Splenic lymphoma

P.K. Srivastava, MD

Wed, 20/01/2010

First published on SonoWorld

Case Presentation
A young man presented with a tender mass in the left upper quadrant. An abdominal ultrasound was performed.

Caption: Sagittal view of the spleen | Description: This spleen was enlarged and was very tender. The normal architecture is completely replaced by multiple hypoechoic, predominantly cystic appearing masses.

Caption: Transverse view of the retroperitoneum | Description: Multiple hypoechoic, almost cystic appearing masses representing enlarged nodes are seen in the retroperitoneum.

Caption: Contrast enhanced view of the CT scan | Description: The spleen is markedly enlarged and confirms the ultrasound findings. This image shows a large cystic appearing mass within the spleen.

Differential Diagnosis

Lymphoma, splenic abscess

Final Diagnosis

Hodgkin`s lymphoma

Discussion

Lymphomatous infiltration of the spleen is usually seen as discreet, usually hypoechoic, masses within the spleen. In this rather advanced case, the lymphomatous tissue has essentially replaced the splenic tissue creating a large and complex mass. The presence of enlarged hypoechoic nodes in the area supports the initial impression of lymphonatous infiltration of the spleen.

Follow Up

An ultrasound guided FNA was performed which confirmed the lymphomatous infiltration. The patient subsequently also developed a massive pleural effusion due to lymphomatous pleural deposits.