CT diagnosis and differentiation of nodular/mass-type hepatic lymphoma

Objective To investigate the CT findings of nodular/mass-type hepatic lymphoma, and to improve its diagnostic level. Methods A retrospective analysis was performed for the CT findings of 6 patients with nodular/mass-type hepatic lymphoma confirmed by pathology or clinical treatment who were diagnosed and treated in Integrated Traditional Chinese and Western Medical Hospital of Jinshan District and Cixi Hospital Affiliated to Wenzhou Medical University from December 2008 to April 2016. The CT findings were closely observed in terms of tumor location, number, morphology, size, boundary, and features of density, features of dynamic enhancement, changes in internal and surrounding structures, and the presence or absence of dropsy and lymph node enlargement in the body surface, the abdominal cavity, or the retroperitoneal part. Results Of all patients, 2 had primary lymphoma manifesting as a solitary nodule in the liver and 4 had secondary lymphoma, among whom 1 had a solitary nodule and 3 had multiple nodules and masses with different sizes. There were 15 lesions in total, and the maximum diameter ranged from 17 to 108 mm. Five lesions had clear boundaries and 1 had obscure boundary. CT scan showed that 4 patients had homogeneous low-density lesions ( mean CT value = 29. 8-41. 4 Hu) , and 2 had inhomogeneous low-density lesions, with low density in the peripheral region ( mean CT value = 26. 7-39. 6 Hu) and patchy low-density areas in the central region ( mean CT value = 16. 5-27. 8 Hu) . Contrast-enhanced CT scan in arterial phase and portal venous phase showed that all 6 patients had mild-to-moderate continuous enhancement, which was weaker than normal liver tissues, with relatively obvious enhancement in portal venous phase ( mean CT value = 45. 6-63. 9 Hu) . There was a reduction in enhancement in delay phase with low density. Of all patients, 4had homogeneous enhancement, and 2 had inhomogeneous-density lesions on plain CT scan, with peripheral enhancement and patchy non-enhanced areas in the central region. Five patients had“vessel floating sign”inside the tumor. Calcification was not seen in any patient.Of all patients, 2 had slight local broadening of the upstream bile duct, 4 had superficial and abdominal cavity/retroperitoneal lymph node enlargement, and 1 had secondary lymphoma with spleen invasion. Conclusion Although nodular/mass-type hepatic lymphoma is rare, it has its own features. CT has a high value in the diagnosis and differentiation of this disease.