Primary Hepatic Lymphoma in HIV Positive Patients Diagnosed by Image-Guided Fine Needle Aspiration: Clinico-Pathologic Correlation
Matea Deliu, Minh Ly Nguyen, Clifford J Gunthel, Marina B Mosunjac. Emory University, Atlanta, GA
Background: The incidence of primary hepatic lymphoma (PHL) is rare and unexpected. However, recent studies show that it is increasing, particularly in HIV patients. Diagnosis of PHL is difficult not only due to the risks of liver biopsy, but also due to the array of ancillary studies needed for definitive diagnosis. The use of image guided fine needle aspiration (IGFNA) is proven to be safer and also allows obtaining adequate material for ancillary studies. Here, we report on clinico-pathologic characteristics of patients with PHL and the utility of IGFNA.
Design: A retrospective search (1996-2011) was conducted at the inner city hospital to identify 16 cases of PHL diagnosed by IGFNA. IGFNA was conducted by 19 or 20-gauge needles, performing an average of 3 passes.Pathologist was always present for immediate evaluation. Pathology slides and ancillary studies, as well as flow cytometry reports, were reviewed to reconfirm primary diagnosis. Demographic data (race, age, sex), laboratory data (HIV status, and HIV related lab tests, LDH), imaging data (CT), and clinical data were obtained from electronic patient charts.
The most common types of PHL were: B cell lymphomas (12 of 16) including diffuse large B cell lymphoma (DLBCL) (n=6), B cell lymphoma NOS (n=4), follicular B cell lymphoma (n=1) and Burkitt's lymphoma (n=1). There was 1 case of T cell lymphoma and 1 case of Hodgkin's lymphoma. Only 2 cases failed to reach a definitive diagnosis of lymphoma either due to insufficient material or extensive cell necrosis. Imaging showed, predominantly, multiple lesions ranging from 1.7-12.3cm. 15 patients, (94%) were HIV positive, with AIDS defining CD4 counts. None were on HAART therapy, and no unifying risk factors were identified. 8 patients were recently diagnosed with HIV, whereas 4 patients were long standing.
Conclusions: In the population of an inner city hospital, PHL is primarily seen in AIDS patients. Most of the lesions were B-cell lymphomas clinically presenting as multifocal lesions in relatively recent diagnosed and untreated AIDS patients. FNA was proven to be effective, and less invasive, in the diagnosis of PHL.
Wednesday, March 21, 2012 1:00 PM
Poster Session VI # 257, Wednesday Afternoon