Clinicopathological analysis of primary splenic diffuse large B‐cell lymphoma

Abstract

Splenic infiltration is often seen in diffuse large B-cell lymphoma (DLBCL). However, primary splenic DLBCL is rare and studies on its clinicopathological features are limited. We assessed 66 cases of primary splenic DLBCL and 309 control DLBCL, not otherwise specified. Hepatitis C virus antibody prevalence, B symptoms, poor performance status and CD5 positivity differed significantly between the primary splenic DLBCL and control DLBCL groups. Primary splenic DLBCL cases were classified histopathologically into two groups [white pulp pattern (n = 46), red pulp pattern (n = 20)]. Survival analysis showed no difference in overall survival between the primary splenic DLBCL and the control group, but the former had a more favourable progression-free survival. In the examination of primary splenic DLBCL, the white pulp pattern was statistically associated with a lower performance status (2-4), and a lower CD5 positivity than the red pulp pattern. In the survival analysis, the red pulp pattern demonstrated poorer overall survival. Multivariate analysis of overall survival in primary splenic DLBCL cases identified CD5 positivity as an indicator of poor prognosis. Classifying primary splenic DLBCL into white and red pulp patterns was useful in terms of clinicopathological features and overall survival.

Diagnostic and therapeutic splenectomy for splenic lymphomas: analysis of the National Cancer Data Base

“…Although OS and progressionfree survival (PFS) appeared better after splenectomy in stage I/II lymphoma, this observation is confounded by lack of adjustment for guarantee-time bias. In another case series of 66 splenic DLBCL diagnosed by splenectomy, 87% were treated with chemotherapy, but outcomes without chemotherapy were not reported [15]. Our results indicate that up to 29% of splenectomized patients with DLBCL may not receive chemotherapy, which was associated with worse survival, though we could not discern the reasons for omitting chemotherapy.…”

“…Despite clinical advances, it is unknown to what extent the use of diagnostic or therapeutic splenectomy has changed in the community, whether these trends vary by histology, or are paralleled by changes in the application of chemotherapy. Most contemporary series are limited to patients with SMZL or primary splenic DLBCL [12][13][14][15]. In contrast, there is paucity of data on less common histologies, except case reports and small case series [16][17][18][19].…”

Diagnosis of intravascular large B cell lymphoma: novel insights into clinicopathological features from 42 patients at a single institution over 20 years

“…However, the diagnosis of IVLBCL by bone marrow biopsy alone is often problematic (Kajiura et al, 2007;Das et al, 2011), because the bone marrow sinusoids blend seamlessly with other haematopoietic tissues. In addition, the difference between bone marrow involvement of splenic DLBCL (Morice et al, 2005;Ponzoni & Ferreri, 2006;Iannitto & Tripodo, 2011;Shimono et al, 2017) and primary bone marrow DLBCL (Martinez et al, 2012) is not clearly defined. Splenic involvement has been traditionally determined by the enlargement of non-functioning imaging studies, such as CT or abdominal ultrasound.…”

Acute pancreatitis as an unusual presentation of primary splenic lymphoma

“…Within extranodal DLBCL sites, the haematological system has been associated with better prognosis than liver/pancreas 7. Compared with DLBCL of other locations, primary splenic DLBCL showed more frequency of bone marrow infiltration, B symptoms and progression-free survival despite no difference in overall survival 4. Low-intermediate risk in the international prognostic index had a 5-year survival of 51% 5.…”