Skip to main content

Advertisement

SpringerLink
Log in

A case of difficult-to-diagnose hepatic reactive lymphoid hyperplasia finally diagnosed by using PCR analysis of IgH-gene rearrangements: a case report

  • Case report - Surgery
  • Published:
International Cancer Conference Journal Aims and scope Submit manuscript

Abstract

Reactive lymphoid hyperplasia (RLH) of the liver is extremely rare. Despite advancements in diagnostic imaging technology, it is still difficult to distinguish from hepatocellular carcinoma (HCC). Herein, we present a case of hepatic RLH mimicking HCC that was postoperatively diagnosed using several imaging modalities. A 78-year-old female was referred to our hospital with a positive hepatitis C virus antibody (HCV Ab) test. Ultrasonography revealed a 13 mm isoechoic lesion in segment 8 of the liver. Contrast-enhanced computed tomography (CE-CT) demonstrated arterial hyperintensity and washout during the later phase. On ethoxybenzyl magnetic resonance imaging (EOB-MRI), the lesion was hyperenhanced in the arterial phase and of low intensity in the hepatocyte phase. Although the tumor markers were all within normal limits, the pattern of contrast enhancement of the tumor on CT and MRI was consistent with that of HCC. We performed S8 segmentectomy of the liver. Histological examination of the resected specimen revealed dense lymphoid tissue of variable sizes and shapes with expanded germinal centers. Immunohistochemical examination was positive for CD3, CD10 (germinal center), and CD20, and negative for B-cell lymphoma 2 (bcl-2) (germinal center) and Epstein–Barr virus (EBV). A polymerase chain reaction (PCR) analysis of IgH-gene rearrangements revealed polyclonality. Based on these findings, hepatic RLH was diagnosed. The postoperative course was uneventful, and the patient was discharged on the 10th postoperative day. She had a good quality of life after surgery and no liver nodule recurrence was detected at the 4-month medical follow-up. Hepatic RLH is an extremely rare disease and preoperative diagnosis is difficult. This should be considered in the differential diagnosis of single small hepatic tumors. An echo-guided biopsy and careful observation of imaging may help diagnose hepatic RLH, and a PCR analysis of IgH-gene rearrangements would be necessary for the definitive diagnosis of hepatic RLH.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Availability of data and materials

The authors declare that all the data in this article are available within the article.

Abbreviations

RLH:

Reactive lymphoid hyperplasia

HCC:

Hepatocellular carcinoma

CE-CT:

Contrast-enhanced computed tomography

EOB-MRI:

Ethoxybenzyl magnetic resonance imaging

Bcl-2:

B-cell lymphoma 2

EBV:

Epstein–Barr virus

PCR:

Polymerase chain reaction

DWI:

Diffusion-weighted imaging

ICG-R15:

Indocyanine green retention rate at 15 min

CEA:

Carcinoembryonic antigen

CA19-9:

Carbohydrate antigen 19–9

AFP:

Alpha-fetoprotein

PIVKA-II:

Protein induced by vitamin K absence-II

US:

Ultrasonography

IgH:

Immunoglobulin heavy chain

PNE:

Perinodular enhancement

PET-CT:

Positron emission tomography–Computed tomography

SUVmax:

Standardized uptake value max

References

  1. Kobayashi A et al (2011) MR imaging of reactive lymphoid hyperplasia of the liver. J Gastrointest Surg 15(7):1282–1285

    Article  PubMed  Google Scholar 

  2. Zen Y, Fujii T, Nakanuma Y (2010) Hepatic pseudolymphoma: a clinicopathological study of five cases and review of the literature. Mod Pathol 23(2):244–250

    Article  PubMed  Google Scholar 

  3. Okada T et al (2009) Pseudolymphoma of the liver associated with primary biliary cirrhosis: a case report and review of literature. World J Gastroenterol 15(36):4587–4592

    Article  PubMed  PubMed Central  Google Scholar 

  4. Ishida M et al (2010) Hepatic reactive lymphoid hyperplasia in a patient with primary biliary cirrhosis. World J Hepatol 2(10):387–391

    Article  PubMed  PubMed Central  Google Scholar 

  5. Takahashi H et al (2006) Reactive lymphoid hyperplasia of the liver in a patient with colon cancer: report of two cases. BMC Gastroenterol 6:25

    Article  PubMed  PubMed Central  Google Scholar 

  6. Ohtsu T et al (1994) Development of pseudolymphoma of liver following interferon-alpha therapy for chronic hepatitis B. Intern Med 33(1):18–22

    Article  PubMed  Google Scholar 

  7. Talamo TS et al (1980) Primary hepatic malignant lymphoma: its occurrence in a patient with chronic active hepatitis, cirrhosis, and hepatocellular carcinoma associated with hepatitis B viral infection. Cancer 46(2):336–339

    Article  PubMed  Google Scholar 

  8. Kim SR et al (1997) A case of pseudolymphoma of the liver with chronic hepatitis C. J Hepatol 26(1):209–214

    Article  PubMed  Google Scholar 

  9. Zampino R et al (2015) Hepatocellular carcinoma in chronic HBV-HCV co-infection is correlated to fibrosis and disease duration. Ann Hepatol 14(1):75–82

    Article  PubMed  Google Scholar 

  10. Zhang W, Zheng S (2019) Reactive lymphoid hyperplasia of the liver: A case report. Medicine (Baltimore) 98(30):e16491

    Article  PubMed  Google Scholar 

  11. Kanno H et al (2020) A case of reactive lymphoid hyperplasia of the liver in a patient with autoimmune hepatitis. Surg Case Rep 6(1):90

    Article  PubMed  PubMed Central  Google Scholar 

  12. Dong CH et al (2019) Contrast-enhanced ultrasound features of hepatic reactive lymphoid hyperplasia: correlation with histopathologic findings. J Ultrasound Med 38(9):2379–2388

    Article  PubMed  Google Scholar 

  13. Bao C et al (2018) Prognostic value of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography in primary hepatic mucosa-associated lymphoid tissue lymphoma: a case report and review of the literature. Medicine (Baltimore) 97(10):e9877

    Article  PubMed  Google Scholar 

  14. Lu RC et al (2019) Positron-emission tomography for hepatocellular carcinoma: Current status and future prospects. World J Gastroenterol 25(32):4682–4695

    Article  PubMed  PubMed Central  Google Scholar 

  15. Machida T et al (2007) Reactive lymphoid hyperplasia of the liver: a case report and review of literature. World J Gastroenterol 13(40):5403–5407

    Article  PubMed  PubMed Central  Google Scholar 

  16. Yoshida K et al (2013) Hepatic pseudolymphoma: imaging-pathologic correlation with special reference to hemodynamic analysis. Abdom Imaging 38(6):1277–1285

    Article  PubMed  Google Scholar 

  17. Zhou Y et al (2018) Hepatic pseudolymphoma: imaging features on dynamic contrast-enhanced MRI and diffusion-weighted imaging. Abdom Radiol (NY) 43(9):2288–2294

    Article  PubMed  Google Scholar 

  18. Lv A et al (2015) Reactive lymphoid hyperplasia of the liver mimicking hepatocellular carcinoma: incidental finding of two cases. Int J Clin Exp Pathol 8(5):5863–5869

    PubMed  PubMed Central  Google Scholar 

  19. Miyazaki Y et al (2018) Indocyanine green fluorescence-navigated laparoscopic metastasectomy for peritoneal metastasis of hepatocellular carcinoma: a case report. Surg Case Rep 4(1):130

    Article  PubMed  PubMed Central  Google Scholar 

  20. Yoshikawa K et al (2011) Reactive lymphoid hyperplasia of the liver: literature review and 3 case reports. Hepatogastroenterology 58(109):1349–1353

    Article  PubMed  Google Scholar 

  21. Amer A et al (2012) Reactive lymphoid hyperplasia of the liver and pancreas. a report of two cases and a comprehensive review of the literature. Clin Res Hepatol Gastroenterol 36(4):e71-80

    Article  PubMed  Google Scholar 

  22. Bagg A et al (2002) Immunoglobulin heavy chain gene analysis in lymphomas: a multi-center study demonstrating the heterogeneity of performance of polymerase chain reaction assays. J Mol Diagn 4(2):81–89

    Article  PubMed  PubMed Central  Google Scholar 

  23. Lu C et al (2017) The value of detecting immunoglobulin gene rearrangements in the diagnosis of B-cell lymphoma. Oncotarget 8(44):77009–77019

    Article  PubMed  PubMed Central  Google Scholar 

  24. Ota H et al (2006) A case of hepatic pseudolymphoma observed without surgical intervention. Hepatol Res 35(4):296–301

    Article  PubMed  Google Scholar 

  25. Sousa PM, Afonso Goncalves GG, Ana C (2021) Ferreira, reactive Lymphoid Hyperplasia, a Mimicker of Hepatocelular Carcinoma. Acta Radiol Port. 33:39–41

    Google Scholar 

Download references

Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

Funding

All authors have no funding regarding this paper.

Author information

Authors and Affiliations

  1. Department of Surgery, Hiroshima Red Cross & Atomic-bomb Survivors’ Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima, Japan

    Junya Mita, Takashi Maeda, Eiji Tsujita, Keiji Tsuji, Naotaka Hashimoto, Ranma Fujikawa, Yuki Ono, Akihiro Sakai, Shinichi Tanaka, Rumi Matono, Takahiro Ohmine, Takuro Kometani, Shohei Yamaguchi, Kozo Konishi & Kenkichi Hashimoto

  2. Department of Surgery, Oita Red Cross Hospital, 3-2-37 Chiyomachi, Oita-shi, Oita, Japan

    Kyohei Yugawa

  3. Department of Gastroenterology, Hiroshima Red Cross & Atomic-bomb Survivors’ Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima, Japan

    Shintaro Takaki

Authors
  1. Junya Mita
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takashi Maeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eiji Tsujita
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kyohei Yugawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shintaro Takaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Keiji Tsuji
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Naotaka Hashimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ranma Fujikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yuki Ono
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Akihiro Sakai
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Shinichi Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Rumi Matono
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Takahiro Ohmine
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Takuro Kometani
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Shohei Yamaguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Kozo Konishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Kenkichi Hashimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

JM reported the case and wrote the manuscript. KY, TM, ST were engaged in the patient’s care including the surgery. ET helped in drafting the manuscript. TM participated in revising the manuscript critically. All authors have read and approved the final manuscript for publication.

Corresponding author

Correspondence to Takashi Maeda.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval and consent to participate

Not applicable.

Consent for publication

Written informed consent was obtained from the patient for publication of this case report and any accompanying images.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mita, J., Maeda, T., Tsujita, E. et al. A case of difficult-to-diagnose hepatic reactive lymphoid hyperplasia finally diagnosed by using PCR analysis of IgH-gene rearrangements: a case report. Int Canc Conf J 13, 33–39 (2024). https://doi.org/10.1007/s13691-023-00632-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13691-023-00632-8

Keywords

Search

Navigation