Abstract
A 65-year-old man was admitted to our hospital for rectal cancer. Abdominal CT showed three hypovascular tumors, in S1 (15 mm), S4 (12 mm), and S6 (17 mm) of the liver. Abdominal MRI showed low-intensity regions on T1-weighted images, slightly high-intensity regions on T2-weighted images and low-intensity regions in the hepatocyte- phase of Gd-EOB-DTPA. Synchronous metastatic tumors of rectal cancer were diagnosed, and the patient was enrolled in a clinical trial and started on neoadjuvant chemotherapy with TS-1, oxaliplatin, and bevacizumab. We assessed response of chemotherapy as SD (RECIST). Extended left hepatectomy, partial caudate lobectomy, S6 partial hepatectomy and lower anterior resection with lymph node dissection were performed. On histopathology, the rectal lesion was found to be adenocarcinoma in tubulo-villous adenoma with no metastatic lymph nodes. All three liver tumors were malignant lymphoma. On immunohistochemistry, lymphocytes were positive for CD20 and Bcl12. Each was therefore diagnosed as follicular lymphoma. Primary hepatic lymphoma is rare and difficult to diagnose. It is important to differentiate this entity from metastatic hepatic tumors in patients with carcinoma in other organs.
