Non-Hodgkin's Lymphoma as an Extrahepatic Manifestation after Achieving Sustained Virologic Response for Hepatitis C Viral Infection

Hepatitis C virus is a hepatotropic and lymphotropic virus, triggering B-cells and promoting B lymphocyte proliferation. The association between chronic HCV infection and different lymphoproliferative disorders is well known. Antiviral therapy for HCV, including direct acting antivirals, has been proven as effective therapy of HCV-related lymphomas. So far, only few cases of lymphoma after HCV eradication have been reported in the literature. We report a series of 3 cases with HCV-related liver cirrhosis, two of them with sustained virologic response 12 weeks after direct acting antiviral therapy and one with spontaneous eradication of HCV infection, that were diagnosed with large B cell non-Hodgkin’s lymphoma, that are still in remission actually, with a favorable evolution. Engaging the multidisciplinary team is tremendously important, since the diagnosis and management of those cases are successfully made by close collaboration between the gastroenterologist, hematologist, radiologist and pathologist, using imaging techniques, histopathological and immunohistochemical analysis. In the era of highly effective and safe direct acting antivirals, achieving sustained virologic response has been proven to prevent hepatic and extrahepatic malignant complications of chronic HCV infection, including lymphoma. However, recent reports showing the persistent risk for hepatic malignancy in some rare cases, demonstrate that HCV eradication is not the end point and this could be also in line with our cases of extrahepatic non-Hodgkin’s lymphoma.