Pathologic splenic rupture in a patient with follicular lymphoma

Abstract

A middle aged man presented with abdominal pain and fever, with progressive dyspnea for the past one week. He had generalized lymphadenopathy with hepatosplenomegaly and a left sided pleural effusion on admission. Further evaluation revealed that he had lymphocytosis on peripheral blood. He then developed increasing abdominal pain and fall in hemoglobin which was confirmed on imaging to be due to a splenic rupture and he underwent a splenectomy. The diagnosis on lymph node biopsy and peripheral blood immunophenotyping was grade 1 follicular lymphoma. He has completed his 6 cycles of chemotherapy (R-CVP) and is on maintenance rituximab and doing well. The case highlights the fact that splenic rupture can even be caused by indolent lymphomas.

Low-Grade Primary Splenic CD10-Positive Small B-Cell Lymphoma/Follicular Lymphoma

“…As such, the disease may be incidentally found during work up for other medical conditions [ 24 ]. However, pathologic splenic rupture due to massive splenomegaly has been described [ 25 ]. Atypical lymphocytosis observed in peripheral blood smears or liver biopsies and/or mild to moderate splenomegaly may be identified incidentally during clinical encounters unrelated to lymphoma work-up in asymptomatic or paucisymptomatic patients.…”

B-cell hepatosplenic lymphoma presenting in adult patient after spontaneous splenic rupture followed by severe persistent hypoglycaemia: type B lactic acidosis and acute liver failure

“…B-cell hepatosplenic lymphoma (BCHSL) is strikingly rare, with only a handful of published cases 11. Splenic rupture is an unusual presenting sign of lymphoma—we only located 29 reported cases12–41 (online supplemental table 1). Given the rarity of BCHSL, it is not surprising that our case is the first report of this lymphoma presenting with splenic rupture and subsequently the Warburg effect.…”