Malignant lymphoma diagnosed at splenectomy and idiopathic splenomegaly.A clinicopathologic comparison

The clinical, laboratory, and histopathologic findings in 15 cases of malignant lymphoma presenting as splenomegaly and diagnosed at splenectomy were compared with 10 cases of idiopathic splenomegaly. The ages of the patients, the duration of splenomegaly, the hematologic parameters, and the weights of the spleen were similar in the two groups of patients. None of the 15 patients with malignant lymphoma initially diagnosed at splenectomy was considered cured: 8 died with disseminated disease within 2 years, 2 have survived for longer than 3 years with progression to chronic lymphosarcoma cell leukemia, and 5 have been followed for less than 12 months. Idiopathic splenomegaly, an apparently benign inflammatory lesion, may simulate lymphoma clinically and be confused with nodular lymphoma pathologically, particularly when associated with lymphocytic infiltrates of the liver and bone marrow and atypical lymphocytes in the peripheral blood. Splenectomy is indicated in patients with persistent splenomegaly without known contributing or related disease, and care must be exercised in the pathologic distinction between splenic lymphoma and idiopathic splenomegaly.