EURORAD ESR

Case 10619

Imaging of a secondary hepatic lymphoma

Author(s)
Sergio Savastano1, Emanuele SG D’Amore2, Alessandra Costantini1, Andrea Busolo1, Stefano Trupiani1, Jacopo Dall’Acqua1, Andrea Menin2

U.O. Radiologia1 and
U.O. Anatomia e Istocitopatologia2
Ospedale San Bortolo - V.le F. Rodolfi 37
36100 Vicenza, Italy;
Email: sergio.savastano@ulssvicenza.it
 
Patient
male, 70 year(s)
 
 
  • Figure 1
    US of the liver.

    Numerous solid hypoechoic nodules; the intervening parenchyma is hyperechoic. Nodules are not calcified; intrahepatic biliary ducts are not dilated.

     
    Area of Interest: Liver; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Lymphoma;
     
     
  • Figure 2
    CT of the abdomen.
     

    Non-enhanced scan: the liver is enlarged with sinuous contours.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Lymphoma;

    Arterial phase: no abnormal hepatic hypervascularization.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Lymphoma;

    Numerous hypoattenuating hepatic nodules. The spleen is normal; a fluid film surrounds the medial aspect of the spleen.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Lymphoma;

    On a lower level slightly enlarged mesenteric and paraaortic lymph nodes are evident. The largest node measures 16 mm in the short axis.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Lymphoma;
     
     
  • Figure 3
    MRI of the upper abdomen.
     

    GE T1 out-of-phase MRI: hepatic nodules are hypoattenuating relative to the intervening parenchyma.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Dilation; Special Focus: Lymphoma;

    HASTE T2W fat suppressed MRI: nodules are hyperintense and partially confluent.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Lymphoma;

    HASTE T2W MRI: coronal view.

     
    Area of Interest: Liver; Imaging Technique: MR; MR-Angiography; Procedure: Diagnostic procedure; Special Focus: Lymphoma;
     
     
  • Figure 4
    DWI.
     

    b50 DWI.

     
    Area of Interest: Liver; Imaging Technique: MR-Diffusion/Perfusion; Procedure: Diagnostic procedure; Special Focus: Lymphoma;

    b400 DWI.

     
    Area of Interest: Liver; Imaging Technique: MR-Diffusion/Perfusion; Procedure: Diagnostic procedure; Special Focus: Lymphoma;

    b800 DWI.

     
    Area of Interest: Liver; Imaging Technique: MR-Diffusion/Perfusion; Procedure: Diagnostic procedure; Special Focus: Lymphoma;

    Corresponding ADC map: all nodules exhibit a low ADC.

     
    Area of Interest: Liver; Imaging Technique: MR-Diffusion/Perfusion; Procedure: Diagnostic procedure; Special Focus: Lymphoma;
     
     
  • Figure 5
    Contrast-enhanced MRI with Gd-BOPTA.
     

    Arterial phase: hepatic nodules are hypovascularized.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Lymphoma;

    Portal phase. Nodules remain hypointense relative to the intervening liver parenchyma.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Lymphoma;

    Late venous phase: some hepatic nodules shows a target-like appearance for central pooling of the contrast medium.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Lymphoma;

    Hepatobiliary phase (coronal view): the target-like apprearance is more prominent in some nodules.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Lymphoma;
     
     
  • Figure 6
    Histologic and immunohistochemical findings.
     

    H &E: mostly sinusoidal hepatic involvement by large blasts

     
    Area of Interest: Liver; Imaging Technique: Percutaneous; Procedure: Diagnostic procedure; Special Focus: Tissue characterisation;

    H &E x 40: blasts of the lymphoma expanding the hepatic sinusoids and compressing the hepatocytes.

     
    Area of Interest: Liver; Imaging Technique: Percutaneous; Procedure: Diagnostic procedure; Special Focus: Tissue characterisation;

    Immunohistochemical staining for CD20, showing the B-cell lineage of the lymphoid proliferation.

     
    Area of Interest: Liver; Imaging Technique: Percutaneous; Procedure: Diagnostic procedure; Special Focus: Tissue characterisation;
     
     
Numerous solid hypoechoic nodules; the intervening parenchyma is hyperechoic. Nodules are not calcified; intrahepatic biliary ducts are not dilated.
 
Non-enhanced scan: the liver is enlarged with sinuous contours.
 
Arterial phase: no abnormal hepatic hypervascularization.
 
Numerous hypoattenuating hepatic nodules. The spleen is normal; a fluid film surrounds the medial aspect of the spleen.
 
On a lower level slightly enlarged mesenteric and paraaortic lymph nodes are evident. The largest node measures 16 mm in the short axis.
 
GE T1 out-of-phase MRI: hepatic nodules are hypoattenuating relative to the intervening parenchyma.
 
HASTE T2W fat suppressed MRI: nodules are hyperintense and partially confluent.
 
HASTE T2W MRI: coronal view.
 
b50 DWI.
 
b400 DWI.
 
b800 DWI.
 
Corresponding ADC map: all nodules exhibit a low ADC.
 
Arterial phase: hepatic nodules are hypovascularized.
 
Portal phase. Nodules remain hypointense relative to the intervening liver parenchyma.
 
Late venous phase: some hepatic nodules shows a target-like appearance for central pooling of the contrast medium.
 
Hepatobiliary phase (coronal view): the target-like apprearance is more prominent in some nodules.
 
H &E: mostly sinusoidal hepatic involvement by large blasts
 
H &E x 40: blasts of the lymphoma expanding the hepatic sinusoids and compressing the hepatocytes.
 
Immunohistochemical staining for CD20, showing the B-cell lineage of the lymphoid proliferation.
 
 
 
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