Reactive lymphoid hyperplasia of the liver and pancreas. A report of two cases and a comprehensive review of the literature.
BACKGROUND
Reactive lymphoid hyperplasia (RLH) is a rare non-neoplastic extranodal pathology with exceedingly rare occurrence in the liver and pancreas. We present two cases of hepatic RLH, one which had coinciding pancreatic involvement. To the best of our knowledge, concomitant hepatic and pancreatic RLH has not been previously reported. We also present a comprehensive review of the literature on hepatic and pancreatic RLH.


METHODS
An extensive literature search for all published reports on hepatic or pancreatic RLH was conducted. Data on clinical, radiographic and histopathological features were extracted in addition to therapeutic options and outcomes.


RESULTS
Forty-two hepatic and three pancreatic cases of RLH were described in the literature. The mean age of hepatic cases was 58 years, with a male-to-female ratio of above 1:7. Almost 25% of cases were associated with internal malignancy. Four hepatic cases were managed through active observation. The remainder (84%) underwent surgical resection. Due to their small number, no meaningful analysis could be made on the pancreatic cases. No recurrences were identified in any of the reported cases.


CONCLUSIONS
RLH should be considered in the diagnosis of hepatic nodules where biopsies fail to demonstrate malignant cells. Confirmed RLH lesions should be managed by active observation. Investigation and treatment of any potential source of lymphoid reactivity should be undertaken. More reports on pancreatic RLH need to be studied prior to drawing any useful recommendations on its management.
Department of Hepato-Pancreatico-Biliary Surgery, Freeman Hospital, Newcastle upon Tyne, UK. aimen.amer@ncl.ac.uk
Aimen
A
Amer
Sebastian
S
Mafeld
Danish
D
Saeed
Wissam
W
Al-Jundi
Beate
B
Haugk
Richard
R
Charnley
Steven
S
White
D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis*; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000175:diagnosis*; D019310:Pseudolymphoma / Q000175:diagnosis*