Chic Acevedo Carolina, Ruiz Molina Inmaculada, Contreras De Miguel Elvira, Solís García Eduardo
Infanta Margarita Hospital, Cabra, Spain.
Infanta Margarita Hospital, Cabra, Spain.
Hematol Transfus Cell Ther. 2022 Jul-Sep;44(3):433-436. doi: 10.1016/j.htct.2020.12.003. Epub 2020 Dec 25.
Involvement of the peritoneum occurs very rarely and is exceptional as an exclusive extranodal presentation of lymphomas. In most cases lymphomas associated with this rare entity are high-grade ones. PL secondary to high-grade nodal lymphoma is more frequent than primary peritoneal lymphoma, and there are only a few cases of the latter described in the literature.
We present the case of a patient with constitutional syndrome and imaging findings suggestive of peritoneal carcinomatosis who was finally diagnosed with a Diffuse Large B-cell Lymphoma (DLBCL) by an ultrasound-guided core needle biopsy (CNB) of peritoneum. The patient received one polychemotherapy cycle; however tumor lysis syndrome occurred with death of the patient in the following days. This case tries to show the existence of a PL without other radiological findings of lymphoma, a fact that is very exceptionally described in the literature.
The differential diagnosis between PL and others peritoneum diseases such as peritoneal carcinomatosis, malignant primary peritoneal mesotheliomas, tuberculous peritonitis, sarcomatosis, diffuse peritoneal leiomyomatosis or benign splenosis, constitutes a major problem in imaging techniques. An exhaustive analysis of the radiological characteristics as well as a clinical-analytical context allows the differential diagnosis against peritoneal carcinomatosis and the rest of the entities previously referred although the final diagnosis will always be a biopsy.
PL usually manifests as an aggressive histological subtype of high-grade lymphomas leading to a rapid progression and deterioration of the patient. It is crucial for the radiologist and the clinician to be aware of this rare entity providing the earliest possible diagnosis and optimal treatment to prolong the patient's life.
腹膜受累极为罕见，作为淋巴瘤唯一的结外表现更是异常。在大多数情况下，与这种罕见实体相关的淋巴瘤是高级别淋巴瘤。继发于高级别结内淋巴瘤的腹膜淋巴瘤比原发性腹膜淋巴瘤更常见，而文献中描述的后者病例仅有少数。
我们报告一例有全身症状且影像学表现提示腹膜癌病的患者，最终经腹膜超声引导下粗针穿刺活检（CNB）确诊为弥漫性大B细胞淋巴瘤（DLBCL）。该患者接受了一个周期的多药化疗；然而，随后发生了肿瘤溶解综合征，患者在数日后死亡。本病例旨在展示存在一种无其他淋巴瘤影像学表现的腹膜淋巴瘤，这一情况在文献中极少描述。
腹膜淋巴瘤与其他腹膜疾病如腹膜癌病、原发性恶性腹膜间皮瘤、结核性腹膜炎、肉瘤病、弥漫性腹膜平滑肌瘤病或良性脾组织植入的鉴别诊断，是影像技术中的一个主要问题。详尽分析放射学特征以及临床分析背景有助于与腹膜癌病及其他上述实体进行鉴别诊断，尽管最终诊断仍需活检。
腹膜淋巴瘤通常表现为高级别淋巴瘤的侵袭性组织学亚型，导致患者病情迅速进展和恶化。放射科医生和临床医生认识这种罕见实体至关重要，以便尽早诊断并提供最佳治疗，延长患者生命。
