A CASE OF HAIRY CELL LEUKEMIA PRESENTING WITH A SPLENOMA WHICH OFFERED DIFFICULTY IN DIAGNOSIS

Abstract

A 52-year-old woman was seen at the hospital for close examination, because she was pointed out having a splenoma at a nearby hospital when she visited there complaining of abdominal distention. There were no fever, anemia, and jaundice. No superficial lymph nodes were palpated. In the abdomen the spleen extending from an area under the left costal arch to the infraumbilical area was palpated. Abdominal CT and echography revealed a giant splenoma with homogenous internal structure. The liver had no morphological abnormalities nor tumor shadow. No lymph node swelling was also shown. There were no hepatitis nor abnormal findings in peripheral blood (white blood cell fraction), blood biochemical tests, tumor markers, neutrophilic Al-p value, and bone marrow picture. No causative disease for the splenoma was able to be determined preoperatively, and a possibility of lymphoma arising in the spleen or leukemia was not ruled out. So, splenectomy was performed in order to diagnose and to alleviated the symptoms. The excised spleen was 1, 860 g in weight and 24.3×14.7×5.8cm in size. Pathologically it was diagnosed as hairy cell leukemia. This disease is uncommonly encountered, but we should entertain it as a probable differential diagnosis for giant splenoma. This paper presents this case with a review of the literature.