Heterogeneity of Dissemination Patterns in Hepatic Lymphomas in Biopsy Specimens.
Shriram Jakate, Dawn Heagley, Jerome Loew. Rush University Medical Center, Chicago, IL
Background: Primary hepatic lymphoma is rare but liver is a frequent site of extranodal and extramedullary dissemination of lymphoma. However, since lymphomas constitute a wide morphological, immunophenotypic and clinical spectrum, liver involvement is appropriately varied. We examined 30 cases of hepatic lymphomas in liver biopsy specimens to evaluate the heterogeneity of presentation and dissemination patterns.
Design: Pathology and clinical databases from our medical center from 2000-2010 were searched for liver biopsy specimens with diagnoses of lymphoma. 30 patients were identified (ages 21-88, 18 M & 12 F). Their clinical profiles, available imaging studies, indications for liver biopsy, types of lymphomas and patterns of hepatic involvement were reviewed.
Results: The following lymphomas (with necessary immunophenotypic workup) were detected in the liver biopsies: Diffuse large B-cell (DLBCL) 14/30, Hodgkin's (HL) 6/30, T-cell (TCL) 5/30, post transplant lymphoproliferative disorder (PTLD) 2/30, and small lymphocytic (SLL), marginal zone (MZL) and Burkitt (BL) – 1 case each. 27/30 (90%) cases were disseminations from medullary and/or nodal, splenic or other visceral lymphomas (secondary), but in 3 of these, liver was the first identified organ of lymphoma involvement. In all of these secondary cases, there was variable hepatomegaly but radiographically visible liver masses were infrequent (only 3/27 cases) and the biopsies were random. Histologically, the liver involvement was patchy with variable neoplastic cell infiltrate. HL cases were the most histologically challenging and had the fewest neoplastic cell infiltrates limited to a few portal areas. DLBCL, TCL and BL infiltrates were patchy but present in abundance in the sinusoids and portal areas. SLL, PTLD and MZL infiltrates were mainly portal. In 3/30 cases (10%), after extensive imaging studies and bone marrow biopsies, no other sites of lymphoma were identified (primary hepatic lymphoma). All of these 3 cases were DLBCL and presented with radiographically visible masses and the image-guided biopsies showed dense tumor infiltrates without any native liver tissue.
Conclusions: Lymphomas disseminated to the liver are of a variety of types and rarely produce masses on imaging but primary hepatic lymphomas tend to be DLBCL with radiographic masses and dense tumor infiltrates. HL in liver has the fewest tumor cells in the portal areas and poses the highest diagnostic challenge. While SLL, PTLD and MZL are mainly portal infiltrates, DLBCL, TCL and BL show abundant infiltrates in the sinusoids as well as the portal areas.
Category: Liver & Pancreas
Tuesday, March 1, 2011 9:30 AM
Poster Session III # 266, Tuesday Morning