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Kim, Shin, Rha, Jung, Oh, Choi, Jung, and Lee: Primary Hepatic Lymphoma: MR Imaging and Pathologic Correlation
Case Report
Journal of the Korean Society of Magnetic Resonance in Medicine

Journal of the Korean Society of Magnetic Resonance in Medicine 2010; 14(2): 151-155.

Published online: 31 December 2010

DOI: https://doi.org/10.13104/jksmrm.2010.14.2.151

Primary Hepatic Lymphoma: MR Imaging and Pathologic Correlation

Hanna Kim1, Yu Ri Shin1, Sung Eun Rha1, Eun Sun Jung2, Soon Nam Oh1, Joon-Il Choi1, Seung Eun Jung1, Young Joon Lee1

1Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea.

2Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea.

Address reprint requests to: Yu Ri Shin, M.D., Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul 137-701, Korea. Tel. 82-2-2258-1455, Fax. 82-2-599-6771, crystal57@catholic.ac.kr

Received 5 October 2010       Revised 10 October 2010       Accepted 14 October 2010

Copyright © 2010 Korean Society of Magnetic Resonance in Medicine

(open-access):

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

Primary hepatic lymphoma is extremely rare, representing less than 1% of all extranodal lymphomas. We report MR imaging features and pathologic correlation of a case of primary hepatic lymphoma. MR images showed a large lobulated mass with gradual contrast enhancement, resembling intrahepatic cholangiocarcinoma. However, both hepatobiliary phase image obtained 20 minutes after injection of hepatocyte specific contrast agent and diffusion-weighted image demonstrated characteristic three layered pattern representing viable lymphoma in the outer layer, tumor necrosis in the middle layer and necrotic hepatic parenchyma in the center.

Keywords: Lymphoma, Liver, Magnetic resonance imaging (MRI)

Figures and Tables

Fig. 1
A 78-year-old man with primary hepatic lymphoma. (a) Axial fat suppressed T2-weighted fast spin echo image shows a large lobulated hyperintense mass (arrows) in the left hepatic lobe. (b) Coronal T2-weighted single shot fast spin echo image shows a large lobulated heterogeneous hyperintense mass (arrows), surrounding the fissure for ligamentum teres (arrowhead). (c) Axial pre-contrast T1-weighted image shows hypointense mass (arrow) in the left hepatic lobe. (d, e) Axial portal venous (d) and equilibrium (e) phase contrast-enhanced T1-weighted image show poor, heterogeneous enhancement of the mass (arrow). Progressive enhancement is seen in the central portion of the mass. (f) Axial 20 minute-delayed hepatobiliary phase contrast-enhanced T1-weighted image clearly shows two different signal intensity of the lesion: lymphoma with very low signal intensity area (arrow) and slightly low signal intensity entrapped by the tumor with necrotic hepatic parenchyma (dotted arrow). (g) Axial diffusion-weighed image (b = 800) shows three different signal intensity of the lesion: a band-like high signal intensity of the tumor (arrow), thin linear dark signal intensity along the medial margin of the high signal intensity (arrowhead), consistent with necrotic tumor, and intermediate signal intensity area (dotted arrow) entrapped by the tumor consistent with necrotic hepatic parenchyma. (h) F-18 FDG PET-CT shows a band-like hot uptake showing the same configuration with that of diffusion-weighted image, suggestive of a viable tumor. (i) Gross specimen shows three different zones consisting of a band-like lobulated tumor (arrow), focal tumoral necrosis (arrowhead), and necrotic hepatic parenchyma without tumor involvement (dotted arrow). (j) Photomicrography of specimen (immunohistochemical staining for CD20, ×400) shows multiple large atypical lymphoid cells expressing CD20, consistent with diffuse large B-cell lymphoma.
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