Role of contrast-enhanced ultrasonography in primary hepatic lymphoma.
OBJECTIVE
Ultrasonography is the first examination performed for screening of hepatocellular carcinoma (HCC); contrast-enhanced ultrasonography (CEUS) can help discriminate between HCC and other lesions. Primary hepatic lymphoma (PHL), even if rare, should be considered in the differential diagnosis of focal liver lesions (FLLs). Few data are available in the literature about the role of CEUS in the diagnosis of PHL; we tried to determine whether CEUS could have a role in this setting.


METHODS
we describe 2 cases of primary non-Hodgkin lymphoma of the liver associated with hepatitis B virus (HBV) infection. The first patient was a 62-year-old man who was an HBV-inactive carrier, and the second was a 58-year-old man with type 2 diabetes and chronic HBV hepatitis.


RESULTS
in both cases, ultrasonography showed a hypoechoic liver lesion (4 and 3 cm, respectively) with irregular margins in segment 4 of the liver. On CEUS, these lesions were inhomogeneously hyperenhanced in the arterial phase and hypoenhanced in the portal and late phases. Contrast-enhanced computed tomography (CT) in both patients showed slight hyperenhancement in the arterial phase and hypoenhancement in the remaining phases. Needle biopsy showed marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue type in both patients.


CONCLUSIONS
Contrast-enhanced ultrasonography and CT did not help us differentiate PHL from HCC; in fact, in both cases we saw the characteristic findings of primary HCC. Primary hepatic lymphoma is a rare condition, but it should always be considered in the differential diagnosis of FLLs. We stress the important role of liver biopsy when imaging indicates HCC in patients without underlying cirrhosis.
Foschi
Francesco Giuseppe
FG
Department of Internal Medicine, Faenza Hospital, Faenza, Italy. fg.foschi@ausl.ra.it
Dall'Aglio
Anna Chiara
AC
Marano
Giorgio
G
Lanzi
Arianna
A
Savini
Paolo
P
Piscaglia
Fabio
F
Serra
Carla
C
Cursaro
Carmela
C
Bernardi
Mauro
M
Andreone
Piero
P
Stefanini
Giuseppe Francesco
GF
D001706:Biopsy; D003287:Contrast Media; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003937:Diagnosis, Differential; D006509:Hepatitis B / Q000150:complications; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000000981:diagnostic imaging*; D008228:Lymphoma, Non-Hodgkin / Q000000981:diagnostic imaging* / Q000821:virology; D008297:Male; D008875:Middle Aged; D012859:Sjogren's Syndrome / Q000150:complications; D014463:Ultrasonography
D003287:Contrast Media