Successful diagnosis of primary splenic diffuse large B-cell lymphoma by percutaneous splenic biopsy using a core-needle in a patient with rapid progressive splenomegaly: a case report

Abstract

Background: Primary splenic lymphoma has been reported as a rare subtype of non-Hodgkin lymphoma. The common presentations are splenomegaly and splenic mass and this malignancy is extremely rare to diagnose from splenic infarction. Case presentation: A 47-year-old Thai female presented acute abdominal pain for 1 week and fever with thrombocytopenia for 2 days. Her fever failed to respond to antibiotics, and she continued to experience constant high grade fever with abdominal pain. She was followed up by physical examination, and developed progressive splenomegaly 5 cm below the left costal margin. Her serological workups for endemic tropical infections and microbiological results were all negative. A bone marrow study did not reveal an aggregation of lymphoid cells. A contrast abdominal computed tomography was repeated; although it did not detect any lymphadenopathies or masses; it found progressive hepatosplenomegaly and splenic infarction. To make a differential diagnosis between splenic infarction and splenic collection, an ultrasound guided percutaneous splenic biopsy was performed. Histological analysis of the splenic biopsy revealed few small aggregates and infiltration of large atypical lymphoid cells with mild degree of nuclear pleomorphism. The nuclei are hyperchromatic with scant cytoplasm and an irregular nuclear outline. Mitotic figures are frequently observed. The red pulps are congested with a focal infarct area. The focal aggregates of atypical lymphoid cells-CD20(+), CD3(-), cyclin D1(-), CD10(-), BCL6(-), and MUM1(+)-with Ki-67 show high activity in more than 80% of tumor cells. This finding was consistent with diffuse large B-cell lymphoma, nongerminal center subtype. Conclusion: In patients with progressive splenomegaly and splenic infarction, Carrying out a differential diagnosis of aggressive lymphomas would be important. In addition to splenectomy, a percutaneous fine needle biopsy of the spleen can help make a definite diagnosis of primary splenic lymphoma.