{'fraction_non_alphanumeric': 0.02341748993779729, 'fraction_numerical': 0.00804976216611782, 'mean_word_length': 4.943478260869565, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Hepatobiliary and Pancreatic: Primary hepatic lymphoma

Primary hepatic lymphoma is a rare lymphoma that is confined to the liver with no evidence of involvement of the spleen, lymph nodes, bone marrow or other lymphoid structures. The most common presenting symptom is discomfort or pain in the right upper quadrant of the abdomen. This is sometimes accompanied by malaise, anorexia, weight loss, fever, nausea and vomiting. There are also case reports of fulminant hepatic failure with hepatic encephalopathy. The typical radiological appearance is that of a solitary lesion although multiple lesions or diffuse liver infiltration have also been described. In most patients, the differential diagnosis will include primary and secondary hepatic tumors as well as systemic lymphoma with secondary hepatic involvement. Case reports have raised the possibility of an association between primary hepatic lymphoma and hepatitis C but, for most patients, the pathogenesis remains unclear. We describe two patients with primary hepatic, B-cell lymphomas who had negative serological tests for both hepatitis B and C. The first patient was a 92-year-old woman who was admitted to hospital because of epigastric pain, nausea, vomiting, weight loss and fever over the preceding 6 months. Physical examination revealed enlargement of the left lobe of the liver and mild ascites. A contrast-enhanced computed tomography (CT) scan of the abdomen showed multiple hypodense lesions in the left and right lobes of the liver (Figure 1). She also had thrombosis of the inferior vena cava. A liver biopsy under ultrasound control revealed a neoplastic population of intermediate and large lymphoid cells with immunochemical stains that were positive for CD20 and bcl-6. Other investigations including a bone marrow biopsy were normal. She declined therapy and died after 3 months. The second patient was a 51-year-old man who was investigated because of a low-grade fever and night sweats over the preceding 5 months. He had also noted anorexia, weight loss and upper abdominal discomfort. His liver was mildly enlarged, about 3 cm below the right costal margin. Liver enzymes were mildly abnormal while an abdominal CT scan showed a large hypodense mass, 7 cm in diameter, in the right lobe of the liver (Figure 2). A fine-needle biopsy under CT control again showed a neoplastic infiltration of intermediate and large lymphoid cells with histochemical stains that were positive for CD-20, CD-79 and CD-43. Other investigations including a bone marrow biopsy were unhelpful. He was diagnosed with a large B-cell non-Hodgkin’s lymphoma and was treated with 6 courses of combination chemotherapy. He remains in good health after follow-up for 3 years.