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• W2912346167 abstract "We present an unusual case of diffuse large B-cell lymphoma (DLBCL) presenting as an incidental, large, infiltrating hepatic mass. DLBCL is a malignancy arising from mature B-cells, comprising the most common subtype of non-Hodgkin lymphoma (NHL) and accounts for 31% of cases in western countries. Incidence of DLBCL in the US is 7.14/100,000 person years and rises with age, with a median age at presentation of 65 in Caucasians. Only 20% present with localized, early stage disease. Diagnosis of DLBCL is based upon tissue pathology. Our patient is a 77 year old Caucasian male with a 15 pack year history of smoking who underwent CT of the chest for further evaluation of obstructive lung disease. This imaging incidentally revealed a large mass centered within the porta hepatis. His medical history includes prostate cancer status post prostatectomy in remission and hypothyroidism. Routine labs including CBC, CMP, and coagulation panel were all normal except for alkaline phosphatase elevated at 224 u/L. Tumor markers including AFP, CEA, and CA 19-9 were normal. Subsequent MRI and PET-CT imaging demonstrated a hypermetabolic, extensively infiltrating mass centered at the porta hepatis. CT guided liver biopsy of the hepatic mass was performed yielding normal liver tissue. Following referral to gastroenterology, endoscopic ultrasound (EUS) was performed and showed heterogeneous liver parenchyma with an ill-defined, hyperechoic area involving the hepatic hilum, and a 31mm x 26mm mass encasing the roots of the celiac and superior mesenteric arteries. EUS-guided fine needle biopsies (FNB) of the hepatic hilum and celiac mass were performed. DLBCL was diagnosed at Stage IIE by Lugano Classification. He was treated with Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone (R-CHOP). After the first cycle of therapy the patient has done well with subsequent PET/CT imaging showing resolution of hepatic malignancy. This case displays a unique presentation of DLBCL. His DLBCL centered to the portal hepatis remained stable over a four month period which is rare for a usually aggressive malignancy. In this case after failed CT guided liver biopsy, EUS-guided FNB was successfully employed to secure a diagnosis. It is important to consider lymphoma at tissue acquisition to permit appropriate tissue handling and triage for additional studies which led to rapid improvement with R-CHOP therapy.Figure: Coronal MRI image of mass.Figure: Endoscopic ultrasound of 56x36mm paraceliac mass.Figure: Cell block preparation of the liver FNA demonstrating marked lymphocytic infiltrate of large and small lymphocytes with normal bile ducts (H&E, 400X)." @default.
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• W2912346167 date "2017-10-01" @default.
• W2912346167 modified "2023-09-27" @default.
• W2912346167 title "Diagnosis of Hepatic Diffuse Large B-cell Lymphoma by Endoscopic Ultrasound" @default.
• W2912346167 doi "https://doi.org/10.14309/00000434-201710001-02097" @default.
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