A Case of Ruptured Splenic Malignant Lymphoma

Abstract

A 59-year-old male patient was admitted to the emergency room with the chief complaint of left hypochondriac pain. Abdominal CT revealed an irregular mass in the spleen and fluid accumulation around the mass, on the hepatic surface, and in the pelvis, which was thought to be blood. Based on these findings, we made the diagnosis of intra-abdominal hemorrhage due to a ruptured splenic mass. A primary splenic lymphoma was suspected based on the elevated soluble IL-2 receptor level in the serum. A splenectomy was performed for diagnostic and therapeutic purposes. Intraoperative exploration revealed a tear in the splenic membrane, consistent with the diagnosis of a splenic mass, the presumptive cause of the hemorrhage. A pancreatic fistula observed postoperatively improved with conservative treatment. The patient was discharged on postoperative day 21. Histopathological examination of the resected specimen led to the diagnosis of diffuse large B-cell lymphoma (DLBCL) of splenic origin. Currently, 16 months after the operation, CMR (complete metabolic response) is maintained. Splenogenic malignant lymphoma presenting with non-traumatic splenic rupture is very rare. When a splenic tumor is recognized as the cause of non-traumatic splenic rupture, diagnostic splenectomy should be aggressively considered in anticipation of postoperative chemotherapy.