title: A case of contiguous primary hepatic marginal zone B-cell lymphoma and hemangioma ultimately diagnosed using contrast-enhanced ultrasonography.
abstract: Primary hepatic marginal zone B-cell malignant lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) is extremely rare. We present a case in which a lesion was diagnosed as 2 contiguous tumors (MALT lymphoma and hemangioma) using contrast-enhanced ultrasonography (US) with sonazoid. There has been no previous case of contiguous hepatic MALT lymphoma and hemangioma. The present case was a female with no medical history. We detected a snowman-like appearance, which was a tumor of 15 mm in diameter with hypo- and hyper-echogenicities in the lateral and medial parts, respectively, in the Couinaud's segment (S6) of the liver on US. The tumor appeared as a single lesion with a low-density area in the unenhanced phase and prolonged enhancement in the equilibrium phases on dynamic CT. On MRI, the whole lesion showed a low-intensity signal on T1-weighted imaging, but isointensity in the lateral part and high intensity in the medial part were seen on T2-weighted imaging. On contrast-enhanced US, the lateral hypoechoic region was homogenously hyperenhanced in the early vascular phase, and the contrast medium was washed out after about 30 s; in contrast, the medial hyperechoic region was gradually stained from the margin toward the central region. The tumor showed a defect in both hypo- and hyperechoic regions in the postvascular phase. Hemangioma was suspected for the medial part based on the typical image findings, but the lateral part was not given a diagnosis. Thus, surgical resection was performed. The medial part was a hemangioma, and the lateral part was a MALT lymphoma by histopathological findings.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokyo, Japan.
authors.forename: Kazue
authors.initials: K
authors.lastname: Shiozawa
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokyo, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Ikehara
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokyo, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Matsukiyo
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokyo, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Kikuchi
authors.affiliation: Division of Gastroenterological Surgery, Toho University Medical Center, Omori Hospital, Tokyo, Japan.
authors.forename: Hironori
authors.initials: H
authors.lastname: Kaneko
authors.affiliation: Department of Surgical Pathology, Toho University Medical Center, Omori Hospital, Tokyo, Japan.
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Okubo
authors.affiliation: Department of Surgical Pathology, Toho University Medical Center, Omori Hospital, Tokyo, Japan.
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Shibuya
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokyo, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Igarashi
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokyo, Japan.
authors.forename: Yasukiyo
authors.initials: Y
authors.lastname: Sumino
keywords: Contrast-enhanced ultrasonography; Hemangioma; Malignant lymphoma of mucosa-associated lymphoid tissue; Primary hepatic malignant lymphoma
references.citation: Leuk Lymphoma. 1998 Apr;29(3-4):293-9
references.pmid: 9684927
references.citation: Oncology. 2010 Jul;78 Suppl 1:40-5
references.pmid: 20616583
references.citation: Cancer. 1972 Jan;29(1):252-60
references.pmid: 5007387
references.citation: Blood. 2003 Apr 1;101(7):2489-95
references.pmid: 12456507
references.citation: Hepatology. 2003 Apr;37(4):781-7
references.pmid: 12668970
references.citation: Int J Hematol. 2002 Jan;75(1):85-90
references.pmid: 11843297
references.citation: Virchows Arch. 2006 Feb;448(2):223-7
references.pmid: 16331470
references.citation: Magn Reson Imaging. 1988 Nov-Dec;6(6):675-81
references.pmid: 3062298
references.citation: Am J Surg Pathol. 1995 May;19(5):571-5
references.pmid: 7726367
references.citation: Curr Oncol. 2009 Aug;16(4):74-7
references.pmid: 19672429
references.citation: J Gastroenterol Hepatol. 1999 Feb;14 (2):163-7
references.pmid: 10029298
references.citation: J Ultrasound Med. 2010 Sep;29(9):1353-6
references.pmid: 20733192
references.citation: Radiology. 1994 Apr;191(1):135-6
references.pmid: 8134559
references.citation: Cancer. 1983 Oct 15;52(8):1410-6
references.pmid: 6193858
references.citation: J Comput Assist Tomogr. 1993 Jul-Aug;17(4):596-8
references.pmid: 8331231