SELECT ISSUE
Members Area
Primary Hepatic Marginal Zone Lymphoma in a Patient with Chronic Hepatitis C
George S. GHERLAN, Razvan STOIA, Mihaly ENYEDI, Camelia DOBREA and Petre I. CALISTRU
ABSTRACT
Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) is a low-grade malignant lymphoma that appears frequently in the stomach, but other sites can also be involved: the intestinal tract, lungs, head, neck, skin, thyroid, breasts and liver. Recently, epidemiological evidences support the idea that there is an association between hepatitis C and B-cell non-Hodgkin lymphomas (that include MALT as a subtype). Primary non-Hodgkin lymphomas confined only to the liver are very rare (only 0.016% of all cases of all non-Hodgkin’s lymphomas) and MALT is not the most frequent type.
We present the case of a male patient, age 62, known with chronic hepatitis C, previously relapser after a 72 week treatment with peg-interferon alfa and ribavirin that was diagnosed at three years after the relapse with multiple focal liver lesions. One of the tumors was surgically removed and the histological exam performed demonstrated an extranodal marginal zone lymphoma with small B-cell with plasmacytoid differentiation confined only to the liver. Direct acting antiviral (DAA) therapy was started, but the virologic clearance was not obtained by week 10, leading to a change of DAA regimen at week 12. The antiviral therapy was continued until week 24. Imaging showed an increase in number and size of the focal lesions until week 12. At week 12 chemo- and immune-therapy was started with bendamustine and rituximab. Afterwards the evolution was favorable, the patient being now in complete remission and with undetectable viral load.
Keywords: Liver lymphoma, C hepatitis, extranodal marginal zone lymphoma, liver tumor