Reactive Lymphoid Hyperplasia of the Liver in a Patient with Ascending Colon Cancer: Report of a Case

Hiroki Takahashi, Yoichi Matsuo, Minoru Yamamoto, Hirozumi Sawai, Mikinori Satoh, Yuji Okada, Hiromitsu Takeyama and Tadao Manabe

Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences

A 77-year-old woman admitted for upper right abdominal pain was found in a barium enema and colonoscopy to have an ulcerative tumor of the ascending colon and moderately differentiated adenocarcinoma diagnosed from a biopsy. A hepatic left-lobe tumor concurrently found in abdominal ultrasonography, computed tomography, and magnetic resonance imaging suggested liver metastasis by its appearance. Right hemicolectomy and partial hepatectomy were done. On histopathological examination, lymphoid follicles with germinal centers were seen in the tumor-like hepatic lesion, and remarkable lymphoid infiltration with germinal centers was seen in the portal area around the nodule. Immunohistochemical studies showed polyclonality of the infiltrating lymphocytes, suggesting that this lymphoid lesion was reactive rather than neoplastic. The nodular lesion was thus diagnosed as reactive lymphoid hyperplasia of the liver (RLH). Such a diagnosis is possible from histological, immunohistochemical, and/or genetic studies, but it remains very difficult to completely rule out malignancies such as HCC, metastatic liver tumors, or malignant lymphomas based solely on diagnostic imaging findings. Preoperative biopsy is ultimately essential for diagnosis.

Key words
reactive lymphoid hyperplasia, liver, colon cancer

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Hiroki Takahashi Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences
1 Kawasumi, Mizuho-cho, Mizuho-ku, 467-8601 JAPAN

Accepted
July 26, 2006

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