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Liver and intrahepatic bile ducts - tumor

Leukemia / lymphoma

Mucosal associated lymphoid tissue (MALT) lymphoma


Reviewers: Deepali Jain, M.D. (see Reviewers page)
Revised: 9 January 2013, last major update February 2012
Copyright: (c) 2004-2013, PathologyOutlines.com, Inc.

See also Lymphoma and plasma cell neoplasms chapter

General
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● Rare, <50 cases reported; represents 3% of cases of hepatic lymphoma (Int J Hematol 2008;88:418)
● Mean age 60 years, slight female predominance
● Occasionally associated with liver cirrhosis, primary biliary cirrhosis, Hepatitis B and Hepatitis C infection

Treatment
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● Local excision; tumor is indolent

Case reports
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● 57 year old woman with primary biliary cirrhosis (Arch Pathol Lab Med 2000;124:604)
● 69 year old woman (Arch Pathol Lab Med 1999;123:716)
● 75 year old woman post lumpectomy and radiation therapy for invasive ductal carcinoma of breast (Case of the Week #260)

Clinical images
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Solitary or multiple tan, subcapsular nodule


CT scan of Case of Week #260

Micro description
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● Extensive diffuse sheets of small B-cells in the interfollicular areas
● Centrocyte-like cells surround reactive B cell follicles and form lymphoepithelial lesions with bile ducts (Am J Surg Pathol 1995;19:571, Mod Pathol 1998;11:404)
● May arise in settings of chronic inflammation including viral hepatitis
● Note: reactive follicles and lymphoepithelial lesions are non specific

Micro images
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Case of Week #260



Top row: H&E; bottom row: (left to right): CD20, bcl2, Ki-67


Left to right: negative for CD5, CD10, Cyclin D1 (staining of non-MALT cells only)

   
Entrapping bile ducts   CD20


Atypical lymphocytes entrapping islands of hepatocytes


Various images

Cytology images
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Case of Week #260 - fine needle aspirate

Molecular description
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● t(11;18)(q21;q21), t(1;14)(p22;q23), t(14;18)(q32;q21), 37 and t(3;14)(p14.1;q32)

Differential diagnosis
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Reactive lymphoid hyperplasia: not clonal, T cells predominate in interfollicular areas
Inflammatory myofibroblastic tumor: no diffuse sheets of extrafollicular B-cells, no evidence of B cell clonality
Lymphoplasmacytic lymphoma: high levels of serum IgM paraprotein; cryoglobulinemia
Post-transplant lymphoproliferative disease: history of transplantation and frequent EBV positivity

End of Liver and intrahepatic bile ducts - tumor > Leukemia / lymphoma > Mucosal associated lymphoid tissue (MALT) lymphoma


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