Mojtaba Ghadiani1, Faramarz Derakhshan2,Mohammad
Hashemi3
1 Department of Hematology-Oncology,
2 Research Center for Gastroenterology and Liver Disease,
Shahid Beheshti University M.C.,
3 Department of Hematology-Oncology,
ABSTRACT
Background:
Primary liver lymphoma (PLL) is a rare disease. Patients usually present
with abdominal problems and liver mass without any extrahepatic tumor. PLL
usually responds well to chemotherapy, while chemotherapy±radiation is the
standard treatment of choice.
Case report: A
42 year-old man was presented because of abdominal pain, 8.5kg weight loss
and fever for 3 months. There was not lymphadenopathy, splenomegaly,
abdominal mass or hepatomegaly in physical examination. A computed
tomography (CT) scan of the abdomen disclosed multiple large liver masses
without adenopathy. Patient responded well to CHOP chemotherapy regimen.
Three months later, he was visited because of headache, dizziness and
convulsion. A brain CT scan showed a mass in brain. He was treated by brain
radiation plus intrathecal injection of methotrexate (MTX) (15mg) followed
by 6 cycles of ICE protocol.
Conclusion: PLL
is a rare disease that responds well to multi-agent chemotherapy. CNS
metastasis should be considered in the affected patients.
Keywords: Primary liver lymphoma, CNS relapse, Chemotherapy.
(Gastroenterology and Hepatology from bed to bench 2008;1(1):51-54).
INTRODUCTION
Lei defined the following criteria for diagnosis of
PLL: 1- At the time of disease presentation, the patient symptoms are caused
mainly by the liver involvement; 2- There is an absence of palpable
lymphadenopathy, and no radiologic evidence of distant lymphadenopathy; 3- There
is an absence of leukemic blood involvement in the peripheral blood smear (4).
CASE REPORT
A 42 year-old man was visited because of abdominal
pain, 8.5kg weight loss and fever for 3 months. There was not lymphadenopathy,
splenomegaly, abdominal mass or hepatomegaly in physical examination. Past
medical history was negative. Laboratory studies showed the following results:
WBC: 8500/ml
Calcium:
9.5mg/dl
SGOT: 61 IU/l
(5-40)
SGPT: 31 IU/l
(5-40)
Hb: 12.9
Phosphorous:
3.5mg/dl
Platelet:
262000/mm3
ALP: 1220
IU/l(80-306)
Billirubine:
0.7mg/dl |
Retic.
count: 0.4
LDH:1048IU/l
(up to 480)
HCV-Ab:
Negative
HBs-Ag:
Negative
HIV-Ab:
Negative
CEA: 1.1
CA 19-9: 34
ESR: 38 |
A computed tomography (CT) scan of the abdomen
disclosed multiple large liver masses without adenopathy (figure 1).
Figure 1.
A computed tomography (CT) scan of the abdomen
revealed multiple large liver masses without adenopathy.
Figure 2.
Pathologic film of the patient
Patient
was treated by CHOP (cyclophosphamide, Adriamycin, Vincrestin, Prednisolon)
chemotherapy regimen every 3 weeks and responded well to this regimen. After 6
cycles of chemotherapy, abdominal CT scan was repeated and showed only a small
mass in liver. Three months later, he was visited because of headache, dizziness
and convulsion. A brain CT scan showed a mass in brain (figure 3). CSF
examination was positive for lymphoma cells. He was treated by brain radiation
plus intrathecal injection of methotrexate (MTX) (15mg) followed by 6 cycles of
ICE (Ifosfamide, Carboplatin, Etoposide) protocol. He was followed for 3 months
after the last chemotherapy.
Figure 3.
Brain metastasis in patient with primary liver lymphoma
DISCUSSION
PLL
occurs in a wide range of ages (17 to 84 years) and has been reported mainly in
male patients (2). It is usually B-cell type.
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