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Image of the Month—Diagnosis
Arch Surg. 2003;138:1026.
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Answer: Obtain a Biopsy Specimen of the Hepatic Mass
Figure 1. Computed tomographic scan of the liver.
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Figure 2. Magnetic resonance imaging of the liver.
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The computed tomographic and magnetic resonance images demonstrated a 6.6-cm lesion of the medial and lateral segments in the left lobe of the liver, peripheral biliary ductal dilatation in both lobes, and obstruction of the common hepatic duct. A biopsy of this lesion was diagnostic of malignant B-cell lymphoma and was positive by in situ hybridization for the Epstein-Barr virus. Serologic analyses confirmed posttransplantation infection by the Epstein-Barr virus. Immunosuppression was discontinued, temporary biliary stenting via endoscopic retrograde cholangiopancreatography was accomplished, and chemotherapy with cyclophosphamide, adriamycin, rituximab, and prednisone was initiated. Five months later, the mass resolved, renal and hepatic function were preserved (serum creatinine, 1.6 mg/dL [141.4 µmol/L]); total bilirubin, 0.4 mg/dL [6.84 µmol/L]), and low-dose immunosuppression has been reinstituted with cyclosporine microemulsion and prednisone.
Posttransplantation lymphoproliferative . . . [Full Text of this Article]
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Image of the Month—Quiz Case
Amy L. Friedman, Marc I. Lorber, and Dennis Cooper
Arch Surg. 2003;138(9):1025.
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