ABSTRACT
The liver is commonly involved by lymphoma [next to lymph nodes, bone marrow (BM), stomach, gastrointestinal tract, and spleen]. Secondary involvement accounts for majority of the cases and primary hepatic lymphomas are very rare [1–13]. Lack of splenomegaly, lymphadenopathy, and BM involvement usually favors primary lymphoma. In large series of 205 patients published by Loddenkemper et al., 90% of cases (182/205) were non-Hodgkin lymphomas (NHL) and remaining 10% (23/205) were classic Hodgkin lymphoma (cHL) [1]. Among 182 cases of NHL, 157 were of B-cell (86%) and 25 (14%) of T-cell origin. Diffuse large B-cell lymphoma (DLBCL) was the most common type with 93 cases or 45% (including 13 cases or 6% of T-/histiocyte-rich large B-cell lymphoma, THRLBL), followed by chronic lymphocytic leukemia (CLL; 13%), peripheral T-cell lymphoma, not otherwise specified (PTCL; 9%), follicular lymphoma (FL; 7%), marginal zone lymphoma (MZL; 3%), plasma cell tumors (3%), Burkitt lymphoma (BL; 2%), anaplastic large-cell lymphoma (ALCL; 2%), and rare cases of lymphoplasmacytic lymphoma (LPL), mantle cell lymphoma (MCL), hepatosplenic T-cell lymphoma (HSTL), precursor B-cell acute lymphoblastic lymphoma/leukemia (B-ALL/LBL), and hairy cell leukemia (HCL) [1]. Among DLBCL with non-germinal center, B-cell-like phenotypes were almost twice as common as DLBCL with germinal-center B-cell-like phenotype. Five major histologic pattern of lymphoid infiltrate in the liver could be identified (Figure 45.1): dense portal infiltrate (B-CLL, FL, MCL, MZL), loose portal infiltrate (cHL and THRLBL), nodular (DLBCL, BL, HL), sinusoidal (HSTL, DLBCL, B-ALL, HCL), and portal and sinusoidal (DLBCL, PTCL). Primary hepatic lymphomas are exceedingly rare, are predominantly of DLBCL type, and have poor prognosis [3].
