Three-year Diagnosis And Treatment Of A Patient With Primary Hepatic Non-Hodgkin Lymphoma

Primary hepatic lymphoma(PHL)is a very rare malignancy.A 61-year-old female patient has been suffering from intermittent right upper abdominal pain for more than 20 years,exacerbating the progressive enlargement of the liver by 3 years.In November 2014,upper abdomen MR detected multiple abnormal signals in the liver.In the following three years,she improved hepatic function test,antimitochondrial antibodies,tumor markers and parasite related tests.In the same time,She performed almost all liver examinations such as abdominal ultrasound,enhanced CT,upper abdomen MRI,gastroscopy and colonoscopy,ERCP,PET-CT,bone marrow biopsy,liver biopsy,etc.After secondary liver biopsy in November 2017,PHL was considered.In February 2018 PET-CT showed that the tumor had metastasized.After 1 week,retroperitoneal lymph node biopsy confirmed hepatic primary non-Hodgkin's lymphoma,diffuse large B-cell lymphoma,and germinal center source,but PET-CT shows that the tumor has metastasized.The patient currently uses Rituximab Injection(MabThera)for chemotherapy.The patient has been on the right upper abdomen for more than 20 years,after more than 10 blood tests,3 chest CT,3 upper abdominal CT,6 upper abdominal MRI,2 PET-CT,9 puncture pathological examinations,the final diagnosis was confirmed.The case shows that for the diffuse liver lesions with atypical clinical symptoms,the possibility of PHL needs to be eliminated in time,and PET-CT and histological puncture should be performed as early as possible,at the same time choose a doctor with rich pathological experience to confirm the diagnosis.