Gastrosplenic fistula occurring in lymphoma patients: Systematic review with a new case of extranodal NK/T-cell lymphoma

Abstract

AIMTo provide the overall spectrum of gastrosplenic fistula (GSF) occurring in lymphomas through a systematic review including a patient at our hospital.METHODSA comprehensive literature search was performed in the MEDLINE database to identify studies of GSF occurring in lymphomas. A computerized search of our institutional database was also performed. In all cases, we analyzed the clinicopathologic/radiologic features, treatment and outcome of GSF occurring in lymphomas.RESULTSA literature search identified 25 relevant studies with 26 patients. Our institutional data search added 1 patient. Systematic review of the total 27 cases revealed that GSF occurred mainly in diffuse, large B-cell lymphoma (n = 23), but also in diffuse, histiocytic lymphoma (n = 1), Hodgkin’s lymphoma (n = 2), and NK/T-cell lymphoma (n = 1, our patient). The common clinical presentations are constitutional symptoms (n = 20) and abdominal pain (n = 17), although acute gastrointestinal bleeding (n = 6) and infection symptoms due to splenic abscess (n = 3) are also noted. In all patients, computed tomography scanning was very helpful for diagnosing GSF and for evaluating the lymphoma extent. GSF could occur either post-chemotherapy (n = 10) or spontaneously (n = 17). Surgical resection has been the most common treatment. Once patients have recovered from the acute illness status after undergoing surgery, their long-term outcome has been favorable.CONCLUSIONThis systematic review provides an overview of GSF occurring in lymphomas, and will be helpful in making physicians aware of this rare disease entity.

Gastrosplenic Fistula and Coeliac Artery Occlusion

“…It has been postulated that GSF develops from the invasion of malignant tissue from the stomach to the spleen or vice versa, and subsequent necrosis of this tissue results in fistula formation [3]. This case demonstrates that the invasion of an adjacent organ may not be necessary; necrosis itself can cause erosion that ultimately results in fistula formation.…”

“…Frenkel et al reported a median age of 55 years for patients with GSF, and they were predominantly male, at approximately 80% [2]. The most common presentations for GSF are abdominal pain and constitutional symptoms such as fever, weight loss and fatigue [2,3]. Acute upper gastrointestinal (GI) bleed was reported only in less than a quarter of the patients; however, if it occurs, it can be life-threatening.…”

“…It can originate from splenic lymphoma, gastric lymphoma or even extensive lymphoma involving both spleen and stomach [2,3]. There were cases reported to show association with sleeve gastrectomy, Crohn's disease and splenic abscess [2][3][4]. Idiopathic spontaneous GSF has also been described in a 16-yearold boy [5].…”

“…It is most commonly described to be related to lymphoma, particularly diffuse large B-cell lymphoma (DLBCL). Other aetiologies such as splenic abscess, trauma, bariatric surgery and Crohn's disease have been reported to cause GSF [2][3][4]. We present a case of a gastrosplenic fistula resulting from occlusion of the coeliac artery.…”

Nasal NK/T cell lymphoma mimicking mucosa‑associated lymphoid tissue lymphoma in morphology: A case report

“…Asian and indigenous populations of Mexico, central and south of American have the highest incidence rates for this disease, which is associated with Epstein Barr virus infection (1,2). The nose is a common site for the development of this type of lymphoma; however, it can also develop in the skin, digestive tract, testis and lung (3,4). Histologically, classical extranodal NK/T cell lymphoma includes the following morphological features: Neoplastic cells infiltrate diffusely, often invading and destroying the vascular wall, accompanied by massive tissue necrosis.…”