Postmortem diagnosis of intravascular large B-cell lymphoma after atraumatic splenic rupture due to splenic infiltration

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  • KUROKI Wataru
    Department of Hematology, Nephrology and Rheumatology, Akita University Graduate School of Medicine
  • KOBAYASHI Takahiro
    Department of Hematology, Nephrology and Rheumatology, Akita University Graduate School of Medicine
  • UMAKOSHI Michinobu
    Department of Cellular and Organ Pathology, Akita University Graduate School of Medicine
  • KITADATE Akihiro
    Department of Hematology, Nephrology and Rheumatology, Akita University Graduate School of Medicine
  • IMAIZUMI Chihiro
    Department of Hematology, Nephrology and Rheumatology, Akita University Graduate School of Medicine
  • SAITO Masaya
    Department of Hematology, Nephrology and Rheumatology, Akita University Graduate School of Medicine
  • KOBAYASHI Isuzu
    Department of Hematology, Nephrology and Rheumatology, Akita University Graduate School of Medicine
  • FUJISHIMA Masumi
    Department of Hematology, Nephrology and Rheumatology, Akita University Graduate School of Medicine
  • FUJISHIMA Naohito
    Department of Hematology, Nephrology and Rheumatology, Akita University Graduate School of Medicine
  • YOSHIOKA Tomoko
    Department of Hematology, Nephrology and Rheumatology, Akita University Graduate School of Medicine
  • GOTO Akiteru
    Department of Cellular and Organ Pathology, Akita University Graduate School of Medicine
  • TAKAHASHI Naoto
    Department of Hematology, Nephrology and Rheumatology, Akita University Graduate School of Medicine

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Other Title
  • 脾臓浸潤による非外傷性脾破裂をきたし剖検で確定診断した血管内大細胞型B細胞リンパ腫
  • ヒゾウ シンジュン ニ ヨル ヒガイショウセイヒハレツ オ キタシ ボウケン デ カクテイ シンダン シタ ケッカン ナイ ダイ サイボウガタ Bサイボウ リンパシュ

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Abstract

<p>Atraumatic splenic rupture (ASR) is a rare but fatal complication of malignant lymphoma. However, only one case of intravascular large B-cell lymphoma (IVLBCL)-related ASR (IVLBCL-ASR) has previously been reported, and the mechanism of IVLBCL-ASR is unknown. We present the case of a 78-year-old man who died unexpectedly and was diagnosed with IVLBCL-ASR pathologically by autopsy. A massive intraperitoneal hemorrhage and four lacerations on the splenic surface were discovered during the autopsy. CD20-positive lymphoma cells that infiltrated into small vessels were highly concentrated in the center of the spleen and were only slightly distributed in the lacerations on the splenic surface. Therefore, increased intrasplenic pressure due to lymphoma cell proliferation was identified as the cause of ASR. The patient had undergone 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for tongue cancer evaluation 3 months earlier, and positive uptake was found in the right adrenal gland, where lymphoma cell infiltration was confirmed by the autopsy. Our findings suggest that clinicians should be aware that the advanced stage of IVLBCL can cause fatal ASR via increased intrasplenic pressure. Therefore, early diagnosis and early treatment intervention are desirable to prevent the onset of IVLBCL-ASR, and 18F-FDG PET/CT is useful for the early diagnosis of IVLBCL.</p>

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 63 (6), 523-529, 2022

    The Japanese Society of Hematology

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