A 74-year-old woman presented with a 3-month history of progressive weakness, 5-kg weight loss, and pain in the right upper abdominal quadrant. On physical examination, there was splenomegaly without lymphadenopathy and no other remarkable findings. Laboratory tests revealed a hematocrit of 0.38, a white blood cell count of 5.5 × 109/L, a platelet count of 226 × 109/L, a lactate dehydrogenase level of 1468 U/L, an erythrocyte sedimentation rate of 71 mm/h, and a β2-microglobulin level of 4.6 mg/L (normal range, 0.8-2.1 mg/L). Ultrasonography and computed tomography (CT) of the abdomen demonstrated a solid, large splenic mass with lobulated margins without other abnormalities. Magnetic resonance imaging (MRI) showed a splenic mass 12 cm in diameter with isointensity relative to normal splenic parenchyma in T2-weighted sequences, with heterogeneous enhancement after injection of gadolinium (Figure 1). Magnetic resonance imaging also disclosed local invasion of diaphragmatic and pleural surfaces (Figure 1, B, arrow), which was not demonstrated on ultrasonograms or CT scans. The histopathologic diagnosis was diffuse large B cell lymphoma. The result of bone marrow biopsy was normal.
Calvo-Romero JM. Magnetic Resonance Imaging in Primary Lymphoma of the Spleen. Arch Intern Med. 2000;160(11):1706–1707. doi:
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