a rare presentation of primary hepatic lymphoma :a case report

primary hepatic lymphoma (phl) was a rare malignancy usually presenting with abdominal pain, malaise, hepatomegaly, b-symptoms, fatigue, nausea, vomiting and jaundice. it mostly involves liver without any palpable lymphadenopathy and leukemia in peripheral blood smear. on july 22, 2014, a 64 year old man presented with abdominal pain localizing in right upper quadrant and fullness from 2 years ago without any weight loss or constitutional symptoms. his physical examination revealed no mass or lymphadenopathy and lab data showed rise in alkaline phosphatase (alp) and gamma-glutamyl transferase(gamma-gt). abdominal computed tomography (ct) scan with contrast showed a calcified lesion in the left lobe of liver and ill-defined hypodense area in medial segment of the left lobe of liver adjacent to gallbladder associated with mild central intra hepatic bile ducts dilation showing more enhancement in delay phase suggested peripheral cholangiocarcinoma. finally surgical core needle biopsy of the liver confirmed malignant lymphoma of b cell type and patient was referred to oncologist for chemotherapy. his chemotherapy regimen consisted of rituximab 600 milligram (mg), endoxan 1250 mg, adriamycin 80 mg, vincristine 2 mg, prednisolone 100 mg (during five days) for 6 courses. after 5 months chemotherapy, on december 22, 2014 a follow up ct scan with iv and oral contrast was done. there was no evidence of previous mass lesion in the liver. in the follow up on may 9, 2015, he had no specific symptoms and all of his lab data were in normal range.