Reactive lymphoid hyperplasia(RLH), also known as pseudolymphoma or nodular lymphoid lesion of the liver is an extremely rare condition, and only 51 hepatic RLH cases have been described in the literature since the fi...Reactive lymphoid hyperplasia(RLH), also known as pseudolymphoma or nodular lymphoid lesion of the liver is an extremely rare condition, and only 51 hepatic RLH cases have been described in the literature since the first case was described in 1981. The majority of these cases were asymptomatic and incidentally found through radiological imaging. The precise etiology of hepatic RLH is still unknown, but relative high prevalence of autoimmune disorder in these cases suggests an immune-based liver disorder. Imaging features of hepatic RLH often suggest malignant lesions such as hepatocellular carcinoma and cholangiocarcinoma. In this report, we discuss two cases of hepatic RLH in patients with autoimmune hepatitis. We also present pathologic and magnetic resonance imaging findings, including one case utilizing a hepatocellular contrast agent, Eovist. Definitive diagnosis of hepatic RLH often requires surgical excision.展开更多
Mucosa-associated lymphoid tissue(MALT) lymphoma of the liver is a very rare condition and thus the diag-nosis may be challeng-ing-. The clinical presentation is usually variable, rang-ing- from minimal clinical sympt...Mucosa-associated lymphoid tissue(MALT) lymphoma of the liver is a very rare condition and thus the diag-nosis may be challeng-ing-. The clinical presentation is usually variable, rang-ing- from minimal clinical symptoms to severe end stag-e liver disease. In this paper, we describe the clinicopatholog-ic finding-s in two cases of primary hepatic MALT lymphoma. One case is an 80-year-old female with no underlying- chronic liver disease and the second case is a 30-year-old female with autoimmune hepatitis complicated by MALT lymphoma. In both specimens, there was diffuse infiltration of atypical B-lymphocytes that were positive for CD20 and CD79 a, but neg-ative for CD5, CD43 and CD10. There were occasional lymphoepithelial lesions involving- the hepatocytes or bile ducts. Polymerase chain reaction analysis showed monoclonal immunog-lobulin heavy chain g-ene rearrang-ement in both cases. The first case was treated with surg-ery but developed pulmonary recurrence a year after complete resection but went into remission following- treatment with rituximab. A second recurrence occurred in the rig-ht parotid g-land 7 years later, which was treated with idelalisib. The second case was effectively treated with rituximab. To our knowledg-e, the second case is the first reported case linked to autoimmune hepatitis.展开更多
BACKGROUND Liver tumors with dual differentiations[combined hepatocellular carcinoma(HCC)and cholangiocarcinoma]are common.However,liver tumors that exhibit hepatocellular,biliary,and neuroendocrine differentiation ar...BACKGROUND Liver tumors with dual differentiations[combined hepatocellular carcinoma(HCC)and cholangiocarcinoma]are common.However,liver tumors that exhibit hepatocellular,biliary,and neuroendocrine differentiation are exceedingly rare,with only three previous case reports in the literature.CASE SUMMARY A 65-year-old female with a previous history of hepatitis C and a distant history of low grade,well-differentiated rectal neuroendocrine tumor was found to have two liver lesions in segment 4 and segment 7 on imaging.Serum alpha-fetoprotein and chromogranin A were elevated.Biopsy of the larger lesion in segment 4 revealed a high-grade tumor,with morphologic and immunohistochemical features of a neuroendocrine tumor.Given the previous history of rectal neuroendocrine tumor,imaging investigation,serologic markers,and biopsy findings,metastatic neuroendocrine tumor was considered.Subsequent regional resection of these hepatic lesions revealed the segment 4 lesion to be a HCC with additional biliary and neuroendocrine differentiation and the segment 7 lesion to be a cholangiocarcinoma with neuroendocrine differentiation.Follow-up of the patient revealed disease recurrence in the dome of the liver and metastasis in retro-pancreatic lymph nodes.The patient eventually expired due to complications of chemotherapy.CONCLUSION HCC cases with additional biliary and neuroendocrine differentiation are exceedingly rare,posing a diagnostic challenge for clinicians and pathologists.展开更多
BACKGROUND Clear cell sarcoma is an aggressive rare malignant neoplasm with morphologic and immunohistochemical similarities to malignant melanoma.Both disease entities display melanin pigment and melanocytic markers,...BACKGROUND Clear cell sarcoma is an aggressive rare malignant neoplasm with morphologic and immunohistochemical similarities to malignant melanoma.Both disease entities display melanin pigment and melanocytic markers,making differentiation between the two difficult.Although clear cell sarcoma cases in the literature have mainly involved deep soft tissues of the extremities,trunk or limb girdles,we report here two cases of primary clear cell sarcoma in unusual sites and describe their clinicopathologic findings.CASE SUMMARY The first case involves a 37-year-old female,who presented with jaw pain and a submandibular mass.The second case involves a 33-year-old male,who presented with back pain and a thoracic spine tumor.Both cases showed tumors with diffuse infiltration of neoplastic cells that were positive for melanocytic markers,and in both cases this finding led to an initial diagnosis of metastatic melanoma.However,further analysis by fluorescence in situ hybridization(commonly known as FISH)showed a rearrangement of the EWS RNA binding protein 1(EWSR1)gene on chromosome 22q12 in both patients,confirming the diagnosis of clear cell sarcoma.CONCLUSION Distinction between clear cell sarcoma and malignant melanoma can be made by FISH,particularly in cases of unusual tumor sites.展开更多
文摘Reactive lymphoid hyperplasia(RLH), also known as pseudolymphoma or nodular lymphoid lesion of the liver is an extremely rare condition, and only 51 hepatic RLH cases have been described in the literature since the first case was described in 1981. The majority of these cases were asymptomatic and incidentally found through radiological imaging. The precise etiology of hepatic RLH is still unknown, but relative high prevalence of autoimmune disorder in these cases suggests an immune-based liver disorder. Imaging features of hepatic RLH often suggest malignant lesions such as hepatocellular carcinoma and cholangiocarcinoma. In this report, we discuss two cases of hepatic RLH in patients with autoimmune hepatitis. We also present pathologic and magnetic resonance imaging findings, including one case utilizing a hepatocellular contrast agent, Eovist. Definitive diagnosis of hepatic RLH often requires surgical excision.
文摘Mucosa-associated lymphoid tissue(MALT) lymphoma of the liver is a very rare condition and thus the diag-nosis may be challeng-ing-. The clinical presentation is usually variable, rang-ing- from minimal clinical symptoms to severe end stag-e liver disease. In this paper, we describe the clinicopatholog-ic finding-s in two cases of primary hepatic MALT lymphoma. One case is an 80-year-old female with no underlying- chronic liver disease and the second case is a 30-year-old female with autoimmune hepatitis complicated by MALT lymphoma. In both specimens, there was diffuse infiltration of atypical B-lymphocytes that were positive for CD20 and CD79 a, but neg-ative for CD5, CD43 and CD10. There were occasional lymphoepithelial lesions involving- the hepatocytes or bile ducts. Polymerase chain reaction analysis showed monoclonal immunog-lobulin heavy chain g-ene rearrang-ement in both cases. The first case was treated with surg-ery but developed pulmonary recurrence a year after complete resection but went into remission following- treatment with rituximab. A second recurrence occurred in the rig-ht parotid g-land 7 years later, which was treated with idelalisib. The second case was effectively treated with rituximab. To our knowledg-e, the second case is the first reported case linked to autoimmune hepatitis.
文摘BACKGROUND Liver tumors with dual differentiations[combined hepatocellular carcinoma(HCC)and cholangiocarcinoma]are common.However,liver tumors that exhibit hepatocellular,biliary,and neuroendocrine differentiation are exceedingly rare,with only three previous case reports in the literature.CASE SUMMARY A 65-year-old female with a previous history of hepatitis C and a distant history of low grade,well-differentiated rectal neuroendocrine tumor was found to have two liver lesions in segment 4 and segment 7 on imaging.Serum alpha-fetoprotein and chromogranin A were elevated.Biopsy of the larger lesion in segment 4 revealed a high-grade tumor,with morphologic and immunohistochemical features of a neuroendocrine tumor.Given the previous history of rectal neuroendocrine tumor,imaging investigation,serologic markers,and biopsy findings,metastatic neuroendocrine tumor was considered.Subsequent regional resection of these hepatic lesions revealed the segment 4 lesion to be a HCC with additional biliary and neuroendocrine differentiation and the segment 7 lesion to be a cholangiocarcinoma with neuroendocrine differentiation.Follow-up of the patient revealed disease recurrence in the dome of the liver and metastasis in retro-pancreatic lymph nodes.The patient eventually expired due to complications of chemotherapy.CONCLUSION HCC cases with additional biliary and neuroendocrine differentiation are exceedingly rare,posing a diagnostic challenge for clinicians and pathologists.
文摘BACKGROUND Clear cell sarcoma is an aggressive rare malignant neoplasm with morphologic and immunohistochemical similarities to malignant melanoma.Both disease entities display melanin pigment and melanocytic markers,making differentiation between the two difficult.Although clear cell sarcoma cases in the literature have mainly involved deep soft tissues of the extremities,trunk or limb girdles,we report here two cases of primary clear cell sarcoma in unusual sites and describe their clinicopathologic findings.CASE SUMMARY The first case involves a 37-year-old female,who presented with jaw pain and a submandibular mass.The second case involves a 33-year-old male,who presented with back pain and a thoracic spine tumor.Both cases showed tumors with diffuse infiltration of neoplastic cells that were positive for melanocytic markers,and in both cases this finding led to an initial diagnosis of metastatic melanoma.However,further analysis by fluorescence in situ hybridization(commonly known as FISH)showed a rearrangement of the EWS RNA binding protein 1(EWSR1)gene on chromosome 22q12 in both patients,confirming the diagnosis of clear cell sarcoma.CONCLUSION Distinction between clear cell sarcoma and malignant melanoma can be made by FISH,particularly in cases of unusual tumor sites.
