T‐cell‐rich B‐cell lymphoma presenting as liver disease

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Abstract
We describe a series of eight cases of T‐cell‐rich B‐cell lymphoma diagnosed on liver biopsy and collected over a period of 15 years. Of seven cases that were referred from elsewhere, in only one was the correct diagnosis of B‐cell lymphoma suggested. Common errors included misdiagnosis as inflammatory disease on histology, and misinterpretation as T‐cell lymphoma on immunohistochemistry. However, the cases had a distinct morphological appearance and immunohistochemical profile. They showed a lymphohistiocytic or granulomatous infiltrate, usually centred on portal tracts and containing abundant small T‐cells and scanty B‐cell blasts. All patients had an atypical clinical presentation which favoured non‐neoplastic liver disease. In seven cases liver involvement represented Stage IV disease and in one case disease was confined to the liver consistent with a primary hepatic lymphoma. Despite combination chemotherapy, the prognosis was poor with no patients surviving beyond 15 months from diagnosis. We believe T‐cell‐rich B‐cell lymphoma to be an under‐recognized subset of non‐Hodgkin's lymphoma that may mimic primary liver disease.

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