History :
A 49-year-old female developed late afternoon fever, general malaise, and abdominal fullness in these 3 months.

Questions :

1. What are the findings?
2. What is the differential diagnosis?
3. What is the final diagnosis?

Answers:

1. A huge heterogeneous density tumor in the spleen. There is no clear interface between the mass and the stomach, pancreatic tail. A small well defined heterogeneous tumor in the right kidney. Marked lymphadenopathy in the celiac trunk, para-aortic, and mesenteric region.
2. lymphoma, gastric or splenic malignancy with metastatic lymphadenopathy and metastasis to right kidney.
3. Lymphoma

Discussion :
Lymphoma-spleen involved in 70%
(Hodgkin disease, non-Hodgkin lymphoma, primary splenic lymphoma) splenomegaly in non-Hodgkin lymphoma indicates involvement in most patients
30% of patients with splenomegaly have no involvement from non-Hodgkin lymphoma
30% of patients with lymphoma of any kind have splenic involvement without splenomegaly
-homogeneous splenomegaly (from diffuse nfiltration)
-miliary nodules -large 2-10 cm nodules (10-25%)
-nodes in splenic hilum (50%) in NHL; uncommon in Hodgkin disease