A 28-Year-Old Woman with Ascites and Multiple Focal Spleen Lesions

Pirovano, Alice and Matino, Erica and Zecca, Erika and Costanzo, Martina and Croce, Alessandro and Leutner, Monica and Romito, Raffaele and Pirisi, Mario (2019) A 28-Year-Old Woman with Ascites and Multiple Focal Spleen Lesions. European Journal of Case Reports in Internal Medicine, 6 (5). ISSN 2284-2594

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Serous effusions complicating the course of lymphomas occur commonly in the pleural space but seldom in the peritoneum, where they most often present as chylous ascites with diagnostic cytology. Almost invariably, in these rare cases, the serum to ascites albumin gradient is low. We describe a 28-year-old woman with anasarca, ascites and a serum to ascites albumin gradient of 1.1 g/dl, consistent with portal hypertension. No tumour cells were detected in the ascitic fluid. However, a CT scan of the chest and abdomen disclosed liver and spleen enlargement and multiple enlarged retroperitoneal lymph nodes, suspicious for a lymphoproliferative disorder. Bone marrow aspiration and biopsy were not diagnostic, so a decision was made to proceed with a splenectomy despite the onset of low-grade disseminated intravascular coagulation. Surgery was uneventful. Diffuse large B cell lymphoma was diagnosed. A liver biopsy taken at the time of surgery demonstrated that the liver parenchyma was massively infiltrated by reactive T lymphocytes surrounding rare large CD20+ tumour cells. This infiltrate had likely led to increased portal pressure attended by ascites formation, which resolved completely after chemotherapy. The case emphasizes the rewards of pursuing a diagnosis supported by a high prior probability even in the presence of apparently discordant laboratory findings, as well as the importance of performing a diagnostic splenectomy in case of splenomegaly with unexplained focal lesions.

Item Type: Article
Uncontrolled Keywords: Ascites, splenomegaly, lymphoma, disseminated intravascular coagulation, diagnostic splenectomy
Subjects: 600 Tecnologia - Scienze applicate > 610 Medicina e salute (Classificare qui la tecnologia dei servizi medici) > 616 Malattie (classificare qui la Clinica medica, la medicina basata sull'evidenza, la Medicina interna, la Medicina sperimentale) > 616.3 Malattie del sistema digerente
Depositing User: Sr. Francesco Bonaccorsi
Date Deposited: 15 Jan 2020 09:27
Last Modified: 15 Jan 2020 09:27
URI: http://eprints.bice.rm.cnr.it/id/eprint/19419

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