| History :
A 49-year-old female developed late afternoon fever, general malaise,
and abdominal fullness in these 3 months.
Questions :
1. What are the findings?
2. What is the differential diagnosis?
3. What is the final diagnosis?
Answers:
1. A huge heterogeneous density tumor in the spleen. There is no
clear interface between the mass and the stomach, pancreatic tail.
A small well defined heterogeneous tumor in the right kidney. Marked
lymphadenopathy in the celiac trunk, para-aortic, and mesenteric
region.
2. lymphoma, gastric or splenic malignancy with metastatic lymphadenopathy
and metastasis to right kidney.
3. Lymphoma
Discussion :
Lymphoma-spleen involved in 70%
(Hodgkin disease, non-Hodgkin lymphoma, primary splenic lymphoma)
splenomegaly in non-Hodgkin lymphoma indicates involvement in most
patients
30% of patients with splenomegaly have no involvement from non-Hodgkin
lymphoma
30% of patients with lymphoma of any kind have splenic involvement
without splenomegaly
-homogeneous splenomegaly (from diffuse infiltration)
-miliary nodules
-large 2-10 cm nodules (10-25%)
-nodes in splenic hilum (50%) in NHL; uncommon in Hodgkin disease
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