Primary Splenic Lymphoma Mimicking Splenic Abscess - Unusual Presentation of a Rare Malignancy

A 58 year old male presented with pain in left hypochondrium and weight loss of 2 months duration. There was no associated co-morbidity. Physical examination revealed pallor and splenomegaly (4cm below the costal margin). He was afebrile and there was no lymphadenopathy or hepatomegaly. CT scan of Abdomen (FIGURE 1,2) showed peripherally enhancing fluid density lesion in the spleen with perisplenic fat stranding, left pleural effusion, mass effect on left kidney, pancreatic tail and left adrenal, exophytic area adherent to the pancreatic tail - suggestive of possible infected collection in spleen/necrotic neoplasm. His serum Lactate Dehydrogenase (LDH) was raised to 1610 units/litre. He underwent elective splenectomy after receiving appropriate pre splenectomy vaccines. Intraoperatively, there was grossly enlarged spleen, which was adherent to undersurface of the diaphragm, pancreatic tail, and fundus of stomach. The spleen was resected en-bloc with part of undersurface of diaphragm. Distal pancreatectomy and resection of adherent proximal fundus of stomach was performed. Histopathology showed sheets of large centroblastic like lymphoid cells - Non Hodgkins Lymphoma of diffuse large B cell lymphoma phenotype. The tumor cells expressed CD20 and were immunonegative for CD3. Proximal stomach, diaphragm and pancreatic tail were involved by NHL, but all resection margins were free. A liver biopsy specimen was normal. Bone marrow aspiration and biopsy did not reveal any evidence of lymphoma