Multiple hepatic and osseous focal lesions without splenomegaly and/or lymph nodes enlargement

BACKGROUND: Hepatic involvement is a common extranodal manifestation of common and some rare hematologic malignancies. Although the imaging features of more common hepatic diseases such as hepatocellular carcinoma, metastases, and infection may overlap with those of hepatic hematologic malignancies, combining the imaging features with clinical manifestations and laboratory findings can facilitate correct diagnosis. Imaging has an important role in the diagnosis of hepatic focal lesions. CASE PRESENTATION: A case presented with isolated multiple hepatic focal lesions without nodal or spleen enlargement diagnosed only by immunohistochemical study and turned out to be primary hepatic lymphoma (PHL). PHL is rare with roughly 100 described cases and accounts for less than 1% of all non-Hodgkin lymphomas. Osseous involvement adds more challenge to the diagnosis. CONCLUSION: Hepatologists must be aware of PHL as it may be confused with more common hepatic diseases, mainly multifocal HCC and/or hepatic metastasis.