A Rare Case of Spontaneous Splenic Rupture in Refractory Mantle Cell Lymphoma
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A Rare Case of Spontaneous Splenic Rupture in Refractory Mantle Cell Lymphoma Kamal Kant Sahu1 • Ahmad Daniyal Siddiqui2 • Yayan Chen3
Received: 19 February 2020 / Accepted: 18 March 2020 Ó Indian Society of Hematology and Blood Transfusion 2020
Dear Editor, Spleen is one of the essential organs performing various immune related functions in our body. It is one of the common organs to be involved in various myeloid, lymphoproliferative and immunological disorders. Spontaneous rupture is very rare phenomenon and could be fatal if not detected timely. Hereby, we discuss a case of refractory/relapsed mantle cell lymphoma (MCL) who presented as acute abdomen and detected to have splenic rupture. A 57-year-old female came to the emergency for the complaints of acute left-sided abdominal pain. She denied any history of trauma, intense exercise, loose stools, and blood in the stool, fever or sore throat. She had a significant past medical history of refractory mantle cell lymphoma, stage IV for which she was on tablet Venetoclax 400 mg once daily. For abdominal pain, she underwent a computed tomography of the abdomen which showed a marked splenic enlargement with heterogeneous low density concerning for splenic rupture, with adjacent fluid (Fig. 1a). & Kamal Kant Sahu [email protected] Ahmad Daniyal Siddiqui [email protected] Yayan Chen [email protected] 1
Department of Internal Medicine, Saint Vincent Hospital, 123 Summer Street, Worcester, MA 01608, USA
2
Division of Hematology and Medical Oncology, Saint Vincent Cancer and Wellness Center, 1 Eaton Place, Worcester, MA 01608, USA
3
Department of Pathology, Saint Vincent Hospital, Worcester, MA 01608, USA
Her laboratory data showed drop in hemoglobin from 11.5 to 6.5 g/dL with thrombocytopenia of 50,000/lL and WBC count of 7.5 9 103/lL. She received in total five units of packed red blood cells, and three units single donor platelets. Subsequently, she underwent emergent splenectomy that led to stabilisation of her clinical condition and hematological parameters. The pathological examination confirmed the B cell infiltration by MCL (Fig. 1b–d). Retroperitoneum in general is a potential space for fluid collection including bleeding from abdominal and pelvic organs [1] Rupture of spleen is a potential life-threatening condition and challenging to treat [2]. Usually, direct trauma is the most common cause of the splenic rupture followed by spontaneous event. Amongst the spontaneous causes, neoplasms are most common cause followed by infections [3, 4]. Amongst neoplasms, hemato-logical malignancies are more commonly seen than solid malignancies. Usually, non-Hodgkin’s lymphoma (NHL), chronic myeloid leukemia, acute lymphoblastic leukemia are the common hematological neoplasms associated with spontaneous splenic rupture (SSR). Very rarely, solid malignancies like lung cancer has been reported in association with SSR [3]. Internal bleeding is always challenging to diagnose and treat [2]. Due to potential retroper
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