Introduction : Primary hepatic lymphoma (PHL) is rare and accounts for only 0.01% of Non-Hodgkin lymphomas(NHL). Primary hepatic lympoma presenting with non specific symptoms and radiological imaging, PHL was often misdiagnosed. This article presents a case of PHL mimicking cholangiocarcinoma that was treated by resection and subusequent chemotherapy.

Methods : A 61 years old female visted our hospital for epigastric pain. Abdominal CT and MRI scan revealed lobulating hypodense mass involving left hepatic lobe and S8/4 liver, which was suggested cholangiocarcinoma. There was no evidence of retroperitoneal lymphadenopathy. The patient underwent Extended left lobectomy with caudate lobectomy.

Results : The operative findings showed no evidence of a mass originating from any other organs. Microscopically, atypical large lymphoid infiltrates at edges of portal tract, with disruption of hepatic parenchyma and uniform population of lymphoid cells of large size with many mitotic figures. Immunohistochemically, tumor cells were positive for CD20, MuM1, and Ki-67, while CD3, CD10, and anaplastic lymphoma kinase were negative. CT scan of the thorax and abdomen did not reveal any lymphadenopathy or mass lesion. Thus, the tumor was diagnosed as Primary non-Hodgkin lymphoma of the liver, large cell type (diffuse large B-cell lymphoma). She received six cycles of rituximab, cyclophosphamide, hydroxydaunorubicin(Adiramycin), oncovin(Vincristine), prednisolone (R-CHOP), and has disease regression.

Conclusions : Primary non-Hodgkin lymphoma of the liver, although rare, should be considered in the differential diagnosis of patients with large, hypovascular liver lesions. Although the mainstay of therapy for PHL patients is chemotherapy with R-CHOP regimen, surgical resection followed by chemotherapy has a valid role in the treatment.