MDT discussion of a case of primary diffuse large B cell lymphoma of liver_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 HUANG Yang ¹ , LI Xiantai ² , YI Cheng ² , ZHENG Jinli ¹ , PU Xingyu ¹ ,  JIANG Li ¹ , YAN Lünan ¹

1. Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Department of Hepatobiliary Surgery, Jintang Hospital, West China Hospital, Sichuan University, Jintang, Sichuan 610400, P. R. China;

Corresponding author：

JIANG Li, Email: jl339@126.com

Keywords：

primary diffuse large B cell lymphoma of liver; diagnosis; differential diagnosis; multiple disciplinary team; treatment

DOI：

10.7507/1007-9424.202008113

Video：

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Objective To investigate the clinical manifestations, imaging manifestations, etiology, histological origin, pathological characteristics, diagnosis and differential diagnosis, selection of treatment methods, and prognosis of primary diffuse large B cell lymphoma of livers (PDLBCLL), so as to improve understanding and reasonable diagnosis and treatment of this kind of disease.Method The clinicopathologic data of a case of PDLBCLL diagnosed in the West China Hospital of Sichuan University in June 2019 were analyzed retrospectively.Results It was very difficult to diagnose PDLBCLL preoperatively and to distinguish PDLBCLL from primary liver cancer and other liver space occupying lesions. It was also easy to ignore the possibility of invasion of liver by lymphopoietic tissue tumor, which was often diagnosed by postoperative pathological diagnosis or puncture biopsy, and after the elimination of hematological diseases by various examinations. This patient was admitted to the hospital as a space occupying in right liver. Preoperative imaging examination considered that may be a tumor. After MDT discussion, considering that the nature of the tumor should be confirmed by surgical resection, and then go to the Department of Oncology. Irregular right hemihepatectomy + cholecystectomy + hilar lymphadenectomy + diaphragmatic repair was performed after MDT discussion. The diagnosis of PDLBCLL was confirmed by postoperative pathological examination. The operation duration was about 230 min, and the intraoperative blood loss was about 200 mL. The patient recovered well without complications and was discharged on the 10th day after operation. The patient was followed up for 9 months. The liver and kidney function, electrolytes and abdominal Doppler ultrasound examination were regularly reviewed every month. No obvious abnormality was found in these results.Conclusions At present, there is no unified treatment principle, most of them will undergo surgery, chemotherapy, radiotherapy or combined treatment. Due to its unknown etiology and unclear mechanism, clinicians can only implement individualized treatment according to the characteristics of patients’ conditions.

Citation： HUANG Yang, LI Xiantai, YI Cheng, ZHENG Jinli, PU Xingyu, JIANG Li, YAN Lünan. MDT discussion of a case of primary diffuse large B cell lymphoma of liver. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(2): 236-242. doi: 10.7507/1007-9424.202008113 Copy

1.	Miyashita K, Tomita N, Oshiro H, et al. Primary hepatic peripheral T-cell lymphoma treated with corticosteroid. Intern Med, 2011, 50(6): 617-620.
2.	Caccamo D, Pervez NK, Marchevsky A. Primary lymphoma of the liver in the acquired immunodeficiency syndrome. Arch Pathol Lab Med, 1986, 110(6): 553-555.
3.	Ata AA, Kamel IA. Primary reticulum cell sarcoma of the liver. A case report. J Egypt Med Assoc, 1965, 48(7): 514-521.
4.	Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2009. CA Cancer J Clin, 2009, 59(4): 225-249.
5.	Higuchi T, Nomoto K, Mori H, et al. Case report: primary hepatic lymphoma associated with chronic liver disease. J Gastroenterol Hepatol, 1997, 12(3): 237-242.
6.	赵骞, 刘海平, 顾怡瑾, 等. 35例原发性肝脏淋巴瘤的临床病理特点及预后分析. 中华肿瘤杂志, 2013, 35(9): 689-692.
7.	Bronowicki JP, Bineau C, Feugier P, et al. Primary lymphoma of the liver: clinical-pathological features and relationship with HCV infection in French patients. Hepatology, 2003, 37(4): 781-787.
8.	Page RD, Romaguera JE, Osborne B, et al. Primary hepatic lymphoma: favorable outcome after combination chemotherapy. Cancer, 2001, 92(8): 2023-2029.
9.	De Renzo A, Perna F, Persico M, et al. Excellent prognosis and prevalence of HCV infection of primary hepatic and splenic non-Hodgkin’s lymphoma. Eur J Haematol, 2008, 81(1): 51-57.
10.	Armitage JO, Mauch PM, Harris NL, et al. Non-Hodgkin's lymphomas//DeVita VTJr, Hellman S, Rosenberg SA. Cancer: principle and practice of oncology. Philadelphia:Lippincott Williams & Wilkins, 2001: 2256-2316.
11.	Ohsawa M, Aozasa K, Horiuchi K, et al. Malignant lymphoma of the liver. Report of five cases and review of the literature. Dig Dis Sci, 1992, 37(7): 1105-1109.
12.	Avlonitis VS, Linos D. Primary hepatic lymphoma: a review. Eur J Surg, 1999, 165(8): 725-729.
13.	陈亚军, 邵新宏, 王刚, 等. 原发性肝脏弥漫性大B细胞淋巴瘤一例报告并文献复习. 中华肿瘤防治杂志, 2018, 25(11): 821-826.
14.	Lei KI. Primary non-Hodgkin’s lymphoma of the liver. Leuk Lymphoma, 1998, 29(3-4): 293-299.
15.	赵翠翠, 王华庆, 钱正子, 等. 原发性肝淋巴瘤的临床特点及治疗. 中华肝胆外科杂志, 2013, 19(2): 112-115.
16.	Ulcickas Yood M, Quesenberry CP Jr, Guo D, et al. Incidence of non-Hodgkin’s lymphoma among individuals with chronic hepatitis B virus infection. Hepatology, 2007, 46(1): 107-112.
17.	Aozasa K, Mishima K, Ohsawa M. Primary malignant lymphoma of the liver. Leuk Lymphoma, 1993, 10(4-5): 353-357.
18.	Lisker-Melman M, Pittaluga S, Pluda JM, et al. Primary lymphoma of the liver in a patient with acquired immune deficiency syndrome and chronic hepatitis B. Am J Gastroenterol, 1989, 84(11): 1445-1448.
19.	Mills AE. Undifferentiated primary hepatic non-Hodgkin’s lymphoma in childhood. Am J Surg Pathol, 1988, 12(9): 721-726.
20.	Ohsawa M, Tomita Y, Hashimoto M, et al. Hepatitis C viral genome in a subset of primary hepatic lymphomas. Mod Pathol, 1998, 11(5): 471-478.
21.	Emile JF, Azoulay D, Gornet JM, et al. Primary non-Hodgkin’s lymphomas of the liver with nodular and diffuse infiltration patterns have different prognoses. Ann Oncol, 2001, 12(7): 1005-1010.
22.	Gazelle GS, Lee MJ, Hahn PF, et al. US, CT, and MRI of primary and secondary liver lymphoma. J Comput Assist Tomogr, 1994, 18(3): 412-415.
23.	Elsayes KM, Menias CO, Willatt JM, et al. Primary hepatic lymphoma: imaging findings. J Med Imaging Radiat Oncol, 2009, 53(4): 373-379.
24.	Maher MM, McDermott SR, Fenlon HM, et al. Imaging of primary non-Hodgkin’s lymphoma of the liver. Clin Radiol, 2001, 56(4): 295-301.
25.	丁建辉, 彭卫军, 周良平, 等. 肝脏淋巴瘤CT和MRI表现. 中国医学计算机成像杂志, 2008, 14(5): 409-414.
26.	Kelekis NL, Semelka RC, Siegelman ES, et al. Focal hepatic lymphoma: magnetic resonance demonstration using current techniques including gadolinium enhancement. Magn Reson Imaging, 1997, 15(6): 625-636.
27.	Kim H, Kim KW, Park MS, et al. Lymphoma presenting as an echogenic periportal mass: sonographic findings. J Clin Ultrasound, 2008, 36(7): 437-439.
28.	Yasin M, Hartranft TH. Primary hepatic lymphoma: unusual presentation and clinical course. Am Surg, 1997, 63(11): 951-953.
29.	王木森, 王新国, 郑金锋, 等. 原发性肝脏弥漫大B细胞淋巴瘤5例报道并文献复习. 重庆医科大学学报, 2016, 41(6): 605-608.
30.	Patel TS, Malvania R, Shah MC, et al. Primary hepatic lymphoma: a case report. J Cytol, 2015, 32(1): 36-38.
31.	Noronha V, Shafi NQ, Obando JA, et al. Primary non-Hodgkin’s lymphoma of the liver. Crit Rev Oncol Hematol, 2005, 53(3): 199-207.
32.	Eidt S, Nebeling M, Pohl C, et al. Neoadjuvant chemotherapy of primary hepatic non-Hodgkin’s lymphoma. Med Klin (Munich), 2003, 98(2): 96-99.

1. Miyashita K, Tomita N, Oshiro H, et al. Primary hepatic peripheral T-cell lymphoma treated with corticosteroid. Intern Med, 2011, 50(6): 617-620.
2. Caccamo D, Pervez NK, Marchevsky A. Primary lymphoma of the liver in the acquired immunodeficiency syndrome. Arch Pathol Lab Med, 1986, 110(6): 553-555.
3. Ata AA, Kamel IA. Primary reticulum cell sarcoma of the liver. A case report. J Egypt Med Assoc, 1965, 48(7): 514-521.
4. Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2009. CA Cancer J Clin, 2009, 59(4): 225-249.
5. Higuchi T, Nomoto K, Mori H, et al. Case report: primary hepatic lymphoma associated with chronic liver disease. J Gastroenterol Hepatol, 1997, 12(3): 237-242.
6. 赵骞, 刘海平, 顾怡瑾, 等. 35例原发性肝脏淋巴瘤的临床病理特点及预后分析. 中华肿瘤杂志, 2013, 35(9): 689-692.
7. Bronowicki JP, Bineau C, Feugier P, et al. Primary lymphoma of the liver: clinical-pathological features and relationship with HCV infection in French patients. Hepatology, 2003, 37(4): 781-787.
8. Page RD, Romaguera JE, Osborne B, et al. Primary hepatic lymphoma: favorable outcome after combination chemotherapy. Cancer, 2001, 92(8): 2023-2029.
9. De Renzo A, Perna F, Persico M, et al. Excellent prognosis and prevalence of HCV infection of primary hepatic and splenic non-Hodgkin’s lymphoma. Eur J Haematol, 2008, 81(1): 51-57.
10. Armitage JO, Mauch PM, Harris NL, et al. Non-Hodgkin's lymphomas//DeVita VTJr, Hellman S, Rosenberg SA. Cancer: principle and practice of oncology. Philadelphia:Lippincott Williams & Wilkins, 2001: 2256-2316.
11. Ohsawa M, Aozasa K, Horiuchi K, et al. Malignant lymphoma of the liver. Report of five cases and review of the literature. Dig Dis Sci, 1992, 37(7): 1105-1109.
12. Avlonitis VS, Linos D. Primary hepatic lymphoma: a review. Eur J Surg, 1999, 165(8): 725-729.
13. 陈亚军, 邵新宏, 王刚, 等. 原发性肝脏弥漫性大B细胞淋巴瘤一例报告并文献复习. 中华肿瘤防治杂志, 2018, 25(11): 821-826.
14. Lei KI. Primary non-Hodgkin’s lymphoma of the liver. Leuk Lymphoma, 1998, 29(3-4): 293-299.
15. 赵翠翠, 王华庆, 钱正子, 等. 原发性肝淋巴瘤的临床特点及治疗. 中华肝胆外科杂志, 2013, 19(2): 112-115.
16. Ulcickas Yood M, Quesenberry CP Jr, Guo D, et al. Incidence of non-Hodgkin’s lymphoma among individuals with chronic hepatitis B virus infection. Hepatology, 2007, 46(1): 107-112.
17. Aozasa K, Mishima K, Ohsawa M. Primary malignant lymphoma of the liver. Leuk Lymphoma, 1993, 10(4-5): 353-357.
18. Lisker-Melman M, Pittaluga S, Pluda JM, et al. Primary lymphoma of the liver in a patient with acquired immune deficiency syndrome and chronic hepatitis B. Am J Gastroenterol, 1989, 84(11): 1445-1448.
19. Mills AE. Undifferentiated primary hepatic non-Hodgkin’s lymphoma in childhood. Am J Surg Pathol, 1988, 12(9): 721-726.
20. Ohsawa M, Tomita Y, Hashimoto M, et al. Hepatitis C viral genome in a subset of primary hepatic lymphomas. Mod Pathol, 1998, 11(5): 471-478.
21. Emile JF, Azoulay D, Gornet JM, et al. Primary non-Hodgkin’s lymphomas of the liver with nodular and diffuse infiltration patterns have different prognoses. Ann Oncol, 2001, 12(7): 1005-1010.
22. Gazelle GS, Lee MJ, Hahn PF, et al. US, CT, and MRI of primary and secondary liver lymphoma. J Comput Assist Tomogr, 1994, 18(3): 412-415.
23. Elsayes KM, Menias CO, Willatt JM, et al. Primary hepatic lymphoma: imaging findings. J Med Imaging Radiat Oncol, 2009, 53(4): 373-379.
24. Maher MM, McDermott SR, Fenlon HM, et al. Imaging of primary non-Hodgkin’s lymphoma of the liver. Clin Radiol, 2001, 56(4): 295-301.
25. 丁建辉, 彭卫军, 周良平, 等. 肝脏淋巴瘤CT和MRI表现. 中国医学计算机成像杂志, 2008, 14(5): 409-414.
26. Kelekis NL, Semelka RC, Siegelman ES, et al. Focal hepatic lymphoma: magnetic resonance demonstration using current techniques including gadolinium enhancement. Magn Reson Imaging, 1997, 15(6): 625-636.
27. Kim H, Kim KW, Park MS, et al. Lymphoma presenting as an echogenic periportal mass: sonographic findings. J Clin Ultrasound, 2008, 36(7): 437-439.
28. Yasin M, Hartranft TH. Primary hepatic lymphoma: unusual presentation and clinical course. Am Surg, 1997, 63(11): 951-953.
29. 王木森, 王新国, 郑金锋, 等. 原发性肝脏弥漫大B细胞淋巴瘤5例报道并文献复习. 重庆医科大学学报, 2016, 41(6): 605-608.
30. Patel TS, Malvania R, Shah MC, et al. Primary hepatic lymphoma: a case report. J Cytol, 2015, 32(1): 36-38.
31. Noronha V, Shafi NQ, Obando JA, et al. Primary non-Hodgkin’s lymphoma of the liver. Crit Rev Oncol Hematol, 2005, 53(3): 199-207.
32. Eidt S, Nebeling M, Pohl C, et al. Neoadjuvant chemotherapy of primary hepatic non-Hodgkin’s lymphoma. Med Klin (Munich), 2003, 98(2): 96-99.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

MDT discussion of a case of primary diffuse large B cell lymphoma of liver

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