Hepatic Pseudolymphoma Mimicking a Hypervascular Tumor: A Case Report

Bora Im; Suk Ki Jang; Jae Woo Yeon; So Ya Paik; Sang Jong Park; Hyuk Jung Kim

doi:10.3348/jksr.2018.79.6.348

Journal List > J Korean Soc Radiol > v.79(6) > 1108789

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Im, Jang, Yeon, Paik, Park, and Kim: Hepatic Pseudolymphoma Mimicking a Hypervascular Tumor: A Case Report

Case Report

J Korean Soc Radiol 2018;79(6):348-353.

Published online: 19 January 2018

DOI: https://doi.org/10.3348/jksr.2018.79.6.348

Hepatic Pseudolymphoma Mimicking a Hypervascular Tumor: A Case Report

Bora Im, MD¹, Suk Ki Jang, MD^1,, Jae Woo Yeon, MD¹, So Ya Paik, MD², Sang Jong Park, MD³, Hyuk Jung Kim, MD¹

¹Department of Radiology, Daejin Medical Center Bundang Jesaeng General Hospital, Seongnam, Korea

²Department of Pathology, Daejin Medical Center Bundang Jesaeng General Hospital, Seongnam, Korea

³Department of Internal Medicine, Daejin Medical Center Bundang Jesaeng General Hospital, Seongnam, Korea

^∗Corresponding author: Suk Ki Jang, MD Department of Radiology, Daejin Medical Center Bundang Jesaeng General Hospital, 20 Seohyeon-ro 180beon-gil, Bundang-gu, Seongnam 13590, Korea. Tel. 82-31-779-3038 Fax. 82-31-779-0062 E-mail: neverendlove@hanmail.net

Received 2 April 2018 Revised 11 May 2018 Accepted 6 June 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Hepatic pseudolymphoma is a rare benign liver mass that is characterized by proliferation of non-neoplastic lymphocytes extranodally. To the best of our knowledge, only 46 cases have been reported in the English literature. We described the case of a 75-year-old woman with hepatic pseudolymphoma mimicking a hypervascular tumor. After the histological confirmation of the rectal neuroendocrine tumor, CT scan revealed a 1.0 cm-sized, poorly-defined and low-density nodule in the liver. On MRI, the hepatic nodule showed an arterial enhancement and a low-signal intensity on the hepatobiliary phase. On diffusion-weighted imaging, the hepatic nodule showed a high signal intensity on a high b-value. On fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT, it revealed a high standardized uptake value nodule. The US showed the hypoechoic nodule and the US-guided biopsy confirmed the hepatic pseudolymphoma.

Keywords: Liver, Pseudolymphoma, Multidetector Computed Tomography, Magnetic Resonance Imaging, Ultrasonography

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Fig. 1

A 75-year-old woman with a hepatic pseudolymphoma. A, B. Axial contrast-enhanced CT image (A) and coronal reconstructed CT image (B) demonstrate an ill-defined low-attenuated nodule in the liver segment 8 (arrows). C. Fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT shows a high standardized uptake value (maximum standardized uptake value: 4.2) at the liver segment 8, suggesting hypermetabolic nodule (arrow). D. Intraoperative US shows a well-defined, markedly hypoechoic nodule in segment 8 (arrow). E. MRI finding of the hepatic pseudolymphoma using gadoxetic acid (Gd-EOB-DTPA-Primovist®). T2-weighted axial MR image shows a homogeneous high-signal instensity nodule in the liver segment 8 (arrowheads). On DWI, the hepatic nodule shows a high-signal intensity on a high b-value (1000 s/mm²). Gd-EOB-DTPA enhanced dynamic MR images show a homogeneous arterial enhancement and low-signal intensity on the transitional phase. The nodule shows a markedly low-signal intensity on the hepatobiliary phase. DWI = diffusion-weighted images, HBP = hepatobiliary phase, T2WI = T2-weighted images F. Histological specimen shows diffuse infiltration of lymphoid cells seen adjacent to cirrhotic liver nodule (H&E stain, × 40) and lymphocytes are mainly composed of small mature lymphocytes admixed with scattered medium and large cells. There is no cytological atypia of lymphoid cells (H&E stain, × 100). Immunostaining revealed the lymphocytes to be composed of both T cells (positive for CD3) and B cells (positive for CD79a) (H&E stain, × 200). H&E = hematoxylin and eosin stain

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