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Case Reports in Gastrointestinal Medicine
Volume 2014 (2014), Article ID 724256, 5 pages
http://dx.doi.org/10.1155/2014/724256
Case Report

A Novel Use of Early Radiation Therapy in the Treatment of Hyperbilirubinemia in a Patient with Primary Hepatic Lymphoma and Chronic Hepatitis C

1Department of Internal Medicine, Howard University Hospital, 2041 Georgia Avenue, NW, Washington, DC 20060, USA
2Department of Radiation Oncology, Howard University Hospital, Washington, DC, USA
3Department of Radiology, Howard University Hospital, Washington, DC, USA

Received 14 January 2014; Accepted 2 April 2014; Published 29 April 2014

Academic Editor: Haruhiko Sugimura

Copyright © 2014 Venkata S. Tammana et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Lymphomas arising in the liver are extremely rare. Here, we describe a case of Hepatitis C virus infection with primary hepatic lymphoma (PHL) presenting with hyperbilirubinemia. A 45-year-old African American male presented with abdominal pain, pruritus, and itching for two days. CT of abdomen and pelvis with contrast showed numerous masses in the liver. The liver biopsy was consistent with diffuse large B cell lymphoma (DLBCL). Conventional chemotherapy was avoided initially because of hyperbilirubinemia. Hence, radiation therapy was given initially to reduce his bilirubin levels and tumor size. The patient was able to complete six cycles of rituximab combined with cyclophosphamide, adriamycin, vincristine, and prednisone (R-CHOP) chemotherapy and achieved a complete response verified by positron emission tomography-computed tomography (PET-CT). PHL should be considered when there are numerous space occupying liver lesions seen on imaging. Hyperbilirubinemia may be a reason for delay in treatment for some of these patients. Hence, the role of radiation therapy prior to treatment with R-CHOP is an alternative to management for stage IV diffuse large B cell lymphoma.