Massive Splenomegaly

A 63-year-old man presented with a 6 month history of fatigue, weight loss, and gingival bleeding.  On physical examination, he was found to have a massively enlarged spleen.
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Image from NEJM (Massive Hepatomegaly) link.  Image courtesy J Monterroso

A complete blood count revealed thrombocytopenia (platelet count, 27,000 per microliter; reference range, 150,000 to 400,000) and lymphocytosis (lymphocyte count, 8900 per microliter; reference range, 1000 to 4800). Microscopical examination of a bone marrow aspirate revealed abnormal lymphocytes with abundant light-blue cytoplasm, round nuclei, fine chromatin, and irregular projections of the cell membrane. Similarly abnormal lymphocytes were also evident on microscopical examination of a peripheral-blood smear. These findings confirmed a diagnosis of hairy-cell leukemia. Named for the microscopical appearance of its malignant cells, this uncommon, indolent B-cell non-Hodgkin’s lymphoma often presents with cytopenias, systemic symptoms, and massive splenomegaly. This patient had a complete remission after treatment with the purine analogue cladribine. He remained in remission at his last follow-up, at 9 months, with normal peripheral-blood counts, a normal bone marrow aspirate, and no evidence of splenomegaly. (adapted from NEJM)

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