A peculiar case of splenic marginal zone lymphoma and review of literature.

Abstract

INTRODUCTION The term splenic marginal zone lymphoma (SMZL) was first coined by Schmid and colleagues in 1992 who used it to describe four cases of primary low grade B cell lymphomas of the spleen with distinct clinical, morphological and immunophenotypic features (1). It is now clear that SMZL and splenic lymphoma with villous lymphocytes (SLVL) have the same pathologic features but different expressions of circulating cells (2,3). After the recognition of an unusual intrasinusoidal bone marrow infiltration definitive diagnosis can be made by bone marrow biopsy alone (4), avoiding an unnecessary splenectomy (5). CASE REPORT A 44-year-old educated lady presented in outdoor clinic with complaints progressive fatigue and dragging sensation in the abdomen over several months and fever for 20 days. Physical examination revealed a febrile condition, moderately severe pallor, marked splenomegaly extending up to the left iliac fossa and mild hepatomegaly – 3 cm below the right costal margin. During follow up in OPD, the patient was found to have fluctuating splenomegaly as documented on clinical and ultrasonographic examination during routine follow up of the patient. This was further confirmed by computerized tomography (CT) scan. Complete blood count examination (CBC) showed that the patient had hemoglobin of 6.8 g/dl, total leukocyte count of 2400 cell/μl with 55% neutrophils, 50% lymphocytes, 2% monocytes, 3% eosinophils and platelet count of 28,000 cell/μl. Peripheral blood smear showed moderate normocytic normochromic anemia and CBC findings were validated.