Synchronous Hepatocellular Carcinoma and B-Cell Non-Hodgkin's Lymphoma in Chronic Hepatitis C Patient

Soon Il Lee; Nae-Yun Heo; Seung Ha Park; Young-Don Joo; Il Hwan Kim; Jeong-Ik Park; Ji Yeon Kim; Seung Ho Kim; Hye Kyung Shim

doi:10.4166/kjg.2014.64.3.168

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Lee, Heo, Park, Joo, Kim, Park, Kim, Kim, and Shim: Synchronous Hepatocellular Carcinoma and B-Cell Non-Hodgkin's Lymphoma in Chronic Hepatitis C Patient

Case Report

Korean J Gastroenterol 2014;64(3):168-172.

Published online: 4 October 2014

DOI: https://doi.org/10.4166/kjg.2014.64.3.168

Synchronous Hepatocellular Carcinoma and B-Cell Non-Hodgkin's Lymphoma in Chronic Hepatitis C Patient

Soon Il Lee, Nae-Yun Heo, Seung Ha Park, Young-Don Joo, Il Hwan Kim, Jeong-Ik Park¹, Ji Yeon Kim², Seung Ho Kim³, Hye Kyung Shim⁴

Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea

¹Department of Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea

²Department of Pathology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea

³Department of Radiology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea

⁴Department of Nuclear Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea

Correspondence to: Nae-Yun Heo, Department of Internal Medicine, Inje University Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan 612-030, Korea. Tel: +82-51-797-0658, Fax: +82-51-797-0941, E-mail: nyheo@hanmail.net

Received 19 January 20143 March 2014 Accepted 3 March 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Hepatitis C virus (HCV) is one of the main viral causes of hepatocellular carcinoma (HCC) and is associated with lymphoproliferative disorder such as non-Hodgkin's lymphoma (NHL). However, there are only few case reports on concomitantly induced NHL and HCC by HCV. Herein, we report a case of synchronous NHL and HCC in a patient with chronic hepatitis C which was unexpectedly diagnosed during liver transplantation surgery. This case suggests that although intrahepatic lymph node enlarge-ments are often considered as reactive or metastatic lymphadenopathy in chronic hepatitis C patients with HCC, NHL should also be considered as a differential diagnosis.

Keywords: Hepatocellular carcinoma, Hepatitis C, Non-Hodgkin lymphoma

References

1. Marcucci F, Mele A. Hepatitis viruses and non-Hodgkin lymphoma: epidemiology, mechanisms of tumorigenesis, and therapeutic opportunities. Blood. 2011; 117:1792–1798.

2. Ono T, Komatsu M, Masamune O. Primary lymphoma of the spleen with hepatocellular carcinoma. Intern Med. 1995; 34:261–264.

3. Suriawinata A, Ye MQ, Emre S, Strauchen J, Thung SN. Hepatocellular carcinoma and non-Hodgkin lymphoma in a patient with chronic hepatitis C and cirrhosis. Arch Pathol Lab Med. 2000; 124:1532–1534.

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8. Utsunomiya T, Okamoto M, Tsujita E, et al. Hepatocellular carcinoma infiltrated with non-Hodgkin's lymphoma: report of a case. Surg Today. 2009; 39:1010–1012.

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Fig. 1.

Gadoxetic acid-enhanced magnetic resonance image shows a 2.3 cm sized hepatic nodule in S8 (white arrows), which is enhanced on arterial phase (A) and washed-out on equilibrium phase (B). Another 2.1 cm sized hepatic nodule in S4 (white arrows) is noted with same enhancement pattern on arterial (C) and equilibrium phase (D). An enlarged lymph node is also seen along the common hepatic artery, and it is enhanced on arterial phase (E) and iso-attenuated on equilibrium phase (F). After the first transarterial chemoembolization, the compact lipiodol uptake by both hepatic nodules is shown in pre-enhanced phase (G, H).

Fig. 2.

(A) Axial and (B) maximum intensity projection image of ¹⁸ F-FDG PET-CT shows hyper-metabolic activity in the enlarged periportal lymph node (white arrow), the maximum standar-dized uptake value (SUVmax) of which is 6.8. The SUVmax of the hepatic nodules is 3.45, which is iso-metabolic compared to normal hepatic paren-chyma.

Fig. 3.

Low-power photomicrograph of the periportal lymph node reveals characteristic nodular growth pattern in H&E (A; ×20) and CD20 immunohistochemical stain (B; ×20). At high-power microscopic view, each follicle is comprised predominantly of large cells resembling centroblasts (C; H&E, ×400). The neoplastic lymphocytes are positive for Bcl-6, which is expressed in germinal center cells (D; ×200).

Table 1.

Clinical Characteristics of Reported Cases on Concomitant Hepatocellular Carcinoma and Non-Hodgkin's Lymphoma in Chronic Hepatitis C Patient in the Literature

First author, published year	Age (yr)/sex	Characteristic of HCC	Characteristic of NHL	Survival
Ono T, 1995²	59/F	Single, size: 3.5 cm	Location: spleen	11 Months
		Moderately differentiated	Pathology: DLBL
		Treatment: TACE
Suriawinata A, 2000³	55/M	Two, size: 1.8 and 0.6 cm	Location: retrocaval lymph node	>15 Months
		Well differentiated	Pathology: DLBL
		Treatment: liver transplantation
Shapira MY, 2001⁴	70/M	Two, size: 3.0 and 4.9 cm	Location: stomach	Not described
		Angiographic diagnosis	Pathology: DLBL
Himoto T, 2006⁵	63/M	Single, size: 4 cm	Location: spleen	Not described
		Moderately differentiated	Pathology: DLBL
		Treatment: PEIT and RFA	Treatment: CHOP chemotherapy
Ohtsubo K, 2006⁶	66/M	Two, size: 1.5 and 1.2 cm	Location: liver	Not described
		Moderately differentiated	Pathology: DLBL
		Treatment: RFA	Treatment: R-CHOP chemotherapy
Lin A, 2008^7,a	70/M	Multiple, size: not mentioned	Location: lymph node (location was not mentioned)	Not described
		Necrotic tumor tissue with few HCC cells
			Pathology: DLBL
			Treatment: R-CHOP chemotherapy
Utsunomiya T, 2009⁸	70/F	Single, size: 3 cm	Location: in non-tumorous liver tissue	4 Months
		Well to moderately differentiated	Pathology: DLBL
		Treatment: partial hepatectomy
Becker DJ, 2010⁹	68/M	Single, size: 2.3 cm	Location: liver, bone marrow	Not described
		Histologic diagnosis	Pathology: SLL/CLL
		Differentiation was not described
		Treatment: RFA
Present case	60/M	Two, 2 cm, respectively	Location: intra-abdominal node	>20 Months
		Radiologic diagnosis	Pathology: follicular lymphoma
		Treatment: TACE and RFA	Treatment: R-CVP

DLBL, diffuse large B cell lymphoma; SLL/CLL, small lymphocyte lymphoma/chronic lymphocytic leukemia; HCC, hepatocellular carcinoma; NHL, non-Hodgkin lymphoma; RFA, radiofrequency ablation; PEIT, percutaneous ethanol injection therapy.

CHOP chemotherapy indicates the regimen includes cyclophosphamide, adriamycin, vincristine and prednisone.

R-CHOP chemotherapy indicates the regimen includes rituximab, cyclophosphamide, adriamycin, vincristine and prednisone.

R-CVP chemotherapy indicates the regimen includes rituximab, cyclophosphamide, vincristine and prednisone.

^a The second case of Lin et al. was excluded in this table because the term of diagnosis of both cancer was more than 1 year.

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