PDF(Pubmed)
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.
摘要：
肝脏的反应性淋巴样增生（RLH）极为罕见。尽管诊断成像技术有了进步，它仍然很难区分肝细胞癌（HCC）。在这里，我们介绍了一例模仿HCC的肝脏RLH病例，该病例使用多种影像学检查方法进行了术后诊断。一名78岁的女性因丙型肝炎病毒抗体（HCVAb）测试阳性而被转诊至我院。超声检查显示肝脏8段有13毫米的等回声病变。对比增强计算机断层扫描（CE-CT）在后期显示出动脉高强度和冲洗。在乙氧基苄基磁共振成像（EOB-MRI）上，病变在动脉期过强，在肝细胞期低强度。尽管肿瘤标志物都在正常范围内，CT和MRI上肿瘤的对比增强模式与HCC一致。我们进行了S8肝段切除术。切除标本的组织学检查显示，大小和形状可变的密集淋巴组织，生发中心扩大。免疫组化检测CD3、CD10（生发中心）阳性，和CD20，对B细胞淋巴瘤2（bcl-2）（生发中心）和EB病毒（EBV）阴性。IgH基因重排的聚合酶链反应（PCR）分析揭示了多克隆性。基于这些发现,诊断为肝RLH。术后进展顺利，患者在术后第10天出院。患者术后生活质量良好，在4个月的医学随访中没有发现肝结节复发。肝脏RLH是一种极其罕见的疾病，术前诊断困难。在单个小肝脏肿瘤的鉴别诊断中应考虑这一点。回声引导活检和影像学仔细观察可能有助于诊断肝脏RLH，和IgH基因重排的PCR分析对于明确诊断肝RLH是必要的。
