J Korean Soc Radiol.  2018 Dec;79(6):348-353. 10.3348/jksr.2018.79.6.348.

Hepatic Pseudolymphoma Mimicking a Hypervascular Tumor: A Case Report

• Im B
• Jang SK
• Yeon JW
• Paik SY
• Park SJ
• Kim HJ

• KMID: 2427384
• DOI: http://doi.org/10.3348/jksr.2018.79.6.348

Abstract

Hepatic pseudolymphoma is a rare benign liver mass that is characterized by proliferation of non-neoplastic lymphocytes extranodally. To the best of our knowledge, only 46 cases have been reported in the English literature. We described the case of a 75-year-old woman with hepatic pseudolymphoma mimicking a hypervascular tumor. After the histological confirmation of the rectal neuroendocrine tumor, CT scan revealed a 1.0 cm-sized, poorly-defined and low-density nodule in the liver. On MRI, the hepatic nodule showed an arterial enhancement and a low-signal intensity on the hepatobiliary phase. On diffusion-weighted imaging, the hepatic nodule showed a high signal intensity on a high b-value. On fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT, it revealed a high standardized uptake value nodule. The US showed the hypoechoic nodule and the US-guided biopsy confirmed the hepatic pseudolymphoma.

MeSH Terms

Aged
Biopsy
Female
Humans
Liver
Lymphocytes
Magnetic Resonance Imaging
Multidetector Computed Tomography
Neuroendocrine Tumors
Positron-Emission Tomography
Pseudolymphoma*
Tomography, X-Ray Computed
Ultrasonography

Figure

• 

  Fig. 1 A 75-year-old woman with a hepatic pseudolymphoma. A, B. Axial contrast-enhanced CT image (A) and coronal reconstructed CT image (B) demonstrate an ill-defined low-attenuated nodule in the liver segment 8 (arrows). C. Fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT shows a high standardized uptake value (maximum standardized uptake value: 4.2) at the liver segment 8, suggesting hypermetabolic nodule (arrow). D. Intraoperative US shows a well-defined, markedly hypoechoic nodule in segment 8 (arrow). E. MRI finding of the hepatic pseudolymphoma using gadoxetic acid (Gd-EOB-DTPA-Primovist®). T2-weighted axial MR image shows a homogeneous high-signal instensity nodule in the liver segment 8 (arrowheads). On DWI, the hepatic nodule shows a high-signal intensity on a high b-value (1000 s/mm2). Gd-EOB-DTPA enhanced dynamic MR images show a homogeneous arterial enhancement and low-signal intensity on the transitional phase. The nodule shows a markedly low-signal intensity on the hepatobiliary phase. DWI = diffusion-weighted images, HBP = hepatobiliary phase, T2WI = T2-weighted images F. Histological specimen shows diffuse infiltration of lymphoid cells seen adjacent to cirrhotic liver nodule (H&E stain, × 40) and lymphocytes are mainly composed of small mature lymphocytes admixed with scattered medium and large cells. There is no cytological atypia of lymphoid cells (H&E stain, × 100). Immunostaining revealed the lymphocytes to be composed of both T cells (positive for CD3) and B cells (positive for CD79a) (H&E stain, × 200). H&E = hematoxylin and eosin stain

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