Three cases of diffuse large B-cell lymphoma presenting as primary splenic lymphoma

Abstract

Primary splenic lymphoma (PSL) is often defined as generalized lymphoma with splenic involvement as the dominant feature. It is a rare disease that comprises approximately 1% of all malignant lymphomas. We investigated three cases of non-Hodgkin's splenic lymphoma that had different clinical features on presentation. The patients' survival times from diagnosis ranged from 59 to 143 months, without evidence of relapse after splenectomy and chemotherapy, with or without radiotherapy. This data suggest that PSL is potentially curable. Further studies are needed to evaluate the impact that different treatment modalities without splenectomy have on patient survival.

Fig. 1

Computed tomography (CT) scans of each case. A) Case 1- a huge splenic mass with homogenous high-density areas, including an area of low-density without perisplenic spread. B) Case 2- a well-localized and capsulated splenic mass with internal necrosis or hemorrhage and partial bulging of the pancreatic tail portion at the junctional lesion with spleen. C) Case 3- a heterogeneous, lobulated splenic mass measuring 10×8×8 cm with bulging contours, necrotic foci and focal calcification.

Fig. 2

Gross examination of the resected spleen of Case 1. The exposed cut surface shows a bulging, well-demarcated grayish-yellow nodular solid mass, measuring 12 cm in the largest dimension. Multifocal grayish-yellow necrotic foci are present. The splenic parenchyma is nearly replaced by this lesion.

Fig. 3

Histopathologic findings of Case 1. A) Mass border on low power (×100) showing an expanding growth pattern of tumor cells. B) Mass on high power (×400) showing non-Hodgkin's lymphoma, diffuse large B-cell type. Tumor cells have large nuclei, open chromatin, and prominent nucleoli. C) Immunohistochemical stain for L26 (B-cell marker) (×200) showing prominent immunopositivity to the tumor cells.