Contributorship statement
VH and JB undertook conceptualisation of this article. VH and PR drafted
and revised the manuscript. JB undertook critical review of the
manuscript and approved final manuscript for submission.
57-year-old man presented with a 3-month history of fatigue, fever and
increasing abdominal pain. He had completed treatment for follicular
lymphoma and JAK2 positive myeloproliferative disorder 2 months
previously.
Clinical examination revealed abdominal distension consistent with
splenomegaly. Computed tomographic imaging showed extension to the
pelvis and right iliac fossa with mass-effect over the ipsilateral
kidney, stomach, pancreas and small bowel and perisplenic fluid.
White-cell count was 1.5 10*9/L (3.9-10.2 10*9/L), haemoglobin level 75
g/L (135-172g/L), and platelet count 44 10*9/L (150-370 10*9/L).
Bone marrow biopsy showed no evidence of high-grade transformation of
his low-grade B-cell lymphoma, nor extensive involvement by lymphoma or
by fibrosis, and therefore failed to explain the degree of his
splenomegaly.
Post-operative examination found it to be 11.4kg and 44cm in length.
Microscopic examination showed complete replacement with follicular
lymphoma without evidence of myelodysplasia or myeloproliferative
neoplasm. The total anaesthetic time was 4 hours 11 minutes. His
recovery was uneventful and he was discharged on post-operative day 7.
Unfortunately, our patient developed high grade B cell lymphoma and died
as a result of disease progression 3 months later.
This case demonstrates therapeutic and diagnostic rationale for open
splenectomy in massive splenomegaly.