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Case Report Open Access

Successful treatment of severe splenic lymphoma‑associated hemophagocytic syndrome by splenectomy and subsequent chemotherapy: A case report

  • Authors:
    • Hideyuki Masui
    • Maki Shindo
    • Yuta Inoue
    • Maki Sugiyama
    • Atsushi Ueda
    • Takero Shindo
    • Kae Okoshi
    • Koichi Kinoshita
  • View Affiliations / Copyright

    Affiliations: Department of Surgery, Japan Baptist Hospital, Kyoto 606‑8273, Japan, Department of Hematology, Japan Baptist Hospital, Kyoto 606‑8273, Japan, Department of Hematology, Kyoto University Hospital, Kyoto 606‑8397, Japan
    Copyright: © Masui et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 222
    |
    Published online on: March 22, 2024
       https://doi.org/10.3892/ol.2024.14355
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Abstract

Hemophagocytic lymphohistiocytosis (HLH) represents a fatal immunopathology derived from excessive inflammatory reactions. In particular, lymphoma‑associated hemophagocytic syndrome (LAHS) is associated with a dismal prognosis. The current study presented a challenging case of splenic LAHS. A 71‑year‑old man presented with fatigue and anorexia. Laboratory test results revealed anemia, thrombocytopenia, lactate dehydrogenase elevation and markedly elevated levels of ferritin (6,210 ng/ml) and soluble interleukin 2 receptor (sIL‑2R; 11,328 U/ml). Abdominal computed tomography revealed marked splenomegaly, while fluorodeoxyglucose positron emission tomography revealed increased tracer uptake in the spleen. An elective splenectomy was performed, which led to the diagnosis of B‑cell splenic lymphoma with transformation from indolent to aggressive lymphoma. Prior to the splenectomy, thrombocytopenia and hepatic dysfunction with rapidly progressing jaundice appeared, accompanying further elevation of ferritin (25,197 ng/ml) and sIL‑2R levels (30,420 U/ml). On postoperative day 5, the patient was transferred to a tertiary care institution and corticosteroid pulse therapy was immediately initiated after establishing the diagnosis of LAHS. Liver dysfunction gradually recovered and subsequent chemotherapy resulted in complete remission with improved performance status. At eight months after the onset, the patient remains alive without any signs of residual lymphoma. Although splenic lymphoma typically manifests with low‑grade lymphoma, it can transform into high‑grade lymphoma associated with severe complications, such as HLH and multiple organ failure. In this case, splenectomy assisted in not only establishing the diagnosis but also in tumor cytoreduction before commencing chemotherapy. Through interdisciplinary collaboration, the patient was successfully treated by performing a timely splenectomy, followed by steroid pulse therapy and chemotherapy.
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Copy and paste a formatted citation
Spandidos Publications style
Masui H, Shindo M, Inoue Y, Sugiyama M, Ueda A, Shindo T, Okoshi K and Kinoshita K: Successful treatment of severe splenic lymphoma‑associated hemophagocytic syndrome by splenectomy and subsequent chemotherapy: A case report. Oncol Lett 27: 222, 2024.
APA
Masui, H., Shindo, M., Inoue, Y., Sugiyama, M., Ueda, A., Shindo, T. ... Kinoshita, K. (2024). Successful treatment of severe splenic lymphoma‑associated hemophagocytic syndrome by splenectomy and subsequent chemotherapy: A case report. Oncology Letters, 27, 222. https://doi.org/10.3892/ol.2024.14355
MLA
Masui, H., Shindo, M., Inoue, Y., Sugiyama, M., Ueda, A., Shindo, T., Okoshi, K., Kinoshita, K."Successful treatment of severe splenic lymphoma‑associated hemophagocytic syndrome by splenectomy and subsequent chemotherapy: A case report". Oncology Letters 27.5 (2024): 222.
Chicago
Masui, H., Shindo, M., Inoue, Y., Sugiyama, M., Ueda, A., Shindo, T., Okoshi, K., Kinoshita, K."Successful treatment of severe splenic lymphoma‑associated hemophagocytic syndrome by splenectomy and subsequent chemotherapy: A case report". Oncology Letters 27, no. 5 (2024): 222. https://doi.org/10.3892/ol.2024.14355
Copy and paste a formatted citation
x
Spandidos Publications style
Masui H, Shindo M, Inoue Y, Sugiyama M, Ueda A, Shindo T, Okoshi K and Kinoshita K: Successful treatment of severe splenic lymphoma‑associated hemophagocytic syndrome by splenectomy and subsequent chemotherapy: A case report. Oncol Lett 27: 222, 2024.
APA
Masui, H., Shindo, M., Inoue, Y., Sugiyama, M., Ueda, A., Shindo, T. ... Kinoshita, K. (2024). Successful treatment of severe splenic lymphoma‑associated hemophagocytic syndrome by splenectomy and subsequent chemotherapy: A case report. Oncology Letters, 27, 222. https://doi.org/10.3892/ol.2024.14355
MLA
Masui, H., Shindo, M., Inoue, Y., Sugiyama, M., Ueda, A., Shindo, T., Okoshi, K., Kinoshita, K."Successful treatment of severe splenic lymphoma‑associated hemophagocytic syndrome by splenectomy and subsequent chemotherapy: A case report". Oncology Letters 27.5 (2024): 222.
Chicago
Masui, H., Shindo, M., Inoue, Y., Sugiyama, M., Ueda, A., Shindo, T., Okoshi, K., Kinoshita, K."Successful treatment of severe splenic lymphoma‑associated hemophagocytic syndrome by splenectomy and subsequent chemotherapy: A case report". Oncology Letters 27, no. 5 (2024): 222. https://doi.org/10.3892/ol.2024.14355
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