Abstract

Non Hodgkin's Lymphoma is a predominantly nodal disease. Hepatic involvement secondary to systemic disease is common-however, a primary hepatic location of non Hodgkin lymphoma is rare and only constitutes 0.01% of all cases. This is a case of a 51 year old female who presented with an abdominal swelling measuring 10 cm. Imaging showed a large mass in the right lobe of the liver and biopsy revealed non Hodgkin lymphoma-diffuse large B cell lymphoma. Patient was treated with 6 cycles of RCHOP chemotherapy and patient followed up regularly for 12 months with resolution of mass on imaging and resolution of symptoms. This case highlights a rare case of primary non hodgkin's lymphoma of the liver and how it was successfully treated with chemotherapy alone. Case Presentation: This is a case of a 51 year old female who presented with an abdominal swelling for 2 months associated with decreased appetite and weight loss. On examination, there was a tender, well-defined, firm to hard mass measuring 10 cm in the epigastric region. Ultrsound of the Abdomen showed hepatomegaly with large ill-defined hyperechoic lesion predominantly in right lobe of liver and moderate ascites with internal echoes. CECT showed a 13.8 x 9 cm mass in left lobe of liver without distant metastasis and was suspected to be a primary hepatic neoplasm. Liver biopsy showed non hodgkin lymphoma-diffuse large B cell lymphoma-germinal center subtype/ high grade B cell lymphoma with MYC and BCL6 rearrangement. Immunohistochemistry showed diffuse membrane positivity for CD20 and CD10, diffuse nuclear positivity for BCL6, CMYC nuclear positive in >40% cells, and Ki67-75%. Patient was treated with pre phase chemotherapy with rituximab and steroids. She was treated with RCHOP chemotherapy and Peg filgrastim. 6 cycles of RCHOP were given in total, PET CT done post chemotherapy in comparison with PET CT done pre chemotherapy showed interval resolution in metabolic activity of the large hypodense lesion in liver and interval resolution in size and metabolic activity of the mediastinal lymph nodes. Patient followed up for 6 months and is asymptomatic on follow up.