Abstract
Primary splenic diffuse large B-cell lymphoma (DLBCL) is a rare clinical condition, which is generally treated by six to eight cycles of chemotherapy involving a combination of rituximab and the cyclophosphamide, adriamycin, vincristine, and prednisolone (CHOP) regimen. However, the treatment for chemorefractory primary splenic DLBCL remains controversial. Therapeutic splenic irradiation (SI) might be a reasonable and possibly the only treatment option with curative intention for patients with chemorefractory primary splenic DLBCL. However, the efficacy and safety of therapeutic SI are unclear. Herein, we present the case of a primary splenic DLBCL patient who was refractory to multiple chemotherapy regimens but achieved complete remission after administration of therapeutic SI. However, his condition was complicated with severe gastric variceal bleeding due to splenic venous thrombosis, which was successfully treated via splenectomy and short gastric vein ligation. On the basis of our findings, we concluded that the splenic venous thrombosis-induced gastric variceal bleeding was a rare but life-threatening adverse effect of the therapeutic SI administered for primary splenic DLBCL. Surgical intervention involving splenectomy and short gastric vein ligation is mandatory and should be performed as soon as possible for such patients.
Highlights
Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin’s lymphoma, accounting for approximately 30% of cases [1]
A combination of rituximab (R) and the cyclophosphamide, adriamycin, vincristine, and prednisolone (CHOP) regimen has become the standard treatment for DLBCL because it greatly improves the outcome of patients with this disease, especially of young patients in the low-risk group [2]
Complete remission was achieved using therapeutic splenic irradiation (SI). His condition was complicated with severe gastric variceal bleeding due to splenic venous thrombosis (SVT), which was successfully treated via splenectomy and short gastric vein ligation
Summary
Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin’s lymphoma, accounting for approximately 30% of cases [1]. Abdominal computed tomography showed the presence of a large mass over his spleen and adjacent lymph nodes (Figure 1). The patient underwent six cycles of chemotherapy with the R-CHOP regimen; positron emission tomography (PET) and computed tomography detected a residual tumor over the spleen after therapy completion. Salvage chemotherapy involving two cycles of etoposide, cisplatin, methylprednisolone, and cytarabine (ESHAP) regimen was administered, but a residual tumor was still detected over his spleen via PET and computed tomography one month after the last ESHAP treatment. Upper gastrointestinal endoscopy showed large gastric varices (GVs) with a red color sign (Figure 2) but the ultrasonography could not detect the splenic vein, which indicated the presence of SVT. Pathological examination of the dissected spleen showed extensive necrosis, an organizing thrombus in the splenic vein, and no viable tumor cells. The GVs regressed completely, and the patient has been in complete remission for more than one year
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