Splenic marginal cell lymphoma (SMZL): report of its presentation with spontaneous rupture of the spleen
We report a case of a 71-year-old woman with a past medical history of inflammatory myelitis, osteoporosis, asthma, coeliac disease and chronic back pain who was admitted as an emergency with new onset and severe back and abdominal pain. She described a 5-day history of persistent bilateral back pain radiating to the shoulder tips and groin worse when lying flat. There was no reported history of trauma or falls.\nThe patient was haemodynamically stable with a slightly distended soft but generally tender abdomen. On admission the haemoglobin was 61 g/l and haematocrit 0.189 l/l. She attended the emergency department 3 days before with a similar complaint but discharged home the same day. The haemoglobin was noted to be 117 g/l during that admission. The inflammatory markers were following: CRP 88 and white cell count 12.3; biochemistry and clotting screen was normal.\nCT scan (Fig. ) was consistent with splenic rupture. Laparotomy was performed and a large splenic haematoma with ∼1 l of blood in the abdomen and a splenectomy was performed. The postoperative period was complicated by a lower respiratory tract infection and some difficulty with mobilization but the patient made good recovery otherwise. During the post-operative period she developed a hypoglossal nerve palsy, which was assessed by the neurologist. An MRI scan failed to reveal a cause and the palsy settled spontaneously. She was discharged after 21 days.\nThe excised spleen weighed 560 g with blood clots and was macroscopically normal. Microscopically (Figs –), the histology and immunohistochemistry was consistent with a diagnosis of SMZL. Subsequently, a bone marrow biopsy and staging CT were performed and no distant spread of disease was demonstrated. The patient is undergoing regular follow-up in the haematology clinic.