Splenic infarct and massive splenomegaly in a patient with MCL
By Vani Vijayakumar, MD, Raman Kansal, MD, and Atiar Rahman, MD, PhD
Anterior and posterior whole-body gallium-67 citrate scintigraphy
performed 48 hours after intravenous injection of 10 mCi of
gallium-67 citrate revealed marked splenomegaly. There was also a
decreased uptake of radiotracer anteriorly in the upper part of the
spleen and a large wedge-shaped defect posteriorly, which is
in-dicative of an infarct. Uptake by MCL involving the right
subclavicular, bilateral axillary, and bilateral in-guinal lymph
nodes were also noted (Figure 1). Contrast-enhanced transaxial CT
of the chest and a transaxial CT image revealed a large bilateral
axillary adenopathy (Figure 2). Contrast-enhanced transaxial CT of
the ab-domen and a transaxial image showed splenomegaly with
hypodense anterior and large wedge-shaped defects posteriorly with
hepatomegaly (Figure 3). Contrast-enhanced CT transaxial image of
the pelvis shows bilateral inguinal lymphadenopathy (Figure 4).
Mantle cell lymphoma is a malignant non-Hodgkin's lymphoma of
These tumors usually present with
lymphoadenopathy and splenomegaly.2-5
In addition to the
involvement of the lymph nodes and spleen, Waldeyer's ring and the
gastrointestinal tract are also involved. The disease is more
commonly seen in elderly people, and it has a male predominance.
CT is the most common modality for staging lymphoma; however,
its role in the evaluation of extranodal involvement is
limited.6 Gallium67 scintigraphy has been used in
monitoring the response to therapy and in the follow-up of patients
with MCL; however, gallium scintigraphy has a 50% false-negative
rate. Recently, positron emission tomography (PET) using
fluorodeoxyglucose (FDG) has been shown to be superior to gallium
imaging. In addition, it may be more accurate and cost-effective
than CT in the detection of extranodal lymphoma.7,8
Various forms of splenic involvement have been described in MCL,
including spontaneous (pathologic) splenic rupture and splenic
involvement by the blastic MCL, which mimicks the splenic marginal
zone lymphoma.2-5 In this case, we describe another
splenic finding associated with MCL, a splenic infarct on
gallium-67 citrate scintigraphy.
An aggressive form of non-Hodgkin's lymphoma, MCL has a poor
prognosis. Various forms of splenic involvement are common with
this disease. CT and gallium-67 citrate scintigraphy are used in
the initial staging and follow-up of patients with MCL. However,
FDG-PET appears to be a more sensitive imaging modality in the
evaluation of MCL. Splenic infarct with massive splenomegaly
associated with MCL is shown on gallium-67 citrate
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Splenic infarct and massive splenomegaly in a patient with MCL.
July 06, 2007