Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Feb 27, 2018; 10(2): 347-351
Published online Feb 27, 2018. doi: 10.4254/wjh.v10.i2.347
Primary hepatic peripheral T-cell lymphoma associated with Epstein-Barr viral infection
Daryl Ramai, Emmanuel Ofori, Sofia Nigar, Madhavi Reddy
Daryl Ramai, Emmanuel Ofori, Sofia Nigar, Madhavi Reddy, Division of Gastroenterology and Hepatology, Brooklyn Hospital Center, Brooklyn, NY 11201, United States
Daryl Ramai, Department of Anatomical Sciences, St. George’s University School of Medicine, Grenada 999166, West Indies
Author contributions: Ramai D, Ofori E and Nigar S designed the report; Ramai D and Reddy M collected the patient’s clinical data; Ramai D wrote the paper; Ofori E, Nigar S and Reddy M edited the manuscript for intellectual content.
Informed consent statement: Regarding consent, we contacted our patient's spouse who reported that the patient has since passed.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Daryl Ramai, MD, Research Fellow, Division of Gastroenterology and Hepatology, Brooklyn Hospital Center, 121 Dekalb Avenue, Brooklyn, NY 11201, United States.
Telephone: +1-718-2508867 Fax: +1-718-250758
Received: October 31, 2017
Peer-review started: November 1, 2017
First decision: December 1, 2017
Revised: December 20, 2017
Accepted: January 23, 2018
Article in press: January 24, 2018
Published online: February 27, 2018
Case characteristics

A 37-year-old male with a past medical history of Epstein-Barr Virus infection reported having jaundice, right upper quadrant pain, and decreased appetite and weight loss of 10 lbs over the past two months.

Clinical diagnosis

Abdominal magnetic resonance imaging showed mild intrahepatic ductal dilatation, peripheral areas of arterial enhancement in the liver felt to be related to vascular shunting, periportal edema, a cut off in the course of biliary tree at the bifurcation, simple liver cyst, and enlarged left retroperitoneal nodes.

Differential diagnosis

Cirrhosis, hepatocellular carcinoma, cholangiocarcinoma.

Laboratory diagnosis

Laboratory was significant for total bilirubin of 5.7 mg/dL, alkaline phosphatase of 1005 U/L, albumin of 3.2 g/dL, and AST/ALT of 257/239 U/L.

Imaging diagnosis

Upper endoscopy showed gastropathy in the gastric fundus and body. Endoscopic ultrasound was unremarkable.

Pathological diagnosis

A liver biopsy showed several large dense clusters of atypical T-lymphocytes, which appeared to be centered in portal areas. The atypical lymphocytes were medium to large in size and were CD2+, CD3+, CD5+, CD7-, CD4+, CD8-, CD56-, CD57-, CD30+, by immunohistochemistry. The proliferation index was approximately 70% by labeling for ki67/mib1. Labeling for CD68 was seen in Kupffer cells, and in a few scattered histiocytes only. There were rare, scattered, unremarkable small B-lymphocytes (CD20+, CD79a+). Stains for CD138, kappa, lambda, were noncontributory. The above histological profile was consistent with hepatic peripheral T-cell lymphoma (H-PTCL).


The patient was transferred to a tertiary center for chemotherapy (CHOP) treatment.

Related reports

H-PTCL has a poor prognosis due to life threatening complications and tumor progression. Clinical studies reports that CHOP therapy can provide up to 60% complete remission, and a 30%-50% five-year survival rate.

Term explanation

H-PTCL is one of the rarest forms of non-Hodgkin lymphoma. It constitutes approximately 0.0016% of all extranodal lymphomas.

Experiences and lessons

In the setting of worsening symptoms and abnormal liver enzymes of unknown etiology, clinicians should consider performing a differential liver biopsy. Clinicians should also be aware of the risk factors for H-PTCL.