HIV-associated hypervascular primary Burkitt's lymphoma of the liver

The liver is an uncommon primary site for malignant lymphoma, comprising only 0.4% of extranodal lymphomas.¹ Involvement of the liver by is almost always secondary to systemic lymphoma, occurring in up to 50% of cases.² Primary hepatic lymphoma has been reported to occur with increased frequency in immunosupressed patients especially with chronic hepatitis C infection³ and may be linked to hepatitis B infection and Epstein-Barr virus.^2,4 Patients usually present with right upper quadrant pain or mass with or without jaundice and classically affects middle-aged male adults. Establishing a diagnosis of extranodal lymphoma or primary hepatic lymphoma can be difficult especially in human immunodeficiency virus (HIV)-positive or acquired immunodeficiency syndrome (AIDS) patients.⁵ Due to its rarity it is often overlooked as a possible differential diagnosis. Imaging findings are non-specific and a definitive diagnosis is usually made only after histological examination. This can have a profound impact on patient care and prognosis. On computed tomography (CT) examination, lymphomatous involvement of the liver is typically represented by hypoattenuating hypovascular lesions. A hypervascular enhancement pattern on CT images has not been described in the literature to this date. We present a case of Burkitt's lymphoma presenting as hypervascular hepatic masses mimicking focal nodular hyperplasia.