A Surgical Case of Primary Splenic Malignant Lymphoma Complicating Chronic Hepatitis C

The patient was a 70-year-old man. Hepatic dysfunction was found in 1988 and chronic hepatitis C was diagnosed in 1993. He received interferon-alpha therapy, but did not respond to it. Thereafter, he was treated with ursodeoxycholic acid. In September 2010, abdominal ultrasound showed a hypoechoic tumor (29 × 25 mm) in the lower pole of the spleen, and this lesion became larger one year later (74 × 66 × 71 mm). Abdominal CT revealed a hypovascular heterogeneous tumor with smooth margins on both dynamic and delayed phase scans. MRI displayed a tumor with a low signal intensity on T2WI. Abdominal angiography confirmed that the lesion was hypovascular. 67Ga scintigraphy showed abnormal accumulation confined to the spleen. Bone marrow biopsy did not reveal any abnormalities. Based on these findings, primary splenic malignant lymphoma (PSML) complicating chronic hepatitis C was diagnosed and splenectomy was performed. A tumor (78 × 60 mm) was found in the lower pole of the resected spleen and pathologic examination revealed diffuse large B cell lymphoma (DLBCL). Four courses of postoperative R-CHOP therapy were performed. At present, he continues to use ursodeoxycholic acid with no recurrence after four years. In conclusion, we report our experience of a patient who had PSML complicating chronic hepatitis C with discussion of the literature.