Primary hepatic lymphoma - Favorable outcome after combination chemotherapy

Background. Primary hepatic non-Hodgkin lymphoma (PHL) is a rare and diffic ult to diagnose lymphoproliferative disorder of unknown etiology. It is bel ieved that the prognosis in affected patients is dismal, consisting of earl y recurrence and 2 short survival. Methods. A retrospective cohort review of patients with PHL diagnosed betwe en 1974 and 1995 at a university cancer center was performed. Results. Twenty-four patients with PHL were identified. Typically, the dise ase occurred in middle-aged men (median age, 50 years). The primary present ing complaint was right upper quadrant abdominal pain, with hepatomegaly fo und at physical examination. Serum liver enzymes, lactate dehydrogenase, an d beta -2-microglobulin levels all were elevated, but a-fetoprotein and car cinoembryonic antigen levels were within normal range. Hypercalcemia was fo und in 6 of 15 patients who were tested. Six of 10 patients who were tested were positive for the hepatitis C virus (HCV). Liver scans demonstrated ei ther a solitary lesion or multiple lesions. Pathologic examination revealed diffuse large cell lymphoma in 23 patients (96%). Combination chemotherapy was the mainstay of treatment; surgery consisted of diagnostic biopsy. The complete remission rate was 83.3%, and the 5-year cause specific and failu re free survival rates were 87.1% and 70.1%, respectively. HCV infection di d not appear to influence the outcome of therapy. Conclusions. The outcome of patients with PHL who are treated with combinat ion chemotherapy may be more favorable than that reported elsewhere. The fr equent association of PHL with HCV infection observed in this series warran ts further investigation. Cancer 2001;92:2023-9. (C) 2001 American Cancer S ociety.