Sarcoidosis-lymphoma syndrome with portal hypertension: diagnostic clues and approach

Fumio Chikamori, MD; Kenji Yorita, MD; Tadashi Yoshino, MD, PhD; Satoshi Ito, MD; Miki Mizobuchi, MD; Koji Ueta, MD; Kai Mizobuchi; Shigeto Shimizu; Kazumasa Nanjo; Sawaka Yukishige; Jun Iwabu, MD; Hisashi Matsuoka, MD; Norihiro Hokimoto, MD; Hiromichi Yamai, MD; Kazuhisa Onishi, MD; Nobuyuki Tanida, MD; Niranjan Sharma, MD

Radiology Case Reports (Aug 2021)

Sarcoidosis-lymphoma syndrome with portal hypertension: diagnostic clues and approach

Fumio Chikamori, MD,
Kenji Yorita, MD,
Tadashi Yoshino, MD, PhD,
Satoshi Ito, MD,
Miki Mizobuchi, MD,
Koji Ueta, MD,
Kai Mizobuchi,
Shigeto Shimizu,
Kazumasa Nanjo,
Sawaka Yukishige,
Jun Iwabu, MD,
Hisashi Matsuoka, MD,
Norihiro Hokimoto, MD,
Hiromichi Yamai, MD,
Kazuhisa Onishi, MD,
Nobuyuki Tanida, MD,
Niranjan Sharma, MD

Affiliations

Fumio Chikamori, MD: Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan; Corresponding author: E-mail address:.
Kenji Yorita, MD: Department of Diagnostic Pathology, Japanese Red Cross Kochi Hospital, Kochi, Japan
Tadashi Yoshino, MD, PhD: Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-ku, Okayama, Japan
Satoshi Ito, MD: Department of Radiology, Japanese Red Cross Kochi Hospital, Kochi, Japan
Miki Mizobuchi, MD: Department of Internal Medicine, Japanese Red Cross Kochi Hospital, Kochi, Japan
Koji Ueta, MD: Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
Kai Mizobuchi: Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
Shigeto Shimizu: Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
Kazumasa Nanjo: Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
Sawaka Yukishige: Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
Jun Iwabu, MD: Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
Hisashi Matsuoka, MD: Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
Norihiro Hokimoto, MD: Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
Hiromichi Yamai, MD: Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
Kazuhisa Onishi, MD: Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
Nobuyuki Tanida, MD: Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
Niranjan Sharma, MD: Department of Surgery, Adv Train Gastroint & Organ Transp Surgery, Dunedin, New Zealand

Journal volume & issue: Vol. 16, no. 8
pp. 2192 – 2201

Abstract

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Sarcoidosis-lymphoma syndrome associated with portal hypertension is very rare. A 68-year-old female presented with a 5 kg weight loss in 6 months. Soluble interleukin-2 receptor activity was increased and total platelet count was decreased. Contrast-enhanced computed tomography showed the presence of hepatosplenomegaly and a 3 cm-sized tumor in segment 3 of the liver. The hepatic venous catheterization showed mild portal hypertension. On fluorodeoxyglucose-positron emission tomography/computed tomography, progressive malignant lymphoma was suspected. However, bone marrow biopsy showed multiple noncaseating granulomas. A laparoscopic liver biopsy revealed that the liver tumor had features of Hodgkin lymphoma. There were multiple noncaseating epithelioid granulomas in the portal tracts of the liver. Splenectomy for splenomegaly and partial hepatectomy for the liver tumor were performed. Pathological examination of the resected specimens revealed multiple noncaseating epithelioid granulomas in the liver and spleen. Histopathology of the liver tumor confirmed classic Hodgkin lymphoma with mixed cellularity. We conclude that hepatic venous catheterization, positron emission tomography/computed tomography, and pathological examinations of bone marrow, liver, and spleen are crucial for the diagnosis of sarcoidosis-lymphoma syndrome associated with portal hypertension.

Published in Radiology Case Reports

ISSN: 1930-0433 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Medicine (General): Medical physics. Medical radiology. Nuclear medicine
Website: https://www.sciencedirect.com/journal/radiology-case-reports

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