[Hepatosplenic T-cell lymphoma with pancytopenia and massive splenomegaly]

A 71-year-old woman was found to have pancytopenia during a routine health check-up and was referred to a local hospital. Bone marrow examination did not yield a definitive diagnosis, and the cytopenia gradually progressed over the following two years. She was subsequently referred to our institution for further evaluation, including assessment of eligibility for hematopoietic stem cell transplantation. ¹⁸F-Fluorodeoxyglucose positron emission tomography (¹⁸F-FDG PET/CT) revealed massive splenomegaly without abnormal FDG uptake. Given the concurrent infection suspected to be fungal pneumonia, a splenectomy was performed for diagnostic and therapeutic purposes. Histopathological examination of the resected spleen, together with T-cell receptor gene rearrangement analysis, led to a diagnosis of hepatosplenic T-cell lymphoma (HSTCL). Following splenectomy, hematologic recovery was achieved rapidly, and CHOP chemotherapy was administered. The patient has remained in remission for approximately one year without evidence of relapse. Although HSTCL generally has a poor prognosis, this case is notable in that splenectomy both established the diagnosis and led to marked improvement in pancytopenia.