Frontiers | Case Report: Discordant diffuse large B-cell lymphoma and splenic peripheral T-cell lymphoma revealed by persistent splenomegaly and cytopenia

Rákkutatás · Diffuse large B-cell lymphoma

Persistent splenomegaly, cytopenia, splenic infarction, or anatomically discordant progression during lymphoma treatment should trigger repeat tissue sampling and integrated pathological reassessment.

A 71‑year‑old man was diagnosed with stage IVB diffuse large B‑cell lymphoma (DLBCL) involving bone marrow. After dose‑reduced R‑CHOPE therapy, partial remission was achieved but thrombocytopenia and marked splenomegaly persisted. Splenectomy revealed a peripheral T‑cell lymphoma (PTCL) with TCR clonality, distinct from the B‑cell lymphoma. Ten months later, a right orbital mass recurred as DLBCL. Multiple salvage regimens (R‑GemOx, zanubrutinib, intrathecal therapy, R‑ICE) were administered but the patient ultimately died 33 months after initial presentation. This case illustrates that persistent splenomegaly, splenic infarction, cytopenia, or discordant disease progression in a patient with lymphoma should trigger repeat tissue sampling and integrated pathological reassessment to uncover lineage‑discordant lymphoma.

In patients with a known aggressive B‑cell lymphoma, residual or new symptoms such as splenomegaly or cytopenia may be incorrectly attributed to the initial disease, treatment side‑effects, or infection. Recognizing the possibility of a second, distinct lymphoma component—especially when disease sites diverge—can prevent diagnostic pitfalls and guide appropriate, component‑specific therapy.

Bizonyítékszint: Számítógépes vagy elméleti. Modellből vagy adatbányászatból származó jel.

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