Lymphoma debuts in the liver of a Puerto Rican patient who manages to survive against all odds


Belinda Zorielie Burgos González
News from the Latina Agency for Medicine and Public Health

The man remains alive after receiving hepatotoxic treatment even with severe liver failure

Cancer diseases have some common places to debut. But there always comes the case that surprises and gives the medical profession the warning that they have no limits and can appear in a new place.

This was demonstrated this time by diffuse B-cell lymphoma (LBDCG) that made its atypical debut in the liver of a healthy man. This new clinical picture has led specialists to consider a treatment which, although it may appear as contraindicated in the midst of a liver failure that has compromised the patient’s life.

LBDCGs are one of the most common and aggressive types of lymphomas in adults, accounting for between 30 and 40% of non-Hodgkin’s lymphoma (NHL) cases. Its origin in the cells of the B line (since cancer cells are large lymphocytes).

It is fast-growing and aggressive due to its high cell proliferation, and the tumors increase in volume over the course of days or weeks. They appear more frequently in men over the age of 70 and their incidence increases with age or as a result of immune disorders.

The most characteristic presentation of this condition is in the region of the lymph nodes such as the cervical and abdominal regions, between 40 and 50%. However, between 20 and 35% of the tumor presentation of this condition can appear in areas such as the stomach, ileocecal region, skin, breast, lungs, bones, liver, kidneys, testes, ovaries, and uterus, exactly as it did in this. case.

Dr. Karla Feliciano Salvá, internist and who is now part of the Gastroenterology Research Unit of the Medical Sciences Campus (RCM), said that this patient arrived at La Concepción Hospital when she was in rotation in Internal Medicine, with a pneumonia which he had treated for three to four months with community doctors.

“His respiratory symptoms worsened and he was given an antibiotic through a vein. Further studies were done, and the chest CT showed the multiple consolidated (areas that were filled with fluid instead of air) that he had in his lung and we found a hypodense lesion (which has a density as usual)

in the liver that hadn’t been seen months ago. Then he started developing night sweats. A gastroenterologist then advised to perform a biopsy, “he explained in the first instance.

“In what we do the biopsy, the patient came out with liver failure, respiratory failure, had to intubate, go to the ICU, came out with kidney failure and all the organs started to fail. It was ruled out that the pneumonia was due to some source of an infection, including a bronchoscopy that was performed and we knew we were dealing with something else, ”he assured.

Similarly, the patient had very high levels of liver enzymes, and precisely because of the hepatic impairment that this patient presented, providing chemotherapy to this patient, being a treatment that presents itself as hepatotoxic and contraindicated for patients with hepatic insufficiency, the decision the clinic should have been made in collaboration with the family.

“The biopsy reflected diffuse B cell lymphoma. All of the chemotherapy we have for this type of lymphoma is hepatotoxic and this patient was already in fulminant liver failure. At the time we suspected that liver failure was then a malignant tumor. We told the family that giving him chemotherapy was a risk we could run knowing that the well-marked side effect of this treatment was that he would go away with liver failure, ”he added.

“A few days after receiving chemotherapy, his liver enzymes were completely normal. So we were surprised that this B-cell lymphoma will debut in the liver first because it is an atypical presentation, the kidney failure is gone, the pneumonia too, and the patient survived. This was a perfectly functioning patient on the verge of death and with multidisciplinary discussion he got a second chance and went into remission, ”he celebrated.

He added that among the things doctors should suspect in clinical pictures where they find pneumonia “not healing” or responding to antibiotic treatment is that it may be an atypical presentation of NHL.

“In the literature we do not find that chemotherapy has been applied to a patient with hepatic insufficiency. It is a relative contraindication that can be considered knowing that liver failure can get worse, “he concluded.

Among the other authors of the case are the hematologist oncologist, Dr. Luis Negrón, Dr. Aida Rodríguez, among others.