Surgical approach of primary splenic lymphoma: report of a case and review of the literature

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 identifi ed a creamy-white soft tumor. Histopathological examination confi rmed the diagnosis of non-Hodgkin B-cells anaplastic lymphoma. Extended range of pathological manifestations explains the variety of radiological appearances and diffi culty in accurate diagnostic process of primary splenic lymphoma.

Primary Splenic Lymphoma: A Case Report

“…In our report, the patient was symptomatic at presentation. Ahmann [11] classified the gross appearance of PSL into four categories namely homogenous enlargement without masses, miliary masses, 2-10 cm neoplasms and large solitary tumors [4]. In our case, there was a large solitary tumor occupying almost 3/4th of the spleen.…”

“…Primary splenic lymphoma has been described both in context of Hodgkin's and Non-Hodgkin's lymphoma. The Non-Hodgkin's type consists of an extra-nodal biologically virulent cancer [4].…”

“…Although majority of them are hypoechoic, rare echogenic lesions or bright echoes due to calcifications or gas may be detected. Anechoic areas generally suggest liquefactive necrosis and in the presence of fever, it may be difficult to distinguish from splenic abscess [4]. Rim enhancement may rarely be encountered indicating pseudocapsule formation or adjacent compressed parenchyma [4].…”

“…Post-treatment differentiation of residual disease or relapse from either fibrosis or necrosis can be accomplished using whole body F-deoxyglucose (FDG) positron emission tomography (PET) [4]. Malignant diseases most commonly involving the spleen are principally F 18 -FDG avid diseases, including lymphoma and metastases from malignant melanoma, lung cancer, ovarian cancer, and gastrointestinal malignancies.…”

“…Core biopsy, obtained with a 21 or 22 gauge needle or even laparoscopically, has also been used successfully for histological identification of PSL subtype [4]. Ultrasound (US) guided fine-needle aspiration biopsy or cytologic examination has been shown to be useful in the diagnosis of splenic involvement by lymphoma.…”