Abstract
Large B-cell lymphomas include both the commonly encountered, as well as not so frequent
entities. We report a rare case of hepatic intravascular large B-cell lymphoma (IVLBCL).
These cases usually pose a major challenge to timely diagnosis due to the limited
clinical exposure and nonspecific symptoms; however, timely diagnosis is possible
with awareness of this entity and close coordination between radiology and pathology.
The patient presented with pain abdomen, fever, edema, hepatomegaly but no lymphadenopathy
or cutaneous lesions were identified. Blood investigations revealed pancytopenia,
high lactate dehydrogenase (LDH) levels and bone marrow investigations were not helpful.
Left-sided portal hypertension, coagulopathy, and hypoalbuminemia raised a clinical
suspicion of chronic liver disease with high LDH levels and liver biopsy was challenging
in view of very low platelet counts. The uniquely explored transjugular biopsy helped
in obtaining liver tissue which showed sinusoidal large atypical lymphoid cells positive
for CD20 rendering a diagnosis of IVLBCL. After administration of the R-miniCHOP chemotherapy,
there was evident clinical and radiological response. This case highlights the importance
of considering transjugular liver biopsy in scenarios where the clinical presentation
is unusual. At the same time, a meticulous histological examination is needed to diagnose
a rare yet potentially treatable large B cell lymphoma.
Keywords
lymphoma - intravascular - transjugular liver biopsy - challenging - rituximab
