delayed (E) phase. Diffusionweighted image with b = 800 sec/mm2 (F) and ADC map (G) show diffusion restriction of the lesions.
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Figure 2: MRI findings for a 58-year-old man with IVLBCL of the liver. (A) Precontrast T1-weighted liver image showing ill-defined hypointense mass-like lesions (arrows) in both hepatic lobes. (B) These lesions appear as homogeneous hyperintense areas on a T2-weighted image (arrows). The small, hyperintense focal lesion (arrowhead) in the subcapsular area of liver segment VII is a known hemangioma. Dynamic MRI images after gadolinium-EOB-DTPA enhancement show little contrast enhancement during the hepatic arterial (C), portal venous (D), or delayed (E) phase. Diffusionweighted image with b = 800 sec/mm2 (F) and ADC map (G) show diffusion restriction of the lesions.

Mentions: A 58-year-old man who was previously healthy presented with six-week history of dyspnea and a one-day history of fever. Body temperature at presentation was 38.8℃. Laboratory studies revealed a white blood cell count of 10.2 × 103/µL with hemoglobin 8.5 g/dL. Total bilirubin level was 2.6 mg/dL (normal range, 0.2-1.5 mg/dL). Liver enzyme levels were elevated with an alanine aminotransferase 72 U/L (normal range, 0-40 U/L), aspartate aminotransferase 151 U/L (normal range, 0-40 U/L), and alkaline phosphatase 155 U/L (normal range, 53-128 U/L). Lactate dehydrogenase (LDH) was 6151 IU/L (normal range, 240-480 IU/L). Erythrocyte sedimentation rate (ESR) was 12 mm/hr (normal range, 0-22 mm/hr). To evaluate the cause of dyspnea, chest CT was performed and there was no demonstrable abnormality to explain the symptom. On laboratory findings patient showed anemia which was suspected as the cause of dyspnea. The patient was known to have a hemangioma in liver segment VII that had been incidentally found in 2004 and had grown from 1.4 cm to 3.0 cm on follow-up ultrasonography. Therefore, imaging studies were performed to further evaluate the hepatic hemangioma and investigate the cause of the elevated liver enzymes. Contrast-enhanced dynamic CT of the liver showed multiple ill-defined non-enhancing areas in the hepatic lobes. Lesions appeared as low-attenuating areas of geographic pattern compared with normal-appearing parenchyma during all three phases. Hepatic vascular structures traversed normally through lesions without mass effects (Fig. 1). Gadoxetic acid-enhanced liver MRI (Fig. 2) revealed multiple mass-like lesions with ill-defined margins and homogeneous hypointensity on pre-contrast T1-weighted images and homogeneous hyperintensity on pre-contrast T2-weighted images. The lesions showed little contrast enhancement during dynamic scans and diffusion restriction on diffusion-weighted images. Hepatic vascular structures within the lesions were normal without mass effects, similar to the CT images. Ultrasonography-guided percutaneous biopsy was performed under the impression of a suspected unusual malignant tumor. Microscopic analysis showed abundant tumor cells filling the hepatic sinusoids and tumor cells positive for CD20 (Fig. 3). The patient was found to have no abnormality in central nerve system, skin, and other parts of the abdomen on physical examination and imaging studies. Bone marrow biopsy was performed and the final pathologic diagnosis was IVLBCL. Immediately after diagnosis, chemotherapy with cyclophosphamide, doxorubicin, vincristine, prednisone and monoclonal antibody rituximab (R-CHOP) was initiated, and after a few days, fever began to subside. Follow-up CT (Fig. 4) 3 months later showed nearly total resolution of the liver lesions. The patient was alive at 17 months with no sign of disease progression.


Imaging findings for intravascular large B-cell lymphoma of the liver.

Bae J, Lim HK, Park HY - Clin Mol Hepatol (2015)

MRI findings for a 58-year-old man with IVLBCL of the liver. (A) Precontrast T1-weighted liver image showing ill-defined hypointense mass-like lesions (arrows) in both hepatic lobes. (B) These lesions appear as homogeneous hyperintense areas on a T2-weighted image (arrows). The small, hyperintense focal lesion (arrowhead) in the subcapsular area of liver segment VII is a known hemangioma. Dynamic MRI images after gadolinium-EOB-DTPA enhancement show little contrast enhancement during the hepatic arterial (C), portal venous (D), or delayed (E) phase. Diffusionweighted image with b = 800 sec/mm2 (F) and ADC map (G) show diffusion restriction of the lesions.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4612291&req=5

Figure 2: MRI findings for a 58-year-old man with IVLBCL of the liver. (A) Precontrast T1-weighted liver image showing ill-defined hypointense mass-like lesions (arrows) in both hepatic lobes. (B) These lesions appear as homogeneous hyperintense areas on a T2-weighted image (arrows). The small, hyperintense focal lesion (arrowhead) in the subcapsular area of liver segment VII is a known hemangioma. Dynamic MRI images after gadolinium-EOB-DTPA enhancement show little contrast enhancement during the hepatic arterial (C), portal venous (D), or delayed (E) phase. Diffusionweighted image with b = 800 sec/mm2 (F) and ADC map (G) show diffusion restriction of the lesions.
Mentions: A 58-year-old man who was previously healthy presented with six-week history of dyspnea and a one-day history of fever. Body temperature at presentation was 38.8℃. Laboratory studies revealed a white blood cell count of 10.2 × 103/µL with hemoglobin 8.5 g/dL. Total bilirubin level was 2.6 mg/dL (normal range, 0.2-1.5 mg/dL). Liver enzyme levels were elevated with an alanine aminotransferase 72 U/L (normal range, 0-40 U/L), aspartate aminotransferase 151 U/L (normal range, 0-40 U/L), and alkaline phosphatase 155 U/L (normal range, 53-128 U/L). Lactate dehydrogenase (LDH) was 6151 IU/L (normal range, 240-480 IU/L). Erythrocyte sedimentation rate (ESR) was 12 mm/hr (normal range, 0-22 mm/hr). To evaluate the cause of dyspnea, chest CT was performed and there was no demonstrable abnormality to explain the symptom. On laboratory findings patient showed anemia which was suspected as the cause of dyspnea. The patient was known to have a hemangioma in liver segment VII that had been incidentally found in 2004 and had grown from 1.4 cm to 3.0 cm on follow-up ultrasonography. Therefore, imaging studies were performed to further evaluate the hepatic hemangioma and investigate the cause of the elevated liver enzymes. Contrast-enhanced dynamic CT of the liver showed multiple ill-defined non-enhancing areas in the hepatic lobes. Lesions appeared as low-attenuating areas of geographic pattern compared with normal-appearing parenchyma during all three phases. Hepatic vascular structures traversed normally through lesions without mass effects (Fig. 1). Gadoxetic acid-enhanced liver MRI (Fig. 2) revealed multiple mass-like lesions with ill-defined margins and homogeneous hypointensity on pre-contrast T1-weighted images and homogeneous hyperintensity on pre-contrast T2-weighted images. The lesions showed little contrast enhancement during dynamic scans and diffusion restriction on diffusion-weighted images. Hepatic vascular structures within the lesions were normal without mass effects, similar to the CT images. Ultrasonography-guided percutaneous biopsy was performed under the impression of a suspected unusual malignant tumor. Microscopic analysis showed abundant tumor cells filling the hepatic sinusoids and tumor cells positive for CD20 (Fig. 3). The patient was found to have no abnormality in central nerve system, skin, and other parts of the abdomen on physical examination and imaging studies. Bone marrow biopsy was performed and the final pathologic diagnosis was IVLBCL. Immediately after diagnosis, chemotherapy with cyclophosphamide, doxorubicin, vincristine, prednisone and monoclonal antibody rituximab (R-CHOP) was initiated, and after a few days, fever began to subside. Follow-up CT (Fig. 4) 3 months later showed nearly total resolution of the liver lesions. The patient was alive at 17 months with no sign of disease progression.

Bottom Line: Intravascular large B-cell lymphoma (IVLBCL) is a rare subtype of extranodal diffuse large B-cell lymphoma that most commonly involves the central nervous system and skin.To our knowledge, no state-of-the art imaging findings have been reported for hepatic IVLBCL in the English literature.We report the first case of hepatic involvement of IVLBCL along with a literature review.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT
Intravascular large B-cell lymphoma (IVLBCL) is a rare subtype of extranodal diffuse large B-cell lymphoma that most commonly involves the central nervous system and skin. To our knowledge, no state-of-the art imaging findings have been reported for hepatic IVLBCL in the English literature. We report the first case of hepatic involvement of IVLBCL along with a literature review.

No MeSH data available.


Related in: MedlinePlus