Although the spleen is frequently involved in disseminated non-Hodgkin's lymphoma (NHL), splenic presentation as the initial or only site of disease is uncommon. Treatment modalities include surgery, chemotherapy, and radiation therapy. The priority of cancer follow up is to perform surveillance for recurrent cancer and evaluation of treatment response. Side effects of treatment are frequently missed or overlooked. A 66-year-old woman was presented to our hospital with a month history of spleen enlargement. On physical examination the spleen was palpated at Schuffner 2. Abdominal MSCT scan was suggestive of lymphoma. Surgery revealed adhesion and obstruction of the stomach. Biopsy and gastrojejunostomy shunting were done, but splenectomy was difficult. The pathology anatomy findings confirmed the diagnosis of diffuse non Hodgkin's lymphoma large B-cell type. Immunohistochemistry showed positive CD3 and CD20. She underwent 6 cycles of rituximab, cyclophosphamide, adriamycin, vincristine, and prednisolone (RCHOP) chemotherapy. CT evaluation done 7 months later revealed that the hilus lienalis lymph nodes and spleen has decrease in size. However, a lumbosacral x-ray done due to back pain revealed metastasis on her 1 st and 2 nd lumbal spine. After a single fraction of radiotherapy, nausea, vomiting and abdominal distension occurred. A 3 position abdominal x-ray revealed signs of small bowel obstruction. After surgery she has received 9 cycles of zoledronic acid and remained in good condition and ambulatory. Splenic presentation as the initial or only site of non-Hodgkin's lymphoma (NHL) is uncommon. Acute small bowel obstruction and fistula due to palliative radiation therapy for bone metastasis needs prompt and appropriate treatment.
ABSTRAKMeskipun lien sering terlibat pada limfoma non-Hodgkin diseminata, keterlibatan lien sebagai awal penyakit atau satu-satunya organ yang terkena adalah jarang. Modalitas terapi meliputi pembedahan, kemoterapi, dan terapi radiasi. Prioritas follow up kanker adalah untuk melakukan surveilans pada kanker yang rekuren dan evaluasi respon terapi. Efek samping terapi seringkali tidak dikenali atau terlewat. Seorang wanita usia 66 tahun datang ke RS Sardjito dengan riwayat pembesaran lien sejak 1 bulan. Pada pemeriksaan palpasi didapatkan pembesaran lien sebesar Schuffner 2. MSCT scan abdomen dicurigai suatu limfoma. Pada saat pembedahan didapatkan obstruksi perut dengan pelekatan. Dilakukan biopsi dan shunt gastrojejunostomy, namun sulit dilakukan splenektomi. Pemeriksaan patologi anatomi mengkonfirmasi diagnosis limfoma non-Hodgkin tipe large J Med Sci, Volume 48, No. 3, 2016 July: 175-183 176 B-cell difus. Imunohistokimia menunjukkan CD3 dan CD20 positif. Pasien menjalani 6 siklus kemoterapi dengan rituximab, siklofosfamid, adriamycin, vincristine, dan prednisolon (RCHOP). Evaluasi CT 7 bulan kemudian menunjukkan bahwa pembesaran limfonodi hillus lienalis dan lien berkurang. Namun demikian, foto x-ray lumbosakral yang dilakukan karena keluhan nyeri pinggang menunjukkan ad...