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A case of reactive lymphoid hyperplasia of the liver in a patient with autoimmune hepatitis

BACKGROUND: Reactive lymphoid hyperplasia (RLH) of the liver is a benign disorder. It is usually observed in the skin, orbit, thyroid, lung, breast, or gastrointestinal tract, but rarely in the liver. Since the first report of RLH of the liver in 1981, only 75 cases have been described in the past l...

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Autores principales: Kanno, Hiroki, Sakai, Hisamune, Hisaka, Toru, Kojima, Satoki, Midorikawa, Ryuta, Fukutomi, Shogo, Nomura, Yoriko, Goto, Yuichi, Sato, Toshihiro, Yoshitomi, Munehiro, Kawahara, Ryuichi, Okuda, Koji
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7198675/
https://www.ncbi.nlm.nih.gov/pubmed/32367275
http://dx.doi.org/10.1186/s40792-020-00856-3
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author Kanno, Hiroki
Sakai, Hisamune
Hisaka, Toru
Kojima, Satoki
Midorikawa, Ryuta
Fukutomi, Shogo
Nomura, Yoriko
Goto, Yuichi
Sato, Toshihiro
Yoshitomi, Munehiro
Kawahara, Ryuichi
Okuda, Koji
author_facet Kanno, Hiroki
Sakai, Hisamune
Hisaka, Toru
Kojima, Satoki
Midorikawa, Ryuta
Fukutomi, Shogo
Nomura, Yoriko
Goto, Yuichi
Sato, Toshihiro
Yoshitomi, Munehiro
Kawahara, Ryuichi
Okuda, Koji
author_sort Kanno, Hiroki
collection PubMed
description BACKGROUND: Reactive lymphoid hyperplasia (RLH) of the liver is a benign disorder. It is usually observed in the skin, orbit, thyroid, lung, breast, or gastrointestinal tract, but rarely in the liver. Since the first report of RLH of the liver in 1981, only 75 cases have been described in the past literature. Herein, we report a case of RLH of the liver in a patient with autoimmune hepatitis (AIH), which was misdiagnosed as hepatocellular carcinoma (HCC) preoperatively and resected laparoscopically. CASE PRESENTATION: A 43-year-old Japanese woman with autoimmune hepatitis was followed up for 5 years. During her medical checkup, a hypoechoic nodule in segment 6 of the liver was detected. The nodule had been gradually increasing in size for 4 years. Abdominal ultrasound (US) revealed a round, hypoechoic nodule, 12 mm in diameter. Contrast-enhanced computed tomography (CT) demonstrated that the nodule was slightly enhanced in the arterial dominant phase, followed by perinodular enhancement in the portal and late phases. A magnetic resonance imaging (MRI) scan showed low signal intensity on the T1-weighted image (T1WI) and slightly high signal intensity on the T2-weighted image (T2WI). The findings of the Gd-EOB-DTPA-enhanced MRI were similar to those of contrast-enhanced CT. Tumor markers were all within the normal range. The preoperative diagnosis was HCC and a laparoscopic right posterior sectionectomy was performed. Pathological examination revealed that the nodular lesion was infiltrated by small lymphocytes and plasma cells, and germinal centers were present. Immunohistochemistry was positive for B cell and T cell markers, indicating polyclonality. The final diagnosis was RLH of the liver. CONCLUSIONS: The pathogenesis of RLH of the liver remains unknown, and a definitive diagnosis based on imaging findings is extremely difficult. If a small, solitary nodule is found in female patients with AIH, the possibility of RLH of the liver should be considered.
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spelling pubmed-71986752020-05-06 A case of reactive lymphoid hyperplasia of the liver in a patient with autoimmune hepatitis Kanno, Hiroki Sakai, Hisamune Hisaka, Toru Kojima, Satoki Midorikawa, Ryuta Fukutomi, Shogo Nomura, Yoriko Goto, Yuichi Sato, Toshihiro Yoshitomi, Munehiro Kawahara, Ryuichi Okuda, Koji Surg Case Rep Case Report BACKGROUND: Reactive lymphoid hyperplasia (RLH) of the liver is a benign disorder. It is usually observed in the skin, orbit, thyroid, lung, breast, or gastrointestinal tract, but rarely in the liver. Since the first report of RLH of the liver in 1981, only 75 cases have been described in the past literature. Herein, we report a case of RLH of the liver in a patient with autoimmune hepatitis (AIH), which was misdiagnosed as hepatocellular carcinoma (HCC) preoperatively and resected laparoscopically. CASE PRESENTATION: A 43-year-old Japanese woman with autoimmune hepatitis was followed up for 5 years. During her medical checkup, a hypoechoic nodule in segment 6 of the liver was detected. The nodule had been gradually increasing in size for 4 years. Abdominal ultrasound (US) revealed a round, hypoechoic nodule, 12 mm in diameter. Contrast-enhanced computed tomography (CT) demonstrated that the nodule was slightly enhanced in the arterial dominant phase, followed by perinodular enhancement in the portal and late phases. A magnetic resonance imaging (MRI) scan showed low signal intensity on the T1-weighted image (T1WI) and slightly high signal intensity on the T2-weighted image (T2WI). The findings of the Gd-EOB-DTPA-enhanced MRI were similar to those of contrast-enhanced CT. Tumor markers were all within the normal range. The preoperative diagnosis was HCC and a laparoscopic right posterior sectionectomy was performed. Pathological examination revealed that the nodular lesion was infiltrated by small lymphocytes and plasma cells, and germinal centers were present. Immunohistochemistry was positive for B cell and T cell markers, indicating polyclonality. The final diagnosis was RLH of the liver. CONCLUSIONS: The pathogenesis of RLH of the liver remains unknown, and a definitive diagnosis based on imaging findings is extremely difficult. If a small, solitary nodule is found in female patients with AIH, the possibility of RLH of the liver should be considered. Springer Berlin Heidelberg 2020-05-04 /pmc/articles/PMC7198675/ /pubmed/32367275 http://dx.doi.org/10.1186/s40792-020-00856-3 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Case Report
Kanno, Hiroki
Sakai, Hisamune
Hisaka, Toru
Kojima, Satoki
Midorikawa, Ryuta
Fukutomi, Shogo
Nomura, Yoriko
Goto, Yuichi
Sato, Toshihiro
Yoshitomi, Munehiro
Kawahara, Ryuichi
Okuda, Koji
A case of reactive lymphoid hyperplasia of the liver in a patient with autoimmune hepatitis
title A case of reactive lymphoid hyperplasia of the liver in a patient with autoimmune hepatitis
title_full A case of reactive lymphoid hyperplasia of the liver in a patient with autoimmune hepatitis
title_fullStr A case of reactive lymphoid hyperplasia of the liver in a patient with autoimmune hepatitis
title_full_unstemmed A case of reactive lymphoid hyperplasia of the liver in a patient with autoimmune hepatitis
title_short A case of reactive lymphoid hyperplasia of the liver in a patient with autoimmune hepatitis
title_sort case of reactive lymphoid hyperplasia of the liver in a patient with autoimmune hepatitis
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7198675/
https://www.ncbi.nlm.nih.gov/pubmed/32367275
http://dx.doi.org/10.1186/s40792-020-00856-3
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