Published online Nov 18, 2015. doi: 10.4254/wjh.v7.i26.2696
Peer-review started: June 4, 2015
First decision: August 14, 2015
Revised: September 5, 2015
Accepted: October 20, 2015
Article in press: October 27, 2015
Published online: November 18, 2015
Reactive lymphoid hyperplasia (RLH), also known as pseudolymphoma or nodular lymphoid lesion of the liver is an extremely rare condition, and only 51 hepatic RLH cases have been described in the literature since the first case was described in 1981. The majority of these cases were asymptomatic and incidentally found through radiological imaging. The precise etiology of hepatic RLH is still unknown, but relative high prevalence of autoimmune disorder in these cases suggests an immune-based liver disorder. Imaging features of hepatic RLH often suggest malignant lesions such as hepatocellular carcinoma and cholangiocarcinoma. In this report, we discuss two cases of hepatic RLH in patients with autoimmune hepatitis. We also present pathologic and magnetic resonance imaging findings, including one case utilizing a hepatocellular contrast agent, Eovist. Definitive diagnosis of hepatic RLH often requires surgical excision.
Core tip: Reactive lymphoid hyperplasia of the liver also known as pseudolymphoma is an extremely rare condition. Because of its rarity, association with underlying inflammatory liver disease and close resemblance to malignant hepatic lesions such as hepatocellular carcinoma and cholangiocarcinoma on imaging studies, this rare lesion is frequently misdiagnosed. We discuss two cases of hepatic reactive lymphoid hyperplasia (RLH) in patients with autoimmune hepatitis and how we came to the correct diagnosis. Definitive diagnosis of hepatic RLH often requires surgical excision.