Diagnostic and Interventional Imaging (2015) 96, 1223—1225

LETTER / Gastrointestinal imaging

Primary plasmacytic hepaticlymphoma mimicking hepatocel-lular tumor on MR imaging

Keywords: Plasmacytic hepatic lymphoma; Non-Hodgkin’slymphoma; PET/CT scanning

Dear Editor,

Plasmacytic hepatic lymphoma is a rare type of tumourwhose presentation may be misleading on imaging. This is acase report about a 50-year-old man with a history of non-Hodgkin’s lymphoma (NHL) treated by chemotherapy andwho had been in remission for 6 years. CT scan monitor-ing revealed a large, hypoattenuating hepatic lesion withno calcifications. No involvement of peripheral or distantlymph nodes or splenomegaly or other visceral lesions wereobserved. Abdominal MR imaging examination (Figs. 1—4)confirmed the presence of a well-delineated, lobulated mass

located in segments 6, 7 and 8 and measuring 18 × 13 cmin the axial plane. The lesion was hyperintense on T2-weighted images and showed rapid enhancement after

Figure 1. MRI, axial T2-weighted slice. A well-delimited, mod-erately hyperintense liver lesion with a lobulated contour and amarkedly hyperintense central scar (arrow) is visible in segmentsVI, VII and VIII.

Figure 2. During the arterial phase of the gadolinium chelateinjection, moderate, heterogeneous, early enhancement of thelesion was observed with no enhancement of the scar (arrow).

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http://dx.doi.org/10.1016/j.diii.2014.11.0072211-5684/© 2015 Published by Elsevier Masson SAS on behalf of the Édi

igure 3. Homogenization of the lesion in the venous phase.

ntravenous administration of a gadolinium chelate. Theesion was surrounded by a hypointense capsule presentingreas of retraction in contact with the lesion with a finger-haped central area, hyperintense on T2-weighted images

tions françaises de radiologie.

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Figure 4. Discrete slow enhancement of the central scar (arrow)as

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nd the tumor capsule, revealing capsular retraction adjacent toegment VII.

nd showing slow enhancement after contrast injection.natomopathological examination of tissue sample obtainedy percutaneous puncture of the lesion revealed the pres-nce of a plasmacytic hepatic lymphoma (Figs. 5 and 6).

iscussion

n imaging, hepatic lymphoma often presents as solitaryesion with diameter of up to 20 cm [1]. A central areahowing slow enhancement mirrors that of focal nodu-ar hyperplasia and fibrolamellar hepatocellular carcinomas2,3].

The MR imaging features of the lobulated lesion thatnhances rapidly after gadolinium-chelate injection with

central stellar area that enhances slowly is suggestivef fibrolamellar hepatocellular carcinoma in which central

alcifications may be present in 50% of tumors as well asreas of necrosis [2,3]. Enhancement was intense but het-rogeneous with no enhancement of the central part, which

igure 5. H&E histological section, × 400: atypical, plasmacytic-ike round cells.

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igure 6. CD138 immunohistochemistry analysis, × 400: tumouropulation frankly and unequivocally positive.

as hypointense in T1- and T2-weighted images. However,elayed enhancement of the scar was unusual [2,3].

Capsular retraction adjacent to a hepatic tumour is veryuggestive for malignancy, being associated with epithelioidemangioendotheliomas, intrahepatic cholangiocarcinomasnd breast cancer liver metastases [4,5]. However, the signs not pathognomonic because it has also been describedith benign tumours such as sclerosing hemangiomas [4,5].

The prevalence of hepatic lymphomas secondary to NHLs estimated to be between 15 and 60% [6,7]. Diagnosis andocalisation of lymphoproliferative disease in the liver isasy when the lymphoid cell infiltrate has the same cyto-ogical and immunohistochemical features as the primaryymph node lesion [7]. Splenic involvement is almost alwaysresent.

The criteria used for the diagnosis of primary NHL of theiver are the presence of a solitary hepatic lesion with noymph node involvement or splenomegaly or other visceralesions and an absence of concomitant haematological disor-ers [7]. 18FDGPET/CT scanning is very useful for assessinghe extent of lymphoma and to confirm that the tumour has

single location [8].

isclosure of interest

he authors declare that they have no conflicts of interestoncerning this article.

eferences

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Rabat, Morocco

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[6] Dupas B, Augeul-Meunier K, Frampas E, Bodet-Milin C, GastinneT, Le Gouill S. Staging and monitoring in the treatment of lym-phomas. Diagn Interv Imaging 2013;94:145—57.

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[8] Bodet-Milin C, Eugène T, Gastinne T, Bailly C, Le Gouill S, DupasB, et al. The role of FDG-PET scanning in assessing lymphoma in2012. Diagn Interv Imaging 2013;94:158—68.

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S. Allal a,∗, F. Kettanib, H. Ennouali a,S. Chaouira, T. Amila, M. Mahia

a Department of Medical Radiology, Mohammed VMilitary Hospital, Rabat, Morocco

b United Nations Laboratory of Anatomopathology,

∗ Corresponding author.E-mail address: alsoumaya@gmail.com (S. Allal)