Abstract:

Diagnostic criteria for extranodal lymphoma (non-Hodgkin's lymphoma) are well known and described in the literature. However, primary extranodal lymphomas are rare and pose problems for differential diagnosis with primary or secondary lesions.

In the presented clinical case of a woman, 58 years old, with primary extranodal lymphoma of the stomach and spleen, an incorrect preoperative diagnosis was made: a tumor of the stomach and spleen abscess. It was mainly due to the presence of pain in the epigastric region and hospitalization for "severe acute biliary pancreatitis" in anamnesisd. Similar complaints and a "blurry" picture of manifestations of lymphoma did not allow her to be suspected preoperatively. The tumor nature of the focal lesion of the stomach was not in doubt, while the underestimation of MRI data, combined with the anamnesis, led to the erroneous diagnosis o f" spleen abscess". Patient underwent surgical operation: extended combined gastrectomy, distal resection of pancreas, splenectomy “en-bloc”, lymphadenectomy, cholecystectomy, “Roux-Y" reconstruction.

The clinical picture of extranodal lymphoma depends on its primary localization and the degree of its spread. Clinical manifestations of primary lymphoma of the stomach and spleen are often non­specific, therefore, against the background of previously transferred diseases of the hepatopancreatobiliary zone and their residual manifestations, an erroneous assessment of the situation is possible. In the presence of focal lesions, it is advisable to be more attentive to results of radiology examination, which can provide comprehensive information about their nature.

References

1.     WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Swerdlow S.H., Campo E., Harris N.L., Jaffe E.S., Pileri S.A., Stein H., Thiele J. (Eds). Revised 4th edition. Lyon: IARC Press, 2017; 585.

2.     Manzella A, Borba-Filho P, D'Ippolito G, Farias M. Abdominal manifestations of lymphoma: spectrum of imaging features. ISRN Radiol. 2013; 2013: 483069.

http://doi.org/10.5402/2013/483069

3.     Lee W-K, Lau EWF, Duddalwar VA, et al. Abdominal manifestations of extranodal lymphoma: spectrum of imaging findings. American Journal of Roentgenology. 2008; 191(1): 198-206.

http://doi.org/10.2214/AJR.07.3146

4.     FSBI «National Medical Research Center of Oncology named after N.N. Blokhin »of the Ministry of Health of Russia Diagnostics and treatment. Types of diseases. Lymphomas, (date of access 08.07.20) [In Russ.].

https://www.ronc.ru/grown/treatment/diseases/limfomy/

5.     Psyrri A, Papageorgiou S, Economopoulos T. Primary extranodal lymphomas of stomach: clinical presentation, diagnostic pitfalls and management. Annals of Oncology. 2008; 19(12): 1992-1999.

http://doi.org/10.1093/annonc/mdn525

6.     Ghai S, Pattison J, Ghai S et al. Primary gastrointestinal lymphoma: spectrum of imaging findings with pathologic correlation. Radiographics. 2007; 27(5): 1371-1388.

http://doi.org/10.1148/rg.275065151

7.     Juarez-Salcedo LM, Sokol L, Chavez JC, Dalia S. Primary Gastric Lymphoma, Epidemiology, Clinical Diagnosis, and Treatment. Cancer Control. 2018; 25(1): 1073274818778256.

http://doi.org/10.1177/1073274818778256

8.     NORD: National Organization for Rare Disorders. Rare Disease Database. Primary Gastric Lymphoma. Luh JY Nabavizadeh N, Thomas CR. Jr., (date of access 20.07.2020).

https://rarediseases.org/rare-diseases/primary-qastric-lymphoma

9.     De Jong PA, Van Ufford HMQ, Baarslag H-J et al. CT and 18F-FDG PET for noninvasive detection of splenic involvement in patients with malignant lymphoma. American Journal of Roentgenology. 2009; 192(3): 745-753.

http://doi.org/10.2214/AJR.08.1160

10.   Ingle SB, Hinge CR. Primary splenic lymphoma: Current diagnostic trends. World J Clin Cases. 2016 December 16; 4(12): 385-389.

http://doi.org/10.12998/wjcc.v4.i12.385

11.   Dobrovolskiene L, Balukeviciute J, Maksimaitiene J. Virskinimo trakto limfomu radiologine diagnostika [Radiographic diagnosis of gastrointestinal lymphoma]. Medicina(Kaunas). 2002; 38(2):165-171.

12.   Chien SH, Liu CJ, Hu YW, et al. Frequency of surveillance computed tomography in non-Hodgkin lymphoma and the risk of secondary primary malignancies: A nationwide population-based study. Int J Cancer. 2015 Aug 1; 137(3): 658-665.

http://doi.org/10.1002/ijc.29433

13.   Chernobai TN, Golovko TS. Radiation diagnosis of extranodal lymphomas. Clinical oncology. 2017; 4(28): 73-76 (date of access 8.07.2020) [In Ukr.].

https://www.clinicaloncology.com.ua/article/19925/luchevaya-diagnostika-ekstranodalnyx-limfom

14.   Frampas E. Lymphomas: Basic points that radiologists should know. Diagnostic and Interventional Imaging. February 2013; 94(2): 131-144.

http://doi.org/10.1016/j.diii.2012.11.006

Abstract:

We have developed and assessed effectiveness of principles of planning a trajectory for the fine-needle aspiration biopsy of splenic focal lesions due to data of three-dimensional imaging. It is shown that the choice of fine-needle puncture trajectory for access of splenic focal lesions due to three-dimensional data allows to reach optimum combination of security, and informativeness of aspiration biopsy.

Reference 

1.       Karaguljan S.R., Grzhimoloyskij A.V., Danishjan K.I. Hirurgicheskie dostupyk selezenke [Surgical access to the spleen]. Amnaby hirurgichsskoj gepatologii. 2006; 11(2): 92-99 [In Russ].

2.       Greschus S., Hackstein N., Puille M.F., Discher T., Rau WS. Extensive abdominal splenosis: imaging features. Abdom. Imaging. 2003; 28(6): 866-7.

3.       Usol'cevJu. K. Atipichnaja rezekcija selezenki. Diss. . k.m.n. [Atypical resection of the spleen]. Irkutsk. 1998: 129 [In Russ].

4.       Harnas S.S., Lotov A.N., Kondrashin S.A. Lecheniepacientov s neparazitarny mikistami selezenki. [Treatment of patients with non-parasitic cysts of the spleen]. Annaly hirurgicheskoj gepatologii. 2008; 13( 2): 36-43 [In Russ].

5.       Napoli A., Catalano C., Silecchia G., Fabiano P., Fraioli F., Pediconi F., Venditti F., Basso N.,Passariello R. Laparoscopic splenectomy: multidetector row CT for preoperative evaluation. Radiology. 2004; 232(2): 361.

6.       Lal A., Ariga R., Gattuso P., Nemcek A.A., Nayar R. Splenic fine needle aspiration and core biopsy. A review of 49 cases. Acta. Cytol. 2003; 47(6):

7.       Cigel'nik A.M., Moshneguc S.V. Trehmernaja vizualizacija v predoperacionnom planirovanii laparoskopicheskoj splenjektomii. [Three-dimensional imaging in the preoperative planning for laparoscopic splenectomy]. Medicinskaja vizualizacija. 2006; 6: 122-125 [In Russ].

8.       Xu W.L., Li S.L., Wang Y., Li M., Niu A.G. Role of color Doppler flow imaging in applicable anatomy of spleen vessels. World J. Gastroenterol. 2009; 15(5): 607-11.

Abstract:

The article presents literature data about splenic lesions, their morphological characteristics and occurrence. Methods of diagnostics of such lesions are considered. Rarely met pathology as lymphangioma of spleen is discussed. Article describes peculiarities of clinical and morphological classifications of lymphangiomas with different locations, their morphological structure, clinical features of this disease in children and adults. Detailed diagnostic algorithm for detection of splenic lymphangioma is described. Possibilities and advantages of modern methods of diagnostic testing, perspective and the leading role CT and MRI are described. Complexities in diagnostics were noted during the research; optimal combinations of diagnostic methods for better verification of such spleen lesions, for estimation of certain anatomical relation with other structures and tissues, spread of the affected area, as well as an assistance in definition of surgical tactics and volume of intervention, based on data were offered. Application of new technologies with the use SCT-dimensional reconstruction of the affected organ and area of further operation, and the 3D planning of intervention, conducting virtual operations for the optimal access, volume of interventions on the base of individual characteristics of vascular and anatomical features of the patient - gives significant advantages. Review of possible treatment methods is presented. As a case report we used obtained data of 26-years woman with identified during ambulatory ultrasound diagnostics lymphangioma of spleen. In conclusion it is pointed that early and accurate diagnostics is important for prevention of complications and for reduce of operational trauma.

References 

1.    Kubyshkin V.A., Ionkin D.A. Opuholi i kisty selezenki [Tumors and cysts of spleen] M.: Medpraktika- M, 2007 [In Russ].

2.    Cappellani A., Zanghi A., Di Vita M. et al. Spontaneous rupture of a giant hemangioma of the liver. Ann. Ital. Chir. 2000; 71: 379-383.

3.    Daltrey I.R., Johnson C.D. Cystic lymphangioma of the pancreas. Postgrad. Med. J. 1996; 72(851): 564-566.

4.    Panferova T.R. Jehografija v kompleksnoj diagnostike zabrjushinnyh vneorgannyh opuholej u detej . [Ultrasonography in complex diagnostics of retroperitoneal extraorganic tumors in children] Avto-ref. dis. kand. med. nauk. M., 1998 [In Russ].

5.    Brian K.P., Goh M., Y-Meng Tan et al. Intra-abdominal and retroperitoneal ymphangiomas in pediatric and adult patients. WTd J. Surg. 2000; 29: 837-840.

6.    Konen O., Rathans V., Dingy E. et al. Childhood abdominal cystic lymphangioma. Pediatr. Radiol. 2002; 32: 88-94.

7.    Christie J.P., Karlan M.S. Lymphangioma of the pancreas with symptoms of «acute surgical abdomen». Calif Med. 1969; 111(1): 22-24.

8.    Umap P. Intra! abdominal cystic lymphangioma. IndianJ. Cancer 1994; 31: 111-113.

9.    Volobuev N.N., Tihonov K.S., Minajkin V.I. Gigantskaja kistoznaja limfangioma brjushnoj polosti. Hirurgija. [Giant cystic lymphangioma of abdominal cavity] 1989;5: 127-128 [In Russ].

10.  Faul J.L., Berry G.J., Colby T.V. et al. Thoracic lymphangiomas, lymphangiectasis, lymphangiomatosis and lymphatic dysplasia syndrome. Am. J. Respir. Crit. Care Med. 2000; 161: 1037-1046.

11.  Wegner G. Veber Lymphangiome. Arch. Klin. Chir. 1877; 20: 641.

12.  Matjunin V.V. Limfangiomy cheljustno-licevoj oblasti u detej. [Lymphangiomas of maxillofacial area in children] Dissertation for degree of Doctor of Philosophy. M., 1993;150 [In Russ].

13.  Takeuchi Y., Fujinami S., Kitagawa S. et al. Laparoscopic observation of retroperitoneal cystic lymphangioma. J. Gastroenterol. Hepatol. 1994; 9(2): 198-200.

14.  Bliss D.P. Jr., Coffin C.M., Bower R.J. et al. Mesenteric cysts in children. Surgery. 1994; 115: 571-577.

15.  Hancock B.J., St. Vil D., Luks F.I. et al. Complication of lymphangiomas in children. J. Pediatr. Surg. 1992; 27(2): 220-226.

16.  Kurtz R.J., Heimann T.M., Holt J. et al. Mesenteric and retroperitoneal cysts. Ann. Swrg. 1986; 203: 109-111.

17.  Chou Y.H., Tiu C.M., Lui W.Y. et al. Mesenteric and omental cysts: an ultrasonographic and clinical study of 15 patients. Gastrointest. Radiol. 1991; 16: 311-314.

18.  Stepanova Ju.A. Diagnostika neorgannyh zabrjushinnyh obrazovanij po dannym kompleksnogo ul'trazvukovogo issledovanija: [Diagnostics of retroperitoneal newgrowth: complex US diagnostics.] Dissertation for degree of Doctor of Philosophy.M., 2002 [In Russ].

19.  Karmazanovskij G.G., Fedorov V.D. Kompjuternaja tomografija podzheludochnoj zhelezy i organov zabrjuwinnogo prostranstva [CT of pancreas and retroperitoneal organs]. M.: Paganel', 2000 [In Russ].

20.  Melihova M.V. Differencial'no diagnosticheskie vozmozhnosti spiral'noj kompjuternoj tomografii s boljusnym kontrastnym usileniem pri neorgannyh zabrjushinnyh obrazovanijah. [MCST with bolus contrast encashment in differential diagnostics of extraorganic retroperitoneal newgrowth.] Dissertation for degree of Doctor of Philosophy. M., 2005 [In Russ].

21.  Leung T.K., Lee C.M., Shen L.K., Chen Y.Y. Differential diagnosis of cystic lymphangioma of the pancreas based on imaging features. J. Formos. Med. Assoc. 2006; 105(6): 512-517.

22.  Khandelwal M., Lichtenstein G., Morris J. et al. Abdominal lymphangioma masquerading as a pancreatic cystic neoplasm. J. Clin. Gastmenterol. 1995; 20: 142-144.

23.  Casadei R., Minni F., Selva S. et al. Cystic lymphangioma of the pancreas: anatomoclinical, diagnostic and therapeutic consideration regarding three personal observations and review of the literature. Hepatogastroenterology. 2003; 50(53): 1681-1686