Case Report
Copyright ©The Author(s) 2003. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 15, 2003; 9(6): 1381-1384
Published online Jun 15, 2003. doi: 10.3748/wjg.v9.i6.1381
Hepato-splenic lymphoma: a rare entity mimicking acute hepatitis: A case report
Federico Perfetto, Roberto Tarquini, Francesco Mancuso, Simonetta di Lollo, Silvia Tozzini, Giampiero Bellesi, Giacomo Laffi
Federico Perfetto, Roberto Tarquini, Francesco Mancuso, Giacomo Laffi, Department of Internal Medicine, University of Florence, Italy
Simonetta di Lollo, Silvia Tozzini, Department of Human Pathology and Oncology, University of Florence, Italy
Giampiero Bellesi, Department of Hematology, University of Florence, Italy
Author contributions: All authors contributed equally to the work.
Correspondence to: Professor Giacomo Laffi, Department of Internal Medicine, University of Florence, Viale Pieraccini, 18, Zip Code 50139 Firenze, Italy. g.laffi@mednuc2.dfc.unifi.it
Telephone: +39-55-4223549 Fax: +39-55-4223549
Received: October 10, 2002
Revised: October 24, 2002
Accepted: November 4, 2002
Published online: June 15, 2003
Abstract

We reported a case of non-Hodgkin's lymphoma where liver involvement was the predominant clinical manifestation. A 27-year old man presented wiht markedly elevated serum aspartate aminotrasferase, alanine aminotransferase and lactate dehydrogenase, reduced prothrombin activity, thrombocytopenic purpura and hepato-splenomegaly without adenopathy. Viral, toxic, autoimmune and metabolic liver diseases were excluded. Bone marrow biopsy showed an intracapillary infiltration of T-lymphocytes with no evidence of lipid storage disease. Because of a progressive spleen enlargement, splenectomy was performed. Histological examination showed lymphomatous intrasinuses invasion of the spleen. Immunohistochemical investigation revealed the T phenotype of the neoplastic cells: CD45+, CD45RO+, CD3+, CD4-, CD8-, TIA1-. About 50% of the lymphoid cells expressed CD56 antigen. The diagnosis of hepatosplenic T cell lymphoma was done. The patient was treated with chemotherapy, which induced a complete remission. Eighteen months later, he had a first relapse with increased aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, thrombocytopenic purpura and blast in the peripheral blood. In spite of autologous bone marrow transplantation, he died twenty months after the diagnosis. Even in the absence of a mass lesion or lymphoadenopathy, hepatosplenic T-cell lymphoma should be considered in the differential diagnosis of a patient whose clinical course is atypical for acute hepatic dysfunction.

Keywords: $[Keywords]