Background: Solitary liver lesions in patients without underlying liver disease or elevated tumor markers (AFP, CEA, CA19-9) are uncommon and can represent hematologic malignancies, including primary hepatic lymphoma (PHL) and, more rarely, hepatic involvement by multiple myeloma. Early recognition is crucial to guide appropriate management and avoid unnecessary surgery.
Methods: A systematic literature review was conducted using PubMed, Scopus, and Google Scholar up to August 2025. Search terms included "primary hepatic lymphoma," "hepatic plasmacytoma," "multiple myeloma liver involvement," and "solitary liver lesion." Articles reporting epidemiology, clinical presentation, imaging characteristics, histopathology, and management of solitary hepatic lesions due to lymphoma or myeloma were included.
Results: Hematologic hepatic solitary lesions typically present as hypodense lesions on CT or hypointense on T1-weighted MRI with variable enhancement. Clinical manifestations are often nonspecific, including mild hepatomegaly or abdominal discomfort, while liver function tests are frequently normal. Definitive diagnosis relies on histopathology via biopsy. Management strategies differ: chemotherapy is first-line for lymphoma, whereas myeloma-related hepatic lesions may require systemic therapy or, rarely, surgical resection if diagnosis is uncertain.
Conclusions: In patients with solitary liver lesions, normal tumor markers, and no chronic liver disease, clinicians should maintain a high index of suspicion for hematologic malignancies. Accurate imaging assessment and tissue diagnosis are essential for optimal treatment planning.
Keywords: Hematologic malignancy; Hepatic plasmacytoma; Liver neoplasms; Multiple myeloma; Primary hepatic lymphoma; Solitary liver lesion.
Copyright © 2025. Published by Elsevier Masson SAS.