PMC6880136_01
Computed tomography and PET findings. A splenomegaly, and multiple intraabdominal swollen lymph nodes were detected at splenic hilum, hepatoduodenal ligament, and along common hepatic artery (a). PET showed diffusely enhanced uptake in the spleen, intraabdominal lymph nodes and splenic hilum (b).
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Contrast-enhanced abdominal computed tomography (CT) revealed splenomegaly with multiple swollen intraabdominal lymph nodes in the splenic hilum, hepatoduodenal ligament, and along the common hepatic artery (Fig. 1). Whole-body positron emission tomography/ CT showed diffusely enhanced uptake in the spleen [maximum standard uptake value (SUVmax) 4.53], which was higher than that in the liver, and enhanced uptake in the swollen intraabdominal lymph nodes (SUVmax 3.08-3.56) (Fig. 1).
Intraoperative findings. The spleen showed partial ischemic change due to the splenic artery embolization (a). The gastrosplenic ligament was cut (b), and superior pole of the spleen was detached using laparoscopic coagulating shears (c). The splenocolic ligament was then dissected (d). At the splenic hilum, the splenic artery and vein were separately clipped and cut (e, f). The spleen became free from fixation to the adjacent organs and mobile by dissecting it from laterally.
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The gastrosplenic ligament was dissected, and, using laparoscopic coagulating shears, the upper pole of the spleen was detached (Fig. 2), followed by dissection of the splenocolic ligament.
The resected specimen and histopathological findings. Macroscopically, the cut surface of resected spleen appeared dark reddish with white granular change (a). Histopathology showed small to medium sized lymphoid cells proliferating in nodules replacing splenic white pulp The proliferating cells resemble monocytoid B cells with diffuse infiltration into the splenic red pulp (b: H.E. x20, c: x100). Immunohistochemistry showed the tumor cells were positive for CD20 (d), which is known for B cell feature.
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Macroscopically, the resected spleen appeared dark reddish with whitish granular changes on the cut surface and weighed 1700 g (Fig. 3). Immunohistochemistry was positive for CD20, which is a known B cell feature (Fig. 3), and negative for CD10 and BCL6.