Primary Hepatic Lymphoma in Pregnant: Clinical Case and Literature Review

Primary hepatic lymphoma (PHL) is an extremely rare disease that presents with non-specific symptoms and variable laboratory and imaging findings. It should be part of the differential diagnosis in a patient with nodular liver lesions, especially in the presence of normal tumor markers and/or elevated LDH levels. A clinical case of a 29-year-old pregnant woman who complained of intermittent pain in the right hypochondrium for six months is presented. Blood biochemistry during control tests at pregnancy were within normal values. The patient didn’t undergo abdominal ultrasound during pregnancy. According to the abdominal ultrasound, the lesions of the SII-III and SVI-VII liver were detected 24 hours before the timely natural birth. During the control abdominal ultrasound the next day after delivery, these focal lesions were confirmed and extrahepatic fluid accumulation was detected in the area of SVI-VII liver lesions localization. Morphological diagnosis was not made before surgery. The patient underwent staged surgical treatment, after which she was referred for consultation to a hematologist. Additional histology and PET-CT were performed. The diagnosis was confirmed: diffuse large B-cell primary non-Hodgkin's liver lymphoma, IVA according to Cotswolds-modified Ann Arbor. The patient receives adjuvant chemotherapy. Thus, morphology verification is mandatory for the final diagnosis of PHL. It is important to recognize PHL, since this disease is sensitive to chemotherapy, and its timely diagnosis allows for early treatment and improves overall survival. Literature data on the relationship between PHL and pregnancy are extremely scarce, there is a single case where the fact of such possibility is noted.