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Meng M, Riera CA, Mosquera J, Parikh HR, Singh A. Atypical diffuse large B-cell lymphoma, primary splenic lymphoma variant; a case report. Int J Surg Case Rep 2023; 111:108861. [PMID: 37769409 PMCID: PMC10539923 DOI: 10.1016/j.ijscr.2023.108861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Primary splenic lymphoma (PSL) is characterized by lymphoma involvement confined to the spleen and hilar lymph nodes, without evidence of liver involvement or other sites. This condition is extremely uncommon, accounting for approximately 1 % of non- Hodgkin lymphomas (NHLs) and <2 % of all lymphomas. Diffuse large B-cell lymphoma (DLBCL) is the most common histological subtype of both PSLs and all NHLs. DLBCL encompasses an aggressive heterogeneous entity with distinct morphological variants. CASE PRESENTATION A 68 year-old gentleman presented to the office with a 10-month history of vague left sided upper abdominal pain. Clinical examination revealed a tender left upper quadrant, evidenced with splenomegaly on radiological evaluation. The patient proceeded with a splenectomy with subsequent pathological and immunohistochemical analysis, confirming a final diagnosis of germinal center type DLBCL. CLINICAL DISCUSSION Primary splenic DLBCL is a rare variant of DLBCL, characterized by exclusive involvement of the spleen. It requires a comprehensive diagnostic evaluation to exclude lymphoma involvement in other organs and lymph nodes. Splenectomy followed by appropriate adjuvant therapy has been demonstrated as the definitive treatment strategy. This case report emphasizes the importance of considering primary splenic DLBCL as a differential diagnosis in patients presenting with splenomegaly and highlights the significance of multidisciplinary collaboration for accurate diagnosis and optimal management of this uncommon entity. CONCLUSION Primary Splenic DLBCL, an exceptionally rare B-Cell neoplasm variant, requires precise diagnosis due to its unique splenic involvement. Splenectomy's efficacy, adjuvant therapy, multidisciplinary collaboration, and ongoing research are crucial for optimal management.
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Affiliation(s)
- Muzi Meng
- General Surgery, BronxCare Health System, Bronx, NY, USA; School of Medicine, American University of the Caribbean, Cupecoy, St. Maarten, the Netherlands
| | - Cesar A Riera
- General Surgery, BronxCare Health System, Bronx, NY, USA.
| | - Jorge Mosquera
- General Surgery, BronxCare Health System, Bronx, NY, USA
| | - Harsh R Parikh
- General Surgery, BronxCare Health System, Bronx, NY, USA; School of Medicine, St. George's University, Grenada
| | - Ajit Singh
- General Surgery, BronxCare Health System, Bronx, NY, USA
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Pirzada S, Hasnain A, Mankani AA, Zahid I. Primary Splenic Diffuse Large B-cell Lymphoma: An Atypical Presentation. Cureus 2023; 15:e40793. [PMID: 37485157 PMCID: PMC10362782 DOI: 10.7759/cureus.40793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 07/25/2023] Open
Abstract
Primary splenic diffuse large B-cell lymphoma (PS-DLBCL) is an extremely rare type of non-Hodgkin's lymphoma. It typically presents with abdominal pain and a rapidly enlarging mass, often accompanied by B symptoms. Here, we present a rare presentation of PS-DLBCL in a 54-year-old woman who experienced splenomegaly. A CT scan of her abdomen revealed an enlarged spleen measuring 12 x 15 x 14 cm with a hypodense lesion. Confirmation of diffuse large B-cell lymphoma was obtained through a splenic core biopsy. A subsequent positron emission tomography scan showed a large hypermetabolic and centrally necrotic infiltrative splenic mass without any evidence of pathology in other parts of the body. The patient's condition was classified as stage I PS-DLBCL, and she underwent treatment with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy for four cycles. This case report highlights the unique presentation of diffuse large B-cell lymphoma with exclusive involvement of the spleen and discusses the potential therapeutic role of radiation therapy and R-CHOP without the need for splenectomy.
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Affiliation(s)
| | - Amana Hasnain
- Internal Medicine, Trinity Health Livonia, Livonia, USA
| | - Ali Abbas Mankani
- Internal Medicine, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, PAK
| | - Ibrahim Zahid
- Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, USA
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Muacevic A, Adler JR, Farkouh CS, Tango T, Bereka L, Ul Ain H, Belay NF, Farkouh M, Ali Khan Q. The Diagnostic Dilemma of Splenic Non-Hodgkin's Lymphoma and Splenic Abscess: A Narrative Review. Cureus 2022; 14:e31944. [PMID: 36582581 PMCID: PMC9794911 DOI: 10.7759/cureus.31944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2022] [Indexed: 11/29/2022] Open
Abstract
Non-Hodgkin's lymphoma (NHL) is a lymphoproliferative disorder that principally displays lymph node involvement but can also spread to extranodal sites such as the spleen. Primary splenic NHL arises in the spleen and, due to its atypical presentation, can sometimes present similarly to other splenic conditions. This review aims to highlight how primary splenic NHL can be effectively differentiated from other splenic conditions, such as splenic abscesses. PubMed, MEDLINE, Scopus, Google, and Google Scholar were used to identify articles mainly focused on splenic non-Hodgkin's lymphoma and splenic abscess. The search was limited to articles published from January 2005 to November 2022. Of the 229 total articles amassed, only 34 were selected and narratively reviewed. From a thorough review of the current literature, it is evident that splenic NHL displays a similar clinical picture to other splenic conditions, namely splenic abscesses. One cannot easily differentiate between the two conditions, both clinically and via diagnostic imaging. Lymphadenopathy, a hallmark sign of nodal NHL, may or may not be present in splenic NHL. Ultimately, splenectomy with biopsy and immunohistochemical staining (IHC) may be required to confirm the diagnosis. In cases of suspected splenic NHL or splenic abscess with little-to-no symptomatic improvement after medication administration, splenectomy followed by histopathological examination may be required for a definitive diagnosis and proper treatment.
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Calcified Splenic Lesions: Pattern Recognition Approach on CT With Pathologic Correlation. AJR Am J Roentgenol 2020; 214:1083-1091. [PMID: 32208005 DOI: 10.2214/ajr.19.22246] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE. Incidental splenic lesions, often found on CT images of the abdomen, may often be ignored or mischaracterized. Calcified splenic lesions are often presumed to be granulomas; however, understanding the broader differential diagnostic considerations can be useful. CONCLUSION. Determining the cause of splenic lesions is essential to guide appropriate management; the pattern of calcification together with other imaging and clinical findings can aid with differentiation.
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Ricci ZJ, Kaul B, Stein MW, Chernyak V, Rozenblit AM, Oh SK, Flusberg M, Mazzariol FS. Improving diagnosis of atraumatic splenic lesions, Part III: malignant lesions. Clin Imaging 2016; 40:846-55. [DOI: 10.1016/j.clinimag.2016.02.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 01/26/2016] [Accepted: 02/17/2016] [Indexed: 12/18/2022]
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Lu YY, Liao JB, Wu CS, Hong CH. Pityriasis lichenoids chronica as a paraneoplastic dermatosis for primary splenic diffuse large B cell lymphoma. Indian J Hematol Blood Transfus 2014; 30:246-9. [PMID: 25332590 DOI: 10.1007/s12288-014-0344-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 01/15/2014] [Indexed: 11/29/2022] Open
Abstract
Paraneoplastic dermatosis is defined as both benign skin lesions and internal malignancy existing at the same time with parallel clinical courses. Herein, we report a 91-year-old male who presented as pityriasis lichenoids chronica (PLC) concomitantly with a primary splenic diffuse large B cell lymphoma. Surgical removal of the spleen cleared his skin lesions dramatically. However, seven months later, the splenic lymphoma relapsed in concordance with the recurrence of the skin lesions of PLC. To our knowledge, he is the first case that PLC is the leading presentation and paraneoplastic manifestation of primary splenic large B-cell lymphoma.
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Affiliation(s)
- Ying-Yi Lu
- Department of Dermatology, Kaohsiung Veterans General Hospital, No. 386 Ta-Chung 1st Rd, Kaohsiung City, 81362 Taiwan
| | - Jia-Bin Liao
- Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chieh-Shan Wu
- Department of Dermatology, Kaohsiung Veterans General Hospital, No. 386 Ta-Chung 1st Rd, Kaohsiung City, 81362 Taiwan
| | - Chien-Hui Hong
- Department of Dermatology, Kaohsiung Veterans General Hospital, No. 386 Ta-Chung 1st Rd, Kaohsiung City, 81362 Taiwan ; School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Li M, Zhang L, Wu N, Huang W, Lv N. Imaging findings of primary splenic lymphoma: a review of 17 cases in which diagnosis was made at splenectomy. PLoS One 2013; 8:e80264. [PMID: 24278265 PMCID: PMC3837000 DOI: 10.1371/journal.pone.0080264] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 10/11/2013] [Indexed: 12/22/2022] Open
Abstract
Purpose This study sought to characterize the imaging features of primary splenic lymphoma (PSL). Materials and Methods Pathological and imaging data from 17 patients with primary splenic lymphoma initially diagnosed at splenectomy were retrospectively analyzed. Pretreatment computed tomography (CT) imaging was available for 16 patients, and magnetic resonance imaging (MRI) data were available for 4 patients. Splenic lymphoma imaging data were categorized based on the gross pathological presentation in the following manner: type 1, homogeneous enlargement; type 2, miliary nodules; type 3, multifocal masses of varying size; and type 4, solitary large mass. Results Of the 17 patients with PSL, 16 cases were non-Hodgkin lymphoma, and of these, 9 cases were diffuse large B cell lymphomas (DLBCL) and 4 cases were splenic marginal zone B-cell lymphoma (SMZL). Imaging showed the following types of PSL presentation: 1 case of type 1, 0 cases of type 2, 4 cases of type 3, and 12 cases of type 4. There was evidence of necrosis in 12 cases (70.6%), and there was evidence of mild enhancement in enhanced CT in 14 cases and in enhanced MRI in 3 cases. Prior to surgery, PSL was considered possible in 8 patients. Conclusion The most frequent histological subtype was DLBCL, followed by SMZL. In both CT and MRI, PSL generally presents as a solitary mass or masses rather than as splenomegaly. In addition, necrosis and mild enhancement are commonly observed, and splenectomy may be required to confirm the diagnosis.
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Affiliation(s)
- Meng Li
- Department of Diagnostic Radiology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Li Zhang
- Department of Diagnostic Radiology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Ning Wu
- Department of Diagnostic Radiology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
- PET-CT Center, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
- * E-mail:
| | - Wenting Huang
- Department of Pathology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Ning Lv
- Department of Pathology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Sánchez Sobrino P, Fernández Vázquez P, Páramo Fernández C, Rivera Gallego A. [Vitamin D producer primary splenic lymphoma: an exceptional cause of hypercalcemia]. Med Clin (Barc) 2013; 141:137-8. [PMID: 23245530 DOI: 10.1016/j.medcli.2012.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Revised: 10/03/2012] [Accepted: 10/04/2012] [Indexed: 10/27/2022]
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Abstract
Diffuse large B cell lymphoma of the spleen is a form of splenic lymphoma, a rare primary neoplasm of the spleen. The clinical presentation is nausea, fatigue, weight loss, and other nonspecific symptoms. The most often seen laboratory finding is anemia. The first sonographic findings are typically splenomegaly and a well-defined hypoechoic mass. Most cases are treated with splenectomies. If the malignancy is confined to the spleen, the prognosis is favorable, but metastasis beyond the spleen is associated with a poor outcome. This case presents a classic case of diffuse large B cell splenic lymphoma with extension into the hilar lymph nodes.
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Konstantiadou I, Mastoraki A, Papanikolaou IS, Sakorafas G, Safioleas M. Surgical approach of primary splenic lymphoma: report of a case and review of the literature. Indian J Hematol Blood Transfus 2009; 25:120-4. [PMID: 23100989 DOI: 10.1007/s12288-009-0025-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2009] [Accepted: 08/19/2009] [Indexed: 12/27/2022] Open
Abstract
A 80-year-old woman was hospitalized due to anemia and fever. Computed tomography depicted a solitary concentric, sharply marginated lesion of the spleen. Laparotomy identified a creamy-white soft tumor. Histopathological examination confirmed the diagnosis of non-Hodgkin B-cells anaplastic lymphoma. Extended range of pathological manifestations explains the variety of radiological appearances and difficulty in accurate diagnostic process of primary splenic lymphoma.
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Affiliation(s)
- Ioanna Konstantiadou
- Department of Surgery, Athens University, Medical School, Attikon University Hospital, 1 Rimini Street, 12462 Chaidari, Athens, Greece
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