TJ
ISSN 0300-8916
Tumori 2016; 102(Suppl 2): S61-S64
© 2015 Wichtg Publishing
Case report
was no history of cough, chest pain, vomitng, icterus, or
bowel or bladder dysfuncton. There was no history of any co-
morbid conditon or signifcant disease in the family. General
physical examinaton was normal except for mild pallor. Ab-
domen examinaton revealed massive splenomegaly and mild
hepatomegaly. Laboratory results showed anemia (10 g/dL),
thrombocytopenia (40,000/µL), and leukocytosis (15,300/µL).
Peripheral smear revealed normocytc, normochromic red
blood cells with mild anisocytosis, few target cells, and How-
ell Jolly bodies. Retculocyte count was 3.98%, suggestve of a
hemolytc picture. Malaria and kala-azar infectons were ex-
cluded. Liver functon tests were abnormal, with bilirubin of
3 mg/dL (normal range 0.3-1.9 mg/dL), alanine aminotrans-
ferase 80 IU/L, and aspartate aminotransferase 120 IU/L (nor-
mal range 0-40 IU/L). HBeAg was positve with high hepatts
B virus DNA load of 2.4 × 108 copies/mL. Viral serology for
hepatts C, hepatts D, and human immunodefciency virus
1 and 2 was negatve. Abdominal ultrasonography confrmed
marked splenomegaly and mild hepatomegaly. No enlarged
lymph nodes were identfed. The patent underwent sple-
nectomy and liver wedge biopsy. Subsequently bone marrow
aspiraton and biopsy was done.
Gross examinaton revealed an enlarged spleen measur-
ing 33 × 21 × 10 cm and weighing 2900 g. Cut surface was
reddish brown, homogenous, and feshy, with an area of in-
farcton. No nodularity or follicular prominence was noted.
Wedge biopsy of liver measured 1 × 0.8 × 0.5 cm. Cut surface
was unremarkable.
Microscopic examinaton of the spleen showed difuse in-
volvement of the red pulp by small to medium-sized lymphoid
cells with a thin rim of pale cytoplasm and irregular nuclei.
DOI: 10.5301/tj.5000445
Hepatosplenic t-cell lymphoma with coexistent
hepatts B infecton: a rare clinicopathologic entty
Fouzia Siraj
1
, Varsha Dalal
1
, Afaq A. Khan
2
, Deepali Jain
3
1
Natonal Insttute of Pathology (ICMR), New Delhi - India
2
JLNM Hospital, Srinagar, Kashmir - India
3
Department of Pathology, AIIMS, New Delhi - India
Introducton
Hepatosplenic T-cell lymphoma (HSTL) is a rare peripheral
T-cell lymphoma derived from cytotoxic T-cells, and manifests
as an extranodal systemic lymphoma (1). It is characterized
by primary extranodal disease with typical sinusoidal infltra-
ton of the liver and the spleen. The neoplasm is seen mostly
in adolescents and young adults with a strong predilecton
for males (2, 3). Hepatosplenic T-cell lymphoma has been re-
ported in the context of immunosuppressive states and cer-
tain infectons (1, 4). There is a possibility that proliferaton of
neoplastc T cells in response to infectve agents like hepatts
B, as seen in the present case, plays a role in the pathogenesis
of hepatosplenic T-cell lymphoma.
Case report
A 29-year-old man presented with fever, abdominal pain,
and signifcant weight loss for a period of 5 months. There
ABStrACt
Background: Hepatosplenic T-cell lymphoma (HSTL) is a rare extranodal and systemic lymphoma derived from
cytotoxic T cells usually of γδ T cell receptor type. It is characterized by primary extranodal disease with typical
sinusoidal infltraton of liver, spleen, and bone marrow by medium-sized lymphoid cells.
Case report: A 29-year-old man, with no signifcant prior medical history, presented with fever and massive sple-
nomegaly. A diagnosis of HSTL was established by histologic examinaton and immunohistochemistry. Staging
workup demonstrated bone marrow involvement by lymphoma. In additon, the patent was found to have hepa-
tts B infecton. The associaton of these 2 enttes has been described rarely.
Conclusions: Hepatosplenic T-cell lymphoma is a distnct T cell lymphoma associated with an aggressive clinical
course, a poor response to conventonal treatment, and an exceedingly high mortality rate. An associaton of
HSTL with hepatts B as seen in the present case is exceedingly rare, with few cases reported in the literature.
Keywords: γδ T cell receptor, Hepatts B, Hepatosplenic T-cell lymphoma
Accepted: September 17, 2015
Published online: October 13, 2015
Corresponding author:
Varsha Dalal
Senior Resident
Natonal Insttute of Pathology (Indian Council of Medical Research)
Sriramachari Bhawan
Safdarjung Hospital Campus
New Delhi 110029, India
vndreamon12@gmail.com