title: Clinico-pathologic characteristics of patients with hepatic lymphoma diagnosed using image-guided liver biopsy techniques.
abstract: Primary hepatic lymphoma is a rare presentation of a common disease. Diagnosis is difficult due to the risks of liver biopsy. We report the clinico-pathologic features of this presentation and specifically the utility of image-guided biopsy as a safe method of diagnosis. We retrospectively studied patients diagnosed with 'hepatic lymphoma' at a single center. Twenty-two patients fulfilled the criteria. Median age was 53 years (range 29-87). Nine patients were human immunodeficiency virus (HIV)-positive. The most frequent mode of presentation was with B-symptoms (15/22). All procedures were successful at obtaining diagnostic material with no complications. Six patients had synchronous bone marrow involvement. Nineteen patients received chemotherapy (10 had dose reductions) with an overall response rate of 74%. After a median follow-up of 19 months, 12 patients had died; the median overall survival (OS) was 4 months. Grade 3 or 4 aspartate transaminase (AST) abnormality was associated with very poor outcome. The OS of patients with hepatic lymphoma is poor. However, a response to modern induction therapies may predict a better outcome. The optimal dose adjustment of chemotherapy in this setting is unclear. In patients without readily accessible tissue, an image-guided core biopsy of hepatic lesions is a safe procedure with high diagnostic yield.
authors.affiliation: Department of Hematology, The Royal Free Hospital, London, UK. dima@doctors.org.uk
authors.forename: Dima
authors.initials: D
authors.lastname: El-Sharkawi
authors.forename: Alan
authors.initials: A
authors.lastname: Ramsay
authors.forename: Kate
authors.initials: K
authors.lastname: Cwynarski
authors.forename: Derralynn
authors.initials: D
authors.lastname: Hughes
authors.forename: Archie
authors.initials: A
authors.lastname: Prentice
authors.forename: Neil
authors.initials: N
authors.lastname: Davies
authors.forename: Antony
authors.initials: A
authors.lastname: Goode
authors.forename: Peter
authors.initials: P
authors.lastname: Wylie
authors.forename: Anmol
authors.initials: A
authors.lastname: Malhotra
authors.forename: Victoria
authors.initials: V
authors.lastname: Warbey
authors.forename: James
authors.initials: J
authors.lastname: Dooley
authors.forename: Christopher
authors.initials: C
authors.lastname: McNamara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001219:Aspartate Aminotransferases / Q000378:metabolism; D001707:Biopsy, Needle / Q000379:methods*; D018572:Disease-Free Survival; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008099:Liver / Q000187:drug effects / Q000201:enzymology / Q000473:pathology*; D008113:Liver Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D008223:Lymphoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D001219:Aspartate Aminotransferases