Diffuse large B-cell lymphoma in the splenic hilar lymph node mimicking an intrasplenic lesion

Abstract

Diffuse large B-cell lymphoma (DLBCL) in the splenic hilar lymph node mimicking an intrasplenic lesion is considered rare in the literature. This case is discussed as a form of a primary splenic DLBCL and as a stage I/II abdominal DLBCL. Primary splenic DLBCL was previously defined as a lymphoma confined to the spleen, with or without involvement of the hilar lymph node or distant lesions. However, the condition is not included in the 5^th edition of the World Health Organization classification. In this report, we describe the case of a 63-year-old Japanese male who presented with a 5 cm ¹⁸F-fluorodeoxyglucose-avid mass identified on imaging, presumed to be an intrasplenic mass. Subsequent splenectomy confirmed that the mass was DLBCL originating from the splenic hilar lymph node, distinctly separated from the spleen and the tail of the pancreas. Postoperatively, the patient responded well to treatment comprising three courses of a combined regimen of polatuzumab vedotin, rituximab, cyclophosphamide, daunorubicin, and prednisolone. This case underscores the importance of caution when diagnosing intrasplenic lesions based on imaging, as the lesions may be located outside the spleen.

Keywords

Diffuse large B-cell lymphoma / Splenic hilar lymph node / Non-intrasplenic lymphoma / Positron emission tomography-computed tomography

Acknowledgments

This study was conducted with the support of the medical staff at the Uji Tokushukai Medical Center. The authors thank Professor Kouichi Ohshima, Professor Junji Suzumiya, and Professor Motoko Yamaguchi for their helpful comments on this case.

Funding

None.

Conflict of interest

The authors declare no conflicts of interest.

Author contributions

Conceptualization: Naoyuki Anzai, Yutaka Shimazu, Shinsaku Imashuku

Investigation: Ayaka Fukui, Naoki Nakajima, Shinsaku Imashuku

Writing -original draft: Naoyuki Anzai, Yutaka Shimazu, Shinsaku Imashuku

Writing -review & editing: All authors

Ethics approval and consent to participate

The work was carried out following the Declaration of Helsinki as revised in 2013. This case report was approved by the institutional review board (Uji-Tokushukai Medical Center Ethics Committee; IRB approval No. 2024-45). The patient provided written consent to participate in this study.

Consent for publication

Written informed consent was obtained from the patient.

Availability of data

Data are available upon request from the authors.

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