UNUSUAL CAUSE OF HYPOECHOIC LIVER LESIONS

Problemstellung: Whereas high grade non-Hodgkin-lymphoma (NHL) often secondarily involves the liver, a primary affection is seldom observed. We present the cases of a 69yrs-old woman and a 84yrs-old man with the diagnosis of primary high-grade lymphoma of the liver. While the first patient suffered from polymyositis and was treated with immunosuppressant agents seven years prior to the referral to hospital, the medical history of the second patient was, apart from age related illnesses, uneventful. Both patients complained of discomforting upper abdominal pain.

Methoden: CT and MRl investigations proposed a metastatic tumor in the first and a hepatocellular carcinoma (HCC) in the latter patient. On color coded ultrasonography the liver lesions appeared hypoechoic and hypovascularized without halo. In both cases an ultrasound guided puncture was performed.

Ergebnisse: Histology revealed the final diagnosis of a high grade lymphoma. Other areas especially bone marrow were not involved. Both patients were started on chemotherapy with CHOP and an antibody treatment with Rituximab.

Schlussfolgerungen: Primary lymphoma of the liver is very rare. Often immunodeficient patients are affected. Symptoms are variable. Most patients complain of upper abdominal pain and suffer from b-symptoms, such as weight loss, fever or night-sweats. On imaging these liver lesions are often mistaken as HCC or metastases. A liver biopsy is mandatory. Histological findings frequently reveal a large cell NHL. Chemotherapy in combination with CD 20 antibodies offers a successful treatment of this curable disease.