Contemporary insights into dissemination of primary non-Hodgkin's lymphomas of the spleen

Abstract

6675 Background: The aim of current researches was to study the mode and the steps of dissemination of primary splenic non-Hodgkin's lymphomas (NHL) in regard with its histological types. Methods: A representative group of 155 patients (age range 15 - 82 years) with primary NHL of the spleen was analyzed in our study. According to the N.C.I. Working Formulation, low-grade (LG) NHL were identified in 110 (70.9%) cases, and those high-grade (HG) - in 45 (29.1%). Staging was realized by means of conventional physical and X-ray examinations, computerized tomography, ultrasound and nuclear isotope scannings, bone marrow aspiration and biopsy, laparoscopy, exploratory laparotomy with splenectomy and lymph node biopsy. Stage IV disease was diagnosed in 107 (97.3%) patients with LG NHL, and in 38 (84.6%) with HG NHL. Results: LG splenic NHL showed the prevalent bone marrow (BM) involvement (99.1%), which had been the only one site of tumour dissemination in 24.3% of cases. The liver involvement was revealed in 58.3% of patients. The abdominal lymph node (ALN) and the peripheral lymph node (PLN) affection was registered in 40.0% and 30.8% of cases, respectively. The following combinations of the multiple extrasplenic sites of lymphomatous involvement mainly occurred: BM, liver and ALN - 13.3%, those followed by PLN - 11.4%, BM, liver and PLN - 9.6%, BM and ALN - 8.7%. HG splenic NHL demonstrated the predominant ALN (68.3%) and liver (65.8%) involvement. The BM affection (52.6%) proved to be less frequent. The PLN involvement occurred only in 28.9% of cases. The following combinations of the extrasplenic sites of the tumor dissemination mostly were detected: ALN, liver and BM - 15.6%, ALN, PLN and liver - 13.3%, ALN and BM - 11.1%, ALN and liver - 6.7%. Conclusions:In primary LG NHL of the spleen, early hematogenous dissemination in the BM was common, followed by the consecutive liver, ALN and PLN involvement. In primary HG splenic NHL, initial lymphogenous spread in the ALN was typical, with the following successive liver, BM and PLN involvement. The histology-respecting dissemination features of primary splenic NHL should be taken into consideration in the process of diagnosis and treatment. No significant financial relationships to disclose.