Gastrosplenic fistula occurring in lymphoma patients: Systematic review with a new case of extranodal NK/T-cell lymphoma

Figure 1 Flow diagram for the selection of studies.

Figure 2 On a coronal computed tomography image taken 2 mo after autologous stem-cell transplantation, the spleen was enlarged, measuring 17 cm in the longest dimension, and indicative of recurred lymphoma. The enlarged spleen abutted to the gastric fundus.

Figure 3 On an axial computed tomography image taken after chemotherapy, a huge fistula was shown between the gastric lumen and the spleen. The spleen was totally infarcted.

Figure 4 Microscopic specimen of the spleen and stomach. A: Atypical lymphoma cells were found in the spleen on hematoxylin-eosin stain (left). These cells showed positivity for CD3 on immunohistochemistry stain (middle) and EBV on EBV RNA stain (right). There was also extensive coagulative necrosis indicative of splenic infarction; B: Lymphoma cells were found in the stomach wall near the gastrosplenic fistula on hematoxylin-eosin stain (left), and which also showed positivity for CD3 (middle) and EBV (right). NK/T-cell lymphoma was diagnosed. These findings suggested that lymphoma cells may have infiltrated from the spleen to the stomach wall through the perforation site. EBV: Epstein-Barr virus.