Image in medicine
Massive splenomegaly and pancytopenia
Esplenomegalia masiva y pancitopenia
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With no recent infectious symptoms, the patient reported postprandial fullness and pain in the left hypochondrium for over one month. Presented with elastic, painless splenomegaly and bilateral inguinal centimetric lymphadenopathies. Laboratory results: white blood cells 1.98<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">9</span>/L (differential count: lymphocytes 1, 4<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">9</span>/L; neutrophils 0.43<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">9</span>/L), Hb 99<span class="elsevierStyleHsp" style=""></span>g/L and platelets 50<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">9</span>/L. Peripheral blood morphology: lymphocytes without atypia or blasts. Abdominal CT (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>): large homogeneous splenomegaly (27<span class="elsevierStyleHsp" style=""></span>cm of craniocaudal diameter) and numerous small-size retroperitoneal and common iliac chain lymph nodes. A bone marrow aspirate and biopsy were performed. The initial cytologic study showed hypocellularity with few lymphocytes indicative of hairy cells. Flow cytometry and bone biopsy revealed a low B lymphoproliferative process infiltration. Negativity for specific immunohistochemical markers as well as the absence of BRAF V600E oncogene mutation did not allow a definitive diagnosis, so a diagnostic splenectomy was performed. Spleen immunohistochemistry revealed diffuse and intense positivity for LCA and CD79a, somewhat weaker for cyclin D1 and focal for CD10, negative for CD5 and CD23 which, together with the pathologic description (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), corroborated the diagnostic hypothesis of hairy cell leukaemia. The patient was treated with one cycle of cladribine and remains in complete remission 16 months later.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Valle Feijoo ML, Turcu V, Pérez Expósito MI, de la Fuente Aguado J. Esplenomegalia masiva y pancitopenia. Med Clin (Barc). 2017;148:e27.</p>" ] ] "multimedia" => array:2 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 600 "Ancho" => 338 "Tamanyo" => 57973 ] ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 600 "Ancho" => 800 "Tamanyo" => 260269 ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000014800000005/v1_201704020027/S2387020617301523/v1_201704020027/en/main.assets" "Apartado" => array:4 [ "identificador" => "51820" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in medicine" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000014800000005/v1_201704020027/S2387020617301523/v1_201704020027/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020617301523?idApp=UINPBA00004N" ]
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