Pathologic rupture of the spleen in hematologic malignancies: two additional cases

Abstract

Pathologic rupture of the spleen in hematologic malignancies is rare. We present two cases of splenic rupture which occurred in a man with a secondary high-grade non-Hodgkin's lymphoma and a woman with chronic lymphocytic leukemia (CLL). In a review of the literature, we have been able to identify 136 cases of pathologic splenic rupture since 1861; 34% have occurred in acute leukemias, 34% in non-Hodgkin's lymphomas, and 18% in chronic myelogenous leukemia (CML). We find a male-to-female ratio of 3:1, with considerable differences for the specific diseases encountered. Pathologic rupture of the spleen has happened almost exclusively in adults and the ruptured spleens are generally moderately to severely enlarged. It seems that, apart from splenic infiltration by a hematologic disease, splenic infarcts and coagulation disorders (which have previously been advanced as the most important pathophysiologic factors leading to rupture), male sex, adulthood, severe splenomegaly, and cytoreductive chemotherapy may increase the risk for pathologic splenic rupture. We briefly discuss symptoms preceding the event, diagnostic possibilities, and the outcome with operative and conservative approaches.

Case Report–Spontaneous Splenic Rupture–A Rare Complication of Haematological Malignancies

“…34% have occurred in acute leukaemia, 34% in non Hodgkin's lymphoma and 18% in chronic myelogenous leukaemia. They find male: female ratio of 3:1 with considerable differences for the specific diseases encountered [5].…”

“…Pathological rupture of spleen has happened almost exclusively in adults and ruptured spleen are generally moderate to severely enlarged [5].…”

Spontaneous splenic rupture in an acute leukemia patient with splenic tuberculosis: A case report

“…The physical examination was unremarkable. The peripheral blood smear revealed pancytopenia [hemoglobin (HGB) level of 83 g/l, white blood cell (WBC) count of 2.92x10 9 /l and platelet (PLT) count of 61x10 9 /l], with 22% blasts. Certain blast cells included Auer rods.…”

“…An abdominal and pelvic CT scan revealed no hepatosplenomegaly. The patient was empirically treated with broad-spectrum antibiotics (imipenem and cilastatin sodium for injection, After the second course of chemotherapy, the peripheral blood smear revealed a WBC count of 4.84x10 9 /l with a small number of immature WBCs, an HGB level of 106 g/l and a PLT count of 335x10 9 /l. On repeat bone marrow biopsy, dry tap aspiration, focal granulopoietic progenitors and abnormal localization of immature precursors were observed.…”

Bone Infarcts in a Case of Chronic Myeloid Leukemia: Chronic Phase

“…Although thrombocytosis is common, thrombosis is not seen [2]. Other rare manifestations include splenic rupture [4] and priapism [5]. The radiological changes studied in CML include diffuse osteoporosis, focal osteolytic and osteoblastic lesions, chloromas and arthritis [6].…”