Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2020; 8(21): 5313-5319
Published online Nov 6, 2020. doi: 10.12998/wjcc.v8.i21.5313
Diffusion-weighted imaging might be useful for reactive lymphoid hyperplasia diagnosis of the liver: A case report
Taro Tanaka, Kazuhiro Saito, Daisuke Yunaiyama, Jun Matsubayashi, Yuichi Nagakawa, Maki Tanigawa, Toshitaka Nagao
Taro Tanaka, Kazuhiro Saito, Daisuke Yunaiyama, Department of Radiology, Tokyo Medical University, Tokyo 1600023, Japan
Jun Matsubayashi, Maki Tanigawa, Toshitaka Nagao, Department of Anatomic Pathology, Tokyo Medical University, Tokyo 1600023, Japan
Yuichi Nagakawa, Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo 1600023, Japan
Author contributions: Tanaka T researched the literature and drafted the manuscript; Saito K reviewed the literature and edited the manuscript; Nagakawa Y edited the paper and suggested clinical information; Yunaiyama D, Matsubayashi J, Tanigawa M and Nagao T edited the pathological portions of the manuscript.
Informed consent statement: Informed consent was obtained in a routine manner.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
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Corresponding author: Taro Tanaka, MD, Assistant Professor, Department of Radiology, Tokyo Medical University, 6-7-1, Nishi-Shinjuku, Shinjuku-ku, Tokyo 1600023, Japan. gossip.auction@hotmail.co.jp
Received: July 8, 2020
Peer-review started: July 8, 2020
First decision: August 8, 2020
Revised: August 22, 2020
Accepted: September 22, 2020
Article in press: September 22, 2020
Published online: November 6, 2020
Processing time: 121 Days and 2.9 Hours
Abstract
BACKGROUND

Reactive lymphoid hyperplasia (RLH) of the liver is a rare liver lesion. It is considered difficult to differentiate radiologically from hepatocellular carcinoma, metastatic liver tumor and other pathologies.

CASE SUMMARY

A 54-year-old woman presented to our hospital with RLH of the liver. The patient had a diagnosis of metastatic carcinoma of the liver from an unknown origin and subsequently underwent partial hepatectomy. However, histopathological analysis revealed RLH. The lesion showed perinodular enhancement in the arterial phase on contrast-enhanced computed tomography and magnetic resonance imaging. On diffusion-weighted imaging (DWI), we encountered linear hyperintensity along the portal tract consecutive to the liver lesion, which is a new characteristic radiologic finding. This finding corresponded to the lymphoid cell infiltration of the portal tract. Furthermore, there was strongly restricted diffusion on the apparent diffusion coefficient map. We used these characteristic radiologic findings to diagnose the lesion as a lymphoproliferative disease.

CONCLUSION

The linear hyperintensity consecutive to the liver lesion on DWI provided additional valuable diagnostic information.

Keywords: Reactive lymphoid hyperplasia; Pseudolymphoma; Magnetic resonance imaging; Diffusion-weighted imaging; Perinodular enhancement; Portal tract infiltration; Case report

Core Tip: Reactive lymphoid hyperplasia of the liver is a rare liver lesion. It is known to be difficult to differentiate radiologically from hepatocellular carcinoma, metastatic liver tumor and other pathologies. We encountered a new radiologic characteristic finding on diffusion-weighted imaging. This new finding was linear hyperintensity along the portal tract, consecutive to the liver lesion and corresponded to the lymphoid cell infiltration of the portal tract. Perinodular enhancement in the arterial phase or equilibrium phase on contrast-enhanced computed tomography and magnetic resonance imaging indicated lymphocytic infiltration.