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Hematological malignancy manifesting as ascites

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From Nature Clinical Practice Gastroenterology & Hepatology

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Abstract

Background A 63-year-old Caucasian woman presented with intermittent, left-sided abdominal discomfort without other symptoms. Physical examination revealed massive splenomegaly and complete blood counts showed thrombocytopenia. Splenectomy was recommended but the patient declined. She was lost to follow-up twice but returned with tense ascites about 2 years after the initial presentation. Despite aggressive medical management, the ascites did not improve.

Investigations Bone-marrow and liver biopsies, abdominal ultrasound, esophagogastroduodenoscopy, abdominal CT scan and peripheral blood smear.

Diagnosis Primary splenic lymphoma with hepatic infiltration causing portal hypertension and ascites.

Management Paracentesis, dietary sodium restriction and diuretics, splenectomy, splenorenal shunt and chemotherapy (cyclophosphamide, doxorubicin, vincristine and prednisone).

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Figure 1: Hematoxylin and eosin staining showing hepatic involvement of low grade B-cell malignant lymphoma.
Figure 2: Reticulin staining highlighting the nodular regenerative hyperplasia pattern.

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Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology,

    Konstantinos N Lazaridis, Susan C Abraham & Patrick S Kamath

  2. Division of Anatomic Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA

    Konstantinos N Lazaridis, Susan C Abraham & Patrick S Kamath

Authors
  1. Konstantinos N Lazaridis
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  2. Susan C Abraham
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  3. Patrick S Kamath
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Corresponding author

Correspondence to Patrick S Kamath.

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The authors declare no competing financial interests.

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Lazaridis, K., Abraham, S. & Kamath, P. Hematological malignancy manifesting as ascites. Nat Rev Gastroenterol Hepatol 2, 112–116 (2005). https://doi.org/10.1038/ncpgasthep0095

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  • DOI: https://doi.org/10.1038/ncpgasthep0095

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