Imaging Pearls ❯ Liver ❯ Lymphoma
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- “Posttransplant malignancies can arise by means of three different mechanisms: de novo, donor-related, and recurrent cancers. De novo malignancies are new cancers arising in transplant recipients that originate separately from the transplanted organs, such as NMSC and Kaposi sarcoma. Donor-related cancers can either be from direct transmission of tumors that preexisted in the donor or de novo development of cancer in the transplanted organ without a preexisting history.”
Malignancy after Solid Organ Transplantation: Comprehensive Imaging Review
Katabathina VS et al.
RadioGraphics 2016; 36:1390–1407 - “Direct oncogenic effects of immunosuppressive drugs, impaired immunosurveillance of neoplastic cells, and increased incidence of virally induced malignancies are also mechanisms in the pathogenesis of malignancies that develop in transplant recipients.”
Malignancy after Solid Organ Transplantation: Comprehensive Imaging Review
Katabathina VS et al.
RadioGraphics 2016; 36:1390–1407 
Malignancy after Solid Organ Transplantation: Comprehensive Imaging Review
Katabathina VS et al.
RadioGraphics 2016; 36:1390–1407- "Kaposi sarcoma is a multifocal angioproliferative endothelial malignancy driven by HHV-8 infection. HHV-8 is a complex DNA virus that can induce malignancy by inhibition of apoptosis, damaging antigen-processing pathways, evasion of mutated host cells from immunosurveillance, activating the mTOR pathway, and upregulating vascular endothelial growth factor receptors. Although most Kaposi sarcomas are due to reactivation of HHV-8 in recipients because of prolonged immunosuppression, infection can also be transmitted from the donor. There is a 400- to 500-fold greater incidence of Kaposi sarcoma in solid organ transplant recipients than in the general population."
Malignancy after Solid Organ Transplantation: Comprehensive Imaging Review
Katabathina VS et al.
RadioGraphics 2016; 36:1390–1407 - “Visceral Kaposi sarcoma can involve the gastrointestinal tract, lymph nodes, and lungs. Although rare, direct involvement of the allografts has also been described. At imaging, skin lesions can be seen as vascular nodules or masses with associated hypervascular lymph nodes. Abdominal findings of Kaposi sarcoma include nodular bowel wall thickening, enhanced masses in the liver and spleen, lymphadenopathy, and vascular mesenteric masses.”
Malignancy after Solid Organ Transplantation: Comprehensive Imaging Review
Katabathina VS et al.
RadioGraphics 2016; 36:1390–1407 - “PTLD is a spectrum of lymphoproliferative diseases that occur after organ transplantation and range from benign lymphoid hyperplasia to lymphoma. The incidence of PTLD ranges from 1% to 20%, depending on the level of immunosuppression and the presence of Epstein-Barr virus infection. Lung, heart, and pancreas transplants, which require higher doses of immunosuppressive agents, are associated with a higher risk of PTLD than are kidney or liver transplants. About 85% of PTLDs are from activation of B lymphocytes by Epstein-Barr virus, although proliferation of T-cells, natural killer cells, or plasma cells may also cause PTLD. PTLD manifests in two well-recognized forms: early-onset PTLD, which develops within the first year after transplantation (80% of cases) and late-onset PTLD, which manifests 4–5 years after transplant.”
Malignancy after Solid Organ Transplantation: Comprehensive Imaging Review
Katabathina VS et al.
RadioGraphics 2016; 36:1390–1407 - “About 85% of PTLDs are from activation of B lymphocytes by Epstein-Barr virus, although proliferation of T-cells, natural killer cells, or plasma cells may also cause PTLD. PTLD manifests in two well-recognized forms: early-onset PTLD, which develops within the first year after transplantation (80% of cases) and late-onset PTLD, which manifests 4–5 years after transplant.”
Malignancy after Solid Organ Transplantation: Comprehensive Imaging Review
Katabathina VS et al.
RadioGraphics 2016; 36:1390–1407 - “Approximately 50%–75% of PTLD cases manifest in the abdomen and primarily involve the gastrointestinal tract (more often in the distal small bowel than in the proximal small bowel). Imaging findings in gastrointestinal PTLD include irregular bowel wall thickening with eccentric mural masses, aneurysmal dilatation, luminal ulceration, and, rarely, intussusception. The liver is the most common solid organ involved in PTLD of the abdomen.”
Malignancy after Solid Organ Transplantation: Comprehensive Imaging Review
Katabathina VS et al.
RadioGraphics 2016; 36:1390–1407 - “PTLD is potentially fatal, with a mortality rate between 22% and 70%, and early diagnosis is a key factor for overall survival rates. Limited levels of immunosuppression can help to prevent PTLD, and reduction in immunosuppression is the initial step in the treatment of PTLD and may result in complete regression of early lesions or polymorphic PTLD. Antibody or antiviral therapy and chemotherapy are other treatment strategies.”
Malignancy after Solid Organ Transplantation: Comprehensive Imaging Review
Katabathina VS et al.
RadioGraphics 2016; 36:1390–1407
- “Primary Hepatic Lymphoma (PHL) is an extremely rare tumor comprising only 0.016% of all cases of Non-Hodgkin's Lymphoma (NHL). PHL commonly presents in the mid-50s, with a male pre- dominance (M:F ratio of 2.3:1), and it is often associated with HCV, HBV, HIV, and Epstein-Barr Virus (EBV). Patients with PHL may present with a range of symptoms including hepatomegaly, abdominal pain, fatigue, jaundice, fever, and weight loss. Labs are typically normal with the exception of abnormal liver function tests (LFTs) and LDH; AFP and CA19–9 are normal.”
Rare primary hepatic malignancies: A case-based review
Victoria Wu et al.
Clinical Imaging 69 (2021) 196-204 - “There are several imaging features of PHL which may help to differentiate it from other more common liver malignancies. First, PHL may present with three distinct morphologic patterns; the most common being a single, well-defined lesion in 64% of cases. The other two less common forms include multiple discrete lesions or a diffuse, miliary pattern. On ultrasound, PHL most often appears as an homogeneous hypoechoic lesion with well-defined margins . On contrast enhanced ultrasound, there is washout on late phase. CT demonstrates hypoenhancement in comparison to normal liver parenchyma during both arterial and delayed phases with occasional rim enhancement. These lesions rarely contain calcification. On MR, PHL presents as homogeneous lesions which are hypo- to iso- intense on T1 weighted imaging and hyperintense on T2 weighted imaging. Due to a relatively higher nucleus to cytoplasm ratio and compacted cellularity, PHL also appears as marked restriction on DWI with low ADC values.”
Rare primary hepatic malignancies: A case-based review
Victoria Wu et al.
Clinical Imaging 69 (2021) 196-204
- "Primary hepatic lymphoma (PHL) is a rare primary liver tumor. Due to its clinical and radiological resemblance to liver metastases of adenocarcinoma, PHL is frequently diagnosed intra- or post-operatively. Since chemotherapy is the treatment of first choice for lymphoma, adjuvant chemotherapy should be given to patients for optimal treatment. The existing literature on PHL reveals the difficulties involved in diagnosis and treatment."
Primary lymphoma of the liver - A complex diagnosis
Steller EJA et al.
World J Radiol. 2012 Feb 28; 4(2): 53–57. - "Primary hepatic NHL is very rare, only 0.016% of all NHL. Of all primary extranodal NHL only 0.4% arise in the liver. 1.1% of all primary hepatic tumors in 30 years in the Johns Hopkins tumor registry consisted of PHL. The incidence of hepatic involvement in NHL is described between 16% and 22%, stressing the importance of careful investigation to disseminated disease outside of the liver."
Primary lymphoma of the liver - A complex diagnosis
Steller EJA et al.
World J Radiol. 2012 Feb 28; 4(2): 53–57. - "At initial presentation a third of patients present with a solitary liver nodule while another third have multiple lesions, and the remaining cases have diffuse infiltration of the liver."
Primary lymphoma of the liver - A complex diagnosis
Steller EJA et al.
World J Radiol. 2012 Feb 28; 4(2): 53–57. - "On tri-phasic liver CT scan PHL usually presents itself as a hypodense lesion, with possible areas of inhomogeneity. Occasionally local areas of rim enhancement or calcifications may be seen."
Primary lymphoma of the liver - A complex diagnosis
Steller EJA et al.
World J Radiol. 2012 Feb 28; 4(2): 53–57. - "Liver involvement by secondary Non Hodgkin’s lymphoma is relatively common. Primary liver lymphoma (PLL) is extremely rare. Among all extra nodal lymphomas, PLL constitutes <1% of all cases."
PRIMARY LIVER LYMPHOMA
S. Khalid et al.
JBR–BTR, 2013, 96: 84-86. - "Four of eighteen patients presented with a single focal lesion. Thirteen of eighteen patients presented with multiple well defined focal lesions. One patient presented with a diffuse hepatic involvement. On triphasic CT, three patients showed gradual progressive contrast enhancement. Lesions remained isodense to the liver on the arterial phase with mild enhancement in the portal phase and showed washout on the delayed phase in two patients. The remaining thirteen patients showed multiple hypodense non-enhancing lesions."
Multidetector CT (MDCT) Findings Of Primary Hepatic Lymphoma.
El-Badrawy A et al.
Gulf J Oncolog. 2016 Jan;1(20):64-70.