title: An operative case of hepatic pseudolymphoma difficult to differentiate from primary hepatic marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue.
abstract: Hepatic pseudolymphoma (HPL) and primary hepatic marginal zone B cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) are rare diseases and the differential diagnosis between these two entities is sometimes difficult. We herein report a 56-year-old Japanese woman who was pointed out to have a space occupying lesion in the left lateral segment of the liver. Hepatitis viral-associated antigen/antibody was negative and liver function tests including lactic dehydrogenase, peripheral blood count, tumor markers and soluble interleukin-2 receptor were all within normal limit. Imaging study using computed tomography and magnetic resonance imaging were not typical for hepatocellular carcinoma, cholangiocarcinoma, or other metastatic cancer. Fluorodeoxyglucose-positron emission tomography examination integrated with computed tomography scanning showed high standardized uptake value in the solitary lesion in the liver. Under a diagnosis of primary liver neoplasm, laparoscopic-assisted lateral segmentectomy was performed. Liver tumor of maximal 1.0 cm in diameter was consisted of aggregation of lymphocytes of predominantly B-cell, containing multiple lymphocyte follicles positive for CD10 and bcl-2, consistent with a diagnosis of HPL rather than MALT lymphoma, although a definitive differentiation was pending. The background liver showed non-alcoholic fatty liver disease/early non-alcoholic steatohepatitis. The patient is currently doing well with no sign of relapse 13 months after the surgery. Since the accurate diagnosis is difficult, laparoscopic approach would provide a reasonable procedure of diagnostic and therapeutic advantage with minimal invasiveness for patients. Considering that the real nature of this entity remains unclear, vigilant follow-up of patient is essential.
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan. sur083@poh.osaka-med.ac.jp
authors.forename: Michihiro
authors.initials: M
authors.lastname: Hayashi
authors.forename: Noboru
authors.initials: N
authors.lastname: Yonetani
authors.forename: Fumitoshi
authors.initials: F
authors.lastname: Hirokawa
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Asakuma
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Miyaji
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takeshita
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Hironori
authors.initials: H
authors.lastname: Haga
authors.forename: Takayuki
authors.initials: T
authors.lastname: Takubo
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Tanigawa
mesh_terms: D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000473:pathology* / Q000601:surgery; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery; D018442:Lymphoma, B-Cell, Marginal Zone / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D019310:Pseudolymphoma / Q000473:pathology* / Q000601:surgery