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Ratti N, Ly KH, Dumonteil S, François M, Sailler L, Lambert M, Hot A, Gondran G, Palat S, Bezanahary H, Desvaux E, Aslanbekova N, Parreau S, Fauchais AL, Sève P, Liozon E. Recurrent (or episodic) fever of unknown origin (FUO) as a variant subgroup of classical FUO: A French multicentre retrospective study of 170 patients. Clin Med (Lond) 2024; 24:100202. [PMID: 38642612 PMCID: PMC11107460 DOI: 10.1016/j.clinme.2024.100202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 02/23/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Recurrent FUO (fever of unknown origin) is a rare subtype of FUO for which diagnostic procedures are ill-defined and outcome data are lacking. METHODS We performed a retrospective multicentre study of patients with recurrent FUO between 1995 and 2018. By multivariate analysis, we identified epidemiological, clinical and prognostic variables independently associated with final diagnosis and mortality. RESULTS Of 170 patients, 74 (44%) had a final diagnosis. Being ≥ 65 years of age (OR = 5.2; p < 0.001), contributory history (OR = 10.4; p < 0.001), and abnormal clinical examination (OR = 4.0; p = 0.015) independently increased the likelihood of reaching a diagnosis, whereas lymph node and/or spleen enlargement decreased it (OR = 0.2; p = 0.004). The overall prognosis was good; 58% of patients recovered (70% of those with a diagnosis). Twelve (7%) patients died; patients without a diagnosis had a fatality rate of 2%. Being ≥ 65 years of age (OR = 41.3; p < 0.001) and presence of skin signs (OR = 9.5; p = 0.005) significantly increased the risk of death. CONCLUSION This study extends the known yield of recurrent FUO and highlights the importance of repeated complete clinical examinations to discover potential diagnostic clues during follow-up. Moreover, their overall prognosis is excellent.
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Affiliation(s)
- N Ratti
- Departments of Internal Medicine, University Hospitals of Limoges, Dupuytren, France.
| | - K H Ly
- Departments of Internal Medicine, University Hospitals of Limoges, Dupuytren, France
| | - S Dumonteil
- Departments of Internal Medicine, University Hospitals of Limoges, Dupuytren, France
| | - M François
- Departments of Internal Medicine, University Hospitals of Lyon Sud, Pierre-Bénite, France
| | - L Sailler
- Departments of Internal Medicine, University Hospitals of Toulouse, Purpan, France
| | - M Lambert
- Departments of Internal Medicine, University Hospitals of Lille, Claude Huriez, France
| | - A Hot
- Departments of Internal Medicine, University Hospitals of Lyon, Édouard Herriot, France
| | - G Gondran
- Departments of Internal Medicine, University Hospitals of Limoges, Dupuytren, France
| | - S Palat
- Departments of Internal Medicine, University Hospitals of Limoges, Dupuytren, France
| | - H Bezanahary
- Departments of Internal Medicine, University Hospitals of Limoges, Dupuytren, France
| | - E Desvaux
- Departments of Internal Medicine, University Hospitals of Limoges, Dupuytren, France
| | - N Aslanbekova
- Departments of Internal Medicine, University Hospitals of Limoges, Dupuytren, France
| | - S Parreau
- Departments of Internal Medicine, University Hospitals of Limoges, Dupuytren, France
| | - A L Fauchais
- Departments of Internal Medicine, University Hospitals of Limoges, Dupuytren, France
| | - P Sève
- Departments of Internal Medicine, University Hospitals of Lyon, La Croix-Rousse, France
| | - E Liozon
- Departments of Internal Medicine, University Hospitals of Limoges, Dupuytren, France
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Beji H, Bouassida M, Laamiri G, Chelbi E, Nechi S, Touinsi H. Primary splenic lymphoma discovered on massive splenomegaly: A case report. Int J Surg Case Rep 2022; 94:107124. [PMID: 35658295 PMCID: PMC9079000 DOI: 10.1016/j.ijscr.2022.107124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/24/2022] [Accepted: 04/24/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Malignant lymphoma occurs in all the systemic organs. Rarely, large B-cell lymphoma is located in the spleen, making the diagnosis difficult. Herein, we report a patient presenting with massive splenomegaly due to LBCL. Splenectomy was essential to assess the diagnosis and to guide postoperative therapeutics. PRESENTATION OF A CASE A 47-year-old woman, with no comorbidities, complained of weight loss and abdominal pain. She had a palpable spleen that extended below the navel. CT scan revealed massive splenomegaly and lymph nodes in the spleen hilum. Splenectomy was performed. Histopathological examination confirmed the diagnosis of large B-cell lymphoma. The postoperative course was uneventful. Three courses of chemotherapy were given. The patient was in remission after a follow-up of 8 months. DISCUSSION Massive splenomegaly can be one of the circumstances of the discovery of large B-cell lymphoma. Splenectomy was then essential to confirm the diagnosis and to guide postoperative therapeutics. It also permits reducing hypersplenism and preventing spleen rupture. In patients with high operative risk, splenic needle biopsy should be taken into consideration. Splenic artery embolization before surgery can also be performed in patients having massive splenomegaly to reduce the spleen volume. We highlight the importance of splenectomy to confirm the diagnosis and to relieve the symptoms. Postoperative chemotherapy is essential to prevent relapses. CONCLUSION Splenectomy is essential in spleen localized large B-cell lymphoma. It permits to confirm the diagnosis, relieve symptoms, and treatment of underlying hematologic malignancies. Postoperative chemotherapy is essential to prevent relapses.
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Affiliation(s)
- Hazem Beji
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia.
| | - Mahdi Bouassida
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Ghazi Laamiri
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Emna Chelbi
- University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia; Department of Pathology, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia
| | - Salwa Nechi
- University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia; Department of Pathology, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia
| | - Hassen Touinsi
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
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Diagnostic Splenectomy: Characteristics, Pre-Operative Investigations, and Identified Pathologies for 20 Patients. J Clin Med 2021; 10:jcm10071519. [PMID: 33917291 PMCID: PMC8038722 DOI: 10.3390/jcm10071519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 11/16/2022] Open
Abstract
Splenectomy is indicated in cases of trauma to the spleen or hematological and immunological diseases (hereditary spherocytosis, autoimmune cytopenia). Less frequently, splenectomy is performed for diagnostic purposes to complement unsuccessful prior etiological investigations. The splenectomy remains a surgery at risk of complications and should be considered as a last-resort procedure to make the diagnosis and to be able to treat patients. We studied the medical files of 142 patients who underwent a splenectomy for any reason over a 10-year period and identified 20 diagnostic splenectomies. Diagnostic splenectomies were mainly performed to explore unexplained splenomegaly for 13 patients and fever of unknown origin for 10. The other patients had surgery for other causes (cytopenia, abdominal symptoms, suspicion of relapsing malignant hemopathies). Splenectomy contributed to the final diagnosis in 19 of 20 cases, corresponding mostly to lymphoid hemopathies (14/20). The most frequent disease was diffuse large B-cell lymphoma (8/20). Splenectomy did not reveal any infectious disease. The most relevant pre-operative procedures to aid the diagnosis were 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) and immuno-hematological examinations. Diagnostic splenectomy is useful and necessary in certain difficult diagnostic situations. Highlights: Diagnostic splenectomy is still useful in 2020 to diagnose unexplained splenomegaly or fever of unknown origin. Lymphoma was the most common final diagnosis. FDG PET/CT was the most useful tool to aid in the diagnosis.
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4
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Niiya F, Takano Y, Azami T, Kobayashi T, Maruoka N, Kabasawa N, Harada H, Norose T, Ohike N, Nagahama M. Usefulness of endoscopic ultrasound-guided fine needle aspiration for splenic parenchyma in patients suspected of having primary splenic malignant lymphoma. Endosc Int Open 2021; 9:E96-E101. [PMID: 33403241 PMCID: PMC7775802 DOI: 10.1055/a-1287-9577] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/18/2020] [Indexed: 11/10/2022] Open
Abstract
Background and study aims The diagnosis of malignant lymphoma (ML) is sometimes difficult, especially in patients with primary splenic malignant lymphomas (psML) which have no lymph nodes capable of acting as the biopsy target. We carried out endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for "splenic parenchyma" in patients suspected of having a psML, even without any obvious neoplastic lesions in the spleen. Patients and methods A retrospective study using medical records was conducted of eight patients suspected of having a psML that received EUS-FNA for the splenic parenchyma between January 2016 and January 2019. Data analyzed included clinical background, EUS-FNA procedure (puncture needle/route), diagnostic ability (pathological/flow cytometry [FCM]), and complications. Results EUS-FNA was performed from the stomach in all eight cases, and no patients had complications. As a result of splenic parenchymal biopsy found on EUS-FNA, 75 % of patients (6/8) were histologically diagnosed with MLs, monoclonality of B-cells was identified in all cases (8/8) with FCM, and all patients (8/8) were definitively diagnosed with psMLs. Conclusion EUS-FNA for "splenic parenchyma" is useful for patients with spML, even if they have no obvious neoplastic lesions in the spleen.
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Affiliation(s)
- Fumitaka Niiya
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Yuichi Takano
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Tetsushi Azami
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Takahiro Kobayashi
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Naotaka Maruoka
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Nobuyuki Kabasawa
- Department of Hematology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Hiroshi Harada
- Department of Hematology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Tomoko Norose
- Department of Diagnostic Pathology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa Japan
| | - Nobuyuki Ohike
- Department of Diagnostic Pathology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa Japan
| | - Masatsugu Nagahama
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
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Djokic M, Plesnik B, Petric M, Trotovsek B. Massive splenomegaly due to B-cell lymphoma: A case report. Int J Surg Case Rep 2018; 48:76-78. [PMID: 29885916 PMCID: PMC6041427 DOI: 10.1016/j.ijscr.2018.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 05/17/2018] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Massive splenomegaly is indicated by spleen weight exceeding 1000 g and largest spleen dimension greater than 20 cm Poulin et al. (1998). In many cases, splenectomy is the treatment of choice for massive splenomegaly because it releases the pressure on adjacent organs and also provides a definitive histopathological diagnosis of the underlying cause Iriyama et al. (2010), Radhakrishnan (2018). PRESENTATION OF CASE Herein we present a clinical case of disseminated diffuse large B - cell lymphoma, clinical stage IV, with massive splenomegaly. A 53 - year old man complaining of unintentional major weight loss, palpable abdominal mass in the left hemiabdomen and cervical lymphadenopathy, was admited to Department of abdominal surgery, UMC Ljubljana. Abdominal CT scan showed massive spleen, enlarged retroperitoneal and upper mediastinal lymph nodes and cervical lymphadenopathy. Splenectomy was performed and spleen was sent on histological analysis. Operation and postoperative course were uneventful. Spleen specimen weighed 5034 g (6% of patient body weight) and measured 33 × 24 × 10 cm. Histological and immunohistochemical analysis set the diagnosis of diffuse large B - cell lymphoma. Patients received 5 cycluses of R-CHOP chemotherapy and 2 cycluses of prophylactic intrathecal chemotherapy postoperatively. DISCUSSION Splenomegaly in combination with weight loss and malaise is very suggestive of underlying neoplastic condition and therefore requires further diagnostic investigations Han et al. (2008). Splenectomy in combination with adjuvant chemotherapy is the treatment of choice in case of spleen infiltration rith tumorous cells of B-cell lymphoma. However there are other possibilities in diagnosing and treatment of massive splenomegaly, including percutaneous image guided splenic needle biopsy and splenic artery embolisation prior to splenectomy. CONCLUSION Our aim with this case report is to present splenectomy in conjuction with chemotherapy as a safe option of treatment for massive splenomegaly due to B-cell lymphoma infiltration.
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Affiliation(s)
- M Djokic
- Department of Abdominal Surgery, University Medical Center Ljubljana, Zaloška Cesta 7, 1000 Ljubljana, Slovenia.
| | - B Plesnik
- Department of Abdominal Surgery, University Medical Center Ljubljana, Zaloška Cesta 7, 1000 Ljubljana, Slovenia.
| | - M Petric
- Department of Abdominal Surgery, University Medical Center Ljubljana, Zaloška Cesta 7, 1000 Ljubljana, Slovenia.
| | - B Trotovsek
- Department of Abdominal Surgery, University Medical Center Ljubljana, Zaloška Cesta 7, 1000 Ljubljana, Slovenia.
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Zhang L, Zhang W, Cai H, Cao X, Chen M, Li J, Zhu T, Duan M, Wang S, Han B, Zhou D. Patients with Fever of Unknown Origin and Splenomegaly: Diagnostic Value of Splenectomy and Preoperative Risk Factors Suggestive of Underlying Lymphomas. Acta Haematol 2017; 137:240-246. [PMID: 28586777 DOI: 10.1159/000473859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 03/30/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND We reviewed patients with fever of unknown origin (FUO) and splenomegaly and assessed the diagnostic value of splenectomy and measured risk factors suggestive of an underlying lymphoma. METHODS FUO patients (n = 83) who had splenomegaly and underwent splenectomy were enrolled into this retrospective single-center study. Clinical presentations were documented and risk factors suggestive of an underlying lymphoma were tested. RESULTS Seventy-four patients (89.2%) had a diagnosis of lymphoma or not after splenectomy and follow-up. Of those (55.4%) diagnosed with lymphoma, 29 had B-cell non-Hodgkin lymphoma and 12 had T-cell non-Hodgkin lymphoma. The remaining 33 (44.6%) had diseases other than lymphoma. Using multivariate logistic analysis, the following 3 independent risk factors were found to be related to a final diagnosis of lymphoma: age (continuous) (HR 1.086; 95% CI 1.033-1.141; p = 0.001), massively enlarged spleen (HR 7.797; 95% CI 1.267-47.959; p = 0.027), and enlarged intra-abdominal lymph nodes (HR 63.925; 95% CI 7.962-513.219; p < 0.001). The calibration of the model was satisfactory (p = 0.248 using the Hosmer-Lemeshow test), and the discrimination power was good (area under the receiver operating characteristic curve 0.925; 95% CI 0.863-0.987). CONCLUSIONS Splenectomy is an effective diagnostic procedure for patients with FUO and splenomegaly and lymphoma is a common cause. Older age, a massively enlarged spleen, and enlarged intra-abdominal lymph nodes are risk factors suggesting an underlying lymphoma, and surgery for high-risk patients should be considered.
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Affiliation(s)
- Lu Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Sun PG, Cheng B, Wang JF, He P. Fever of unknown origin revealed to be primary splenic lymphoma: A rare case report with review of the literature. Mol Clin Oncol 2016; 6:177-181. [PMID: 28357088 DOI: 10.3892/mco.2016.1110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 10/13/2016] [Indexed: 12/30/2022] Open
Abstract
Fever is a common clinical presentation of a number of diseases. A sustained unexplained fever >38.3°C lasting for >3 weeks without an established diagnosis despite intensive diagnostic evaluation is referred to as fever of unknown origin (FUO). FUO remains a clinical challenge for physicians, as it may be attributed to a wide range of disorders, mainly infections, malignancies, non-infectious inflammatory diseases and miscellaneous diseases. We herein report the case of a 59-year-old male patient who presented with prolonged unexplained fever and was found to have a diffusely enlarged hypermetabolic spleen, as shown on 18F-fluorodeoxyglucose positron emission tomography/computed tomography examination. Following splenectomy, histopathological examination revealed primary splenic lymphoma (PSL) of B-cell origin. The patient received 6 courses of systemic chemotherapy with rituximab, etoposide, cyclophosphamide, doxorubicin, vincristine and prednisone (R-ECHOP regimen) and responded well to treatment. Thus, in patients with FUO and splenomegaly, the possibility of PSL should be taken into consideration.
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Affiliation(s)
- Pan-Ge Sun
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Bei Cheng
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Jin-Feng Wang
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Ping He
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
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8
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Handlogten KS, Anderson BW, Mohabbat AB. 72-Year-Old Man With Fever and Malaise. Mayo Clin Proc 2015; 90:e69-73. [PMID: 26141341 DOI: 10.1016/j.mayocp.2014.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 12/05/2014] [Accepted: 12/10/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Kathryn S Handlogten
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Rochester, MN
| | - Bradley W Anderson
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Rochester, MN
| | - Arya B Mohabbat
- Advisor to residents and Consultant in General Internal Medicine, Mayo Clinic, Rochester, MN.
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9
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Sioka C, Assimakopoulos A, Fotopoulos A. The diagnostic role of (18)F fluorodeoxyglucose positron emission tomography in patients with fever of unknown origin. Eur J Clin Invest 2015; 45:601-8. [PMID: 25823953 DOI: 10.1111/eci.12439] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 03/21/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Identification of aetiology for fever of unknown origin (FUO) is challenging, due to the high rates of undiagnosed cases. The current diagnostic approach includes initially first-line procedures such as general examination and various laboratory tests and basic imaging techniques followed by second-line tests such as more advanced imaging techniques including (18)F fluorodeoxyglucose positron emission tomography (FDG PET) and tissue biopsies. If no diagnosis is obtained, more invasive measures may be in order such as liver biopsy and exploratory laparotomy. MATERIALS AND METHODS This review article is based on the relative published material found on MEDLINE and PubMed up to August 2014. We looked for the terms 'fever of unknown origin, FDG PET' in combination with 'cancer, infection and autoimmune disease'. RESULTS Several clinical studies have investigated the utility of the FDG PET during the diagnostic approach of FUO. Recent evidence suggests that FDG PET has the advantage of total body imaging and may depict all common causes of FUO such as infections, noninfectious inflammatory causes and tumours because they all exhibit glucose hypermetabolism. Depiction of an abnormal lesion on FDG PET could guide clinicians to the next diagnostic procedure (another imaging method, culture, biopsy or surgery) to establish the diagnosis. CONCLUSIONS Emerging evidence suggests that FDG PET, when available, may provide critical diagnostic information early during evaluation of FUO.
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Affiliation(s)
- Chrissa Sioka
- Neurosurgical Research Institute, University of Ioannina, Ioannina, Greece.,Department of Nuclear Medicine, University of Ioannina, Ioannina, Greece
| | | | - Andreas Fotopoulos
- Department of Nuclear Medicine, University of Ioannina, Ioannina, Greece
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Ingle SB, Ingle CRH. Splenic lymphoma with massive splenomegaly: Case report with review of literature. World J Clin Cases 2014; 2:478-81. [PMID: 25232555 PMCID: PMC4163774 DOI: 10.12998/wjcc.v2.i9478] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 06/10/2014] [Accepted: 06/27/2014] [Indexed: 02/05/2023] Open
Abstract
As per strict criteria of Das Gupta et al, primary splenic lymphoma is very rare. Herein, we are reporting an unusual case of primary large cell splenic lymphoma of B lineage in a middle aged female presenting with massive splenomegaly (3.8 kg) and hypersplenism. After performing therapeutic splenectomy for hypersplenism, a precise diagnosis of diffuse large B cell lymphoma was made on histopathology and confirmed by immunohistochemistry. The patient responded well to standard (Cyclophosphamide, Hydroxydaunorubicin, Oncovin (vincristine), Prednisone or prednisolone) regimen last year and is now in full remission. The splenectomy thereby has prevented the potential grave complications related to hypersplenism and splenic rupture. Our aim behind highlighting the topic is to specify that emergency splenectomy followed by anticoagulation therapy is an effective plan of management to prevent untoward complications related to disease and treatment.
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Affiliation(s)
- Sachin B Ingle
- Sachin B Ingle, Department of Pathology, MIMSR Medical College, Latur, Maharashtra 4132512, India
| | - Chitra R Hinge Ingle
- Sachin B Ingle, Department of Pathology, MIMSR Medical College, Latur, Maharashtra 4132512, India
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11
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Ingle SB, Ingle CRH. Splenic lymphoma with massive splenomegaly: Case report with review of literature. World J Clin Cases 2014; 2:478-481. [DOI: 10.12998/wjcc.v2.i9.478] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 06/27/2014] [Indexed: 02/05/2023] Open
Abstract
As per strict criteria of Das Gupta et al, primary splenic lymphoma is very rare. Herein, we are reporting an unusual case of primary large cell splenic lymphoma of B lineage in a middle aged female presenting with massive splenomegaly (3.8 kg) and hypersplenism. After performing therapeutic splenectomy for hypersplenism, a precise diagnosis of diffuse large B cell lymphoma was made on histopathology and confirmed by immunohistochemistry. The patient responded well to standard (Cyclophosphamide, Hydroxydaunorubicin, Oncovin (vincristine), Prednisone or prednisolone) regimen last year and is now in full remission. The splenectomy thereby has prevented the potential grave complications related to hypersplenism and splenic rupture. Our aim behind highlighting the topic is to specify that emergency splenectomy followed by anticoagulation therapy is an effective plan of management to prevent untoward complications related to disease and treatment.
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12
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Kim HI, Kim SW, Chang HH, Lee JM, Kim NS, Kwon KT, Ryu SY, Hur JA. Causes and Risk Factors of Mortality in Adult Patients with Hemophagocytic Syndrome. Infect Chemother 2012. [DOI: 10.3947/ic.2012.44.2.51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Hye-In Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Shin-Woo Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyun-Ha Chang
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jong-Myung Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Neung-Su Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ki-Tae Kwon
- Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Seong-Yeol Ryu
- Department of Internal Medicine, Keimyung University Dongsan Medical Centers, Daegu, Korea
| | - Ji-An Hur
- Department of Internal Medicine, Yeungnam University Hospital, Daegu, Korea
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13
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Iriyama N, Horikoshi A, Hatta Y, Kobayashi Y, Sawada S, Takeuchi J. Localized, splenic, diffuse large B-cell lymphoma presenting with hypersplenism: risk and benefit of splenectomy. Intern Med 2010; 49:1027-30. [PMID: 20519821 DOI: 10.2169/internalmedicine.49.3228] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Herein we report a case of a localized, massive, diffuse large B-cell splenic lymphoma diagnosed by splenectomy. A 57-year-old man complaining of weight loss and abdominal pain, was admitted to our hospital. Enhanced computed tomography scanning showed an irregularly enhanced effect in the spleen suggesting a diffuse splenic tumor. Splenectomy was done and the operation progressed without severe complications. The resected spleen weighed 3,500 g. After the operation, the patient recovered from the pancytopenia and pathology diagnosed diffuse large B-cell lymphoma. Standard CHOP plus rituximab chemotherapy was given. Complete remission has continued for 30 months.
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Affiliation(s)
- Noriyoshi Iriyama
- Department of Internal Medicine, Nihon University School of Medicine, Nerima-Hikarigaoka Hospital, Tokyo, Japan.
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