Diffuse large cell (Histiocytic) lymphoma of the spleen: Clinical and pathologic characteristics of ten cases

Abstract

Ten patients with diffuse large cell (histiocytic) lymphoma of the spleen had a characteristic clinical presentation and pathologic findings. Patients presented with left upper quadrant pain, fever, weight loss, and an elevated sedimentation rate. Imaging studies revealed an enlarged spleen with a discrete mass in all cases. Moderate to massive splenomegaly (average weight, 1025 g) was found at laparotomy; a single large mass or multiple confluent nodules with extensive central necrosis replaced 85% to 90% of the parenchyma. The tumor transgressed the splenic capsule in nine of ten cases, and either invaded or was adherent to the diaphragm, stomach, pancreas, or abdominal wall. Lymph nodes in the splenic hilum or retroperitoneum were frequently involved. Seven patients were in Ann Arbor Stage II, and three were in Stage I. Eight of the ten lymphomas were subclassified as centroblastic (large noncleaved cell) and two were immunoblastic. The B‐cell lineage of six tumors was established by the presence of monoclonal immunoglobulin. Despite combination chemotherapy, with or without radiation, three of the seven patients whose follow‐up was adequate died in less than 2 years; four are alive at 7, 12, 12, and 81 months, respectively, the last two with recurrent lymphoma. Large cell lymphoma of the spleen is a likely diagnosis in patients who present with left upper quadrant pain, fever, and radiographic evidence of a splenic mass.

Diffuse large B-cell lymphoma with distinctive patterns of splenic and bone marrow involvement: clinicopathologic features of two cases

“…When splenic involvement by LBCL occurs, it classically forms discrete tumor nodules within the parenchyma, although isolated descriptions of LBCL with diffuse red pulp involvement have appeared in the literature. 2,10,11 A recent report of 33 splenic LBCL described three distinct patterns of lymphomatous infiltration: macronodular (or tumoral, 20 cases), micronodular (or miliary, nine cases), and diffuse (four cases). 3 The diffuse pattern, which was the least common, described cases of LBCL with involvement of the red pulp cords and sinusoids, similar to the pattern observed in this report.…”

“…1 Typically when diffuse LBCL involves the spleen it forms discrete tumoral masses within the splenic parenchyma. 2 A recent report detailed other less common patterns of splenic involvement by LBCL including diffuse infiltration of the splenic red pulp. 3 The clinicopathologic features of diffuse LBCL with these unusual patterns of splenic involvement have yet to be fully elucidated.…”

Primary splenic diffuse large B-cell lymphoma manifesting in red pulp

“…Primary splenic DLBCL is a rare type of lymphoma. The majority of the DLBCLs are derived from the white pulp of the spleen and form one large, or multiple nodules [2]. Before the advent of immunohistological examination, the absence of mass formation and the diffuse infiltration of large neoplastic cells into the red pulp might have been diagnosed as malignant histiocytosis [3].…”

Análise de achados de imagem e alterações clínicas em pacientes com linfoma

“…Na casuística de Thomas et al (8) , grande massa solitária esplênica foi o achado mais comum em pacientes com LNH, e no nosso trabalho o achado mais relevante foi a esplenomegalia homogênea, na maioria em pacientes com LH. Além disso, 16,6% dos pacientes deste estudo que tinham diagnóstico de LNH estavam com esplenomegalia, porcentagem bem abaixo da relatada por Harris et al (7) , que foi de 30%. Outro achado que discordou de outros autores (9) foi a timomegalia, relatada em 30% dos pacientes com linfoma, enquanto o presente trabalho revelou este achado em apenas um paciente com LH (3,3%).…”