J Korean Med Sci.  2008 Feb;23(1):156-160. 10.3346/jkms.2008.23.1.156.

Histiocyte-Rich Reactive Lymphoid Hyperplasia of the Liver: Unusual Morphologic Features

• Park HS
• Jang KY
• Kim YK
• Cho BH
• Moon WS

• KMID: 1786866
• DOI: http://doi.org/10.3346/jkms.2008.23.1.156

Abstract

Reactive lymphoid hyperplasia (RLH) of the liver is a rare entity and has also been termed nodular lymphoid lesion or pseudolymphoma of the liver. We report a case of hepatic RLH exhibiting unusual histiocyte-rich histologic features in a 47-yr-old woman in conjunction with a renal cell carcinoma. A follow-up computed tomography scan was done 14 months after a right radical nephrectomy for renal cell carcinoma revealed a nodular lesion in segment 5 of the liver. The lesion was interpreted as metastatic renal cell carcinoma or hepatocellular carcinoma based on the history of the patient and radiologic findings. Wedge resection of segment 5 was done with sufficient distance from the mass. Microscopically, the lesion was composed predominantly of peculiar histiocytic proliferation and was characterized by lymphoid aggregates forming a lymphoid follicle with germinal centers. The present case and prior cases reported in the literature suggest that RLH of the liver appear to be a heterogenous group of reactive inflammatory lesions that are often associated with autoimmune disease or malignant tumors.

Keyword

Pseudolymphoma; Liver Neoplasms; Lymphoid Hyperplasia, Reactive

MeSH Terms

Carcinoma, Renal Cell/pathology
Female
Histiocytes/*pathology
Humans
Kidney Neoplasms/pathology
Liver Diseases/*pathology
Middle Aged
Pseudolymphoma/*pathology

Figure

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  Fig. 1 (A) The respiratory-triggered T2-weighted turbo spin-echo MR imaging shows a small mass with intermediate high signal intensity (arrow) in liver segment 5. (B) The gadolinium-enhanced arterial phase MR imaging shows small bright nodular enhancement (arrow) in the same location as in A.

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  Fig. 2 (A) A cut section of the resected liver shows a well-circumscribed, yellowish-white mass in segment 5. (B) The lesion is composed predominantly of peculiar histiocytic proliferation and lymphoid aggregate forming lymphoid follicles on the edge of the nodule. Note the dense infiltrate of lymphocytes in several portal tracts immediately around the nodule (arrows, ×20, H&E). (C, D) The lesion is mainly composed of aggregates of epithelioid histiocytes simulating non-caseating granuloma (C ×200, D ×400, H&E). (E) Hyalinized structures in the nodule (arrow, ×200, H&E). (F) CD68 immunostaining highlights the large number of histiocytes (×200, CD68).

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