Primary Hepatic Diffuse Large B-Cell Lymphoma: A Diagnostic Challenge Mimicking Cholangiocarcinoma: Diagnostic Pitfalls and Role of Timely Biopsy

Primary hepatic diffuse large B-cell lymphoma (DLBCL) is a rare malignancy that is often misdiagnosed as hepatocellular carcinoma or cholangiocarcinoma due to nonspecific radiological findings, highlighting diagnostic challenges and underscoring the critical role of systematic biopsy. A 67-year-old Malay woman presented with progressive jaundice, abdominal distension and weight loss. Cross-sectional imaging revealed an infiltrative hepatic mass with vascular involvement, initially suggestive of cholangiocarcinoma. Two percutaneous core biopsies were nondiagnostic, with definitive DLBCL diagnosis (germinal center B-cell subtype) achieved through subsequent laparoscopic wedge biopsy. The patient commenced rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone (R-CHOP) chemotherapy with good tolerance. Primary hepatic lymphoma should be considered in atypical liver masses, particularly with inconclusive initial biopsies. A structured approach beginning with image-guided coaxial biopsy and escalating to surgical biopsy when necessary is essential to avoid diagnostic delays. Modern coaxial techniques minimise tumour seeding risk and should not deter adequate tissue sampling.