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Progressive hepatic lymphoma successfully treated with regional chemotherapy through a hepatic artery catheter

Patients with intermediate or high-grade non-Hodgkin’s lymphoma who present with progressive disease despite optimum therapy pose amajor clinical problem, especially if the disease involves multiple sites or a major organ such as the liver. This report describes successful treatment of progressive hepatic lymphoma with regional chemotherapy. An 82-year-old man first presented with generalized lymphadenopathy and was found to have small-cell follicular lymphoma on inguinal lymph node biopsy. Computed tomography (CT) scan examination showed lymphadenopathy in the thoracic, abdominopelvic, axillary and subcarinal regions; the liver had a normal appearance. Whole-body gallium scan showed multiple sites of avidity only above the diaphragm. Due to the gallium avidity (suggesting intermediate or high-grade disease) he was commenced on rituximab-CHOP chemotherapy, which he tolerated well. One month post-commencement of chemotherapy, his liver function tests became deranged: serum bilirubin 54 mmol/L (n < 25), alkaline phosphatase 350 U/L (normal range, 38–126), gamma glutamyl transpeptidase 262 U/L (n < 50), aspartate aminotransferase 145 U/L (n < 45) and alanine aminotransferase 213 U/L (n < 45). These abnormalities rapidly progressed and were associated with massive hepatomegaly and palpable nodules. Repeat CT examination showed multiple hypoechoic lesions throughout the liver parenchyma (see Fig. 1). Elsewhere, there was reduction in the size of the previously described lymphadenopathy. A CT-guided core biopsy of the liver showed B-cell non-Hodgkin’s lymphoma of intermediate to large cell type.