IBCL-187 Diagnostic Splenectomy: Clinical Profile, Role, and Relevance in Diagnosis of Lymphoma

• Published in: Clinical lymphoma, myeloma and leukemia myeloma and leukemia, 2024-09, Vol.24, p.S494-S494
• Main Authors: Joshi, Nutan, Kulkarni, Uday, Selvarajan, Sushil, Lakshmi, Kavitha M., Sigamani, Elanthenral, Raj, Santhosh, Manesh, Abi, Ninan, Divya, John, Junita, Abraham, Aby, Mathews, Vikram, Korula, Anu
• Format: Article
• Language: English
• Subjects: diagnostic splenectomy; lymphoma
• ISSN: 2152-2650
• DOI: 10.1016/S2152-2650(24)01559-3

There is a paucity of data regarding the role and relevance of diagnostic splenectomy in the diagnosis of lymphoma. To describe the clinical and histopathologic profiles of diagnostic splenectomies. Retrospective analysis of all splenectomies performed between January 2008 and June 2022 (n=1165) screened for indication, with therapeutic/traumatic splenectomies (n=1042) excluded from further analysis. The clinical spectrum and histopathology of 123 diagnostic splenectomies are described further. 75 (61%) patients were male and median age was 44 (range, 17-74) years. ‘B’ symptoms were present in 82 (66.7%) patients. Lymphadenopathy was noted clinically or on imaging in 29 (23.9%) patients, either not amenable for biopsy or nondiagnostic on biopsy. Median preoperative spleen size on imaging was 20 cm (range, 11-37), with 53 (43.1%) showing focal lesions on radiology. Peripheral blood lymphocytosis was seen in 13 (10.6%) patients, with elevated serum LDH in 66.7% of cases. Among 115 available bone marrow reports, 52 (45.2%) had normal findings, 45 (39.1%) were suspicious or suggestive of lymphoma, 5 (5.2%) had infection, and 13 (11.3%) had other diagnoses. Histopathology on the resected spleen was diagnostic of lymphoma in 72 patients (58.5%), 12 (9.8%) revealed infectious causes, 5 (4.1%) showed suspicion of lymphoma, 5 (4%) showed other malignancies, and 29 (23.5%) were normal/nondiagnostic. Among the 72 lymphomas, 48 (66.6%) were B-cell non-Hodgkin (SMZL 26 [36.1%], DLBCL 16 [22.2%], 1 each of splenic diffuse red pulp B-cell lymphoma and T-cell rich B-cell lymphoma), 17 (23.6%) were T-cell lymphomas (PTCL NOS [n=4], NK T-cell [n=4] lymphomas, hepatosplenic gamma delta T-cell lymphoma in 3, and T-LGL in 1 patient), 6 were Hodgkin lymphoma, and 1 was plasmablastic lymphoma. Subtyping was not possible in 4 B-NHL and 5 T-NHL patients. On univariate analysis, none of the preoperative clinical, laboratory, or radiologic parameters could predict a histopathologic diagnosis of lymphoma on the resected specimen. Splenectomy has a clear role in the evaluation of diagnostically challenging cases, allowing for histopathologic confirmation of lymphoma and further subtyping in a majority of cases. In this study, clinical, laboratory, and radiologic parameters were not predictive of a diagnosis of lymphoma.