title: Hematologic malignancies of the liver: spectrum of disease.
abstract: The incidence of hematologic malignancies and their extranodal manifestations is continuously increasing. Previously unsuspected hepatic involvement in hematologic malignancies such as Hodgkin disease and non-Hodgkin lymphoma, posttransplant lymphoproliferative disorder, myeloid sarcoma (chloroma), multiple myeloma, Castleman disease, and lymphohistiocytosis may be seen by radiologists. Although the imaging features of more common hepatic diseases such as hepatocellular carcinoma, metastases, and infection may overlap with those of hepatic hematologic malignancies, combining the imaging features with clinical manifestations and laboratory findings can facilitate correct diagnosis. Clinical features that suggest a hematologic neoplasm as the cause of liver lesions include a young patient (<40 years of age), no known history of cancer, abnormal bone marrow biopsy results, fever of unknown origin, and night sweats. Imaging features that suggest hematologic malignancy include hepatosplenomegaly or splenic lesions, vascular encasement by a tumor without occlusion or thrombosis, an infiltrating mass at the hepatic hilum with no biliary obstruction, and widespread adenopathy above and below the diaphragm. Familiarity with the imaging features of hepatic hematologic malignancies permits correct provisional diagnosis and may influence therapeutic management. For example, when biopsy is performed, core biopsy may be needed in addition to fine-needle aspiration so that the tissue architecture of the neoplasm can be discerned. The predominant treatment of hematologic malignancies is chemotherapy or radiation therapy rather than surgery. Online supplemental material is available for this article.
authors.affiliation: From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (A.T., C.O.M.); Department of Radiology, Indiana University School of Medicine, Indianapolis, Ind (K.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (A. Shanbhogue); and Department of Radiology, University of Utah, Salt Lake City, Utah (A. Shaaban).
authors.forename: Anderanik
authors.initials: A
authors.lastname: Tomasian
authors.forename: Kumar
authors.initials: K
authors.lastname: Sandrasegaran
authors.forename: Khaled M
authors.initials: KM
authors.lastname: Elsayes
authors.forename: Alampady
authors.initials: A
authors.lastname: Shanbhogue
authors.forename: Akram
authors.initials: A
authors.lastname: Shaaban
authors.forename: Christine O
authors.initials: CO
authors.lastname: Menias
mesh_terms: D001706:Biopsy; D003287:Contrast Media; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D019337:Hematologic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000473:pathology
chemical_list: D003287:Contrast Media