PRIMARY LYMPHOMA OF THE LIVER - A CASE-REPORT AND A REVIEW OF THE LITERATURE

A case of primary lymphoma of the liver in a 72-year-old man is report ed. The patient showed a three to four month history of abdominal ache , low grade fever, and weight loss. The presence of a large mass occup ying the V and VT hepatic segments was demonstrated; no other organs w ere involved and no evidence of lymphoadenopathy was found. Laboratory tests showed a remarkable increase in ESR, LDH and alkaline phosphata se while CEA and alpha-1 fetoprotein were within the normal values. Tw o ultrasound-guided needle biopsies on the hepatic lesion did not prod uce any significant tissue for diagnosis. Therefore the V and VI hepat ic segments were excised; a hard, greyish mass with the largest diamet er of 6.5 cm, was found at laparatomy. Histology of the surgical speci men showed the presence of a malignant non-Hodgking's B-cell lymphoma, centroblastic-centrocytic, diffuse type (working formulation: G) of i ntermediate grade of malignancy. Staging was completed with lymphograp hy, and bone marrow biopsy; both proved normal. After the operation ad juvant chemotherapy was commenced (COP for six cycles). Follow-up has so far shown no signs of recurrence after 24 months. In conclusion, th e diagnosis of primary lymphoma of the liver is very difficult and is often reached only after histologic evaluation of the surgical specime n. Moreover, this disease has a much more favourable prognosis than th e hepatocellular carcinoma and other primary or secondary liver cancer s; therefore accurate investigations are important to reach the correc t diagnosis.