P2801 - Hidden Malignancy: EUS-Guided Biopsy Safely Diagnoses Splenic Lymphoma After a Year-Long Delay Due to Benign Misinterpretation of Imaging Results

Mohamed Karam Douedari, MD¹, Rama Tarakji, MD¹, Felipe Ruiz, MD², Mahmoud Mahfouz, MD^3
1Mount Sinai Medical Center, Miami Beach, FL; ²University of Miami Miller School of Medicine at Jackson Memorial Hospital, Miami, FL; ³University of Miami Miller School of Medicine, Miami, FL

Introduction: Primary splenic diffuse large B-cell lymphoma is a rare malignancy, accounting for less than 1% of non-Hodgkin's lymphomas. It often presents with nonspecific symptoms, which can complicate timely diagnosis. While the risk of complications from splenic biopsy, particularly bleeding, can lead to deferred procedures, this delay can sometimes critically impact patient outcomes. Endoscopic ultrasound (EUS)-guided biopsy plays a crucial role in the safe and accurate diagnosis of splenic lesions. This case report highlights a patient whose diagnosis of splenic lymphoma was delayed for over a year due to initial biopsy deferment, resulting in disease progression upon eventual diagnosis.

Case Description/Methods: A 54-year-old female with a past medical history of a splenic lesion presented with persistent fever, chills, abdominal pain and weight loss over the preceding two weeks.
Regarding her splenic lesion, 14 months ago, a CT scan of the abdomen, followed by an MRI revealed the incidental finding of a splenic mass. Images reviewed by tumor board at that time deemed the lesion benign, recommending regular follow-up without immediate biopsy due to perceived risks.
On current presentation, repeat CT scan and MRI demonstrated splenomegaly with the known mass and a new infiltrative lesion at the splenic hilum. Initial differential diagnoses included infectious etiologies including abscess. However, given her constitutional symptoms and progressive splenic mass, lymphoma was considered despite the previous benign assessment. The decision to proceed with an EUS was made, with EUS-guided biopsy of the splenic hilum mass. The pathology indicated diffuse large B-cell lymphoma.

Discussion: This case underscores the critical balance between avoiding procedural complications and the necessity of timely tissue diagnosis. The initial deferment of splenic biopsy, driven by the desire to avoid potential bleeding, delayed the diagnosis of malignancy for over a year. In cases where malignancy is a consideration, earlier biopsy may be warranted despite potential risks. EUS-guided biopsy has proven to be a valuable tool in the diagnosis of splenic lesions, offering a minimally invasive approach with a high degree of safety. This can prevent significant delays in treatment and improve patient outcomes.

References:
Lisotti A et al., Diagnostic performance of endoscopic ultrasound-guided tissue acquisition of splenic lesions: systematic review with pooled analysis, May 26, 2022, Gastroenterol Rep (Oxf), goac022.



Disclosures:


Mohamed Karam Douedari, MD¹, Rama Tarakji, MD¹, Felipe Ruiz, MD², Mahmoud Mahfouz, MD³. P2801 - Hidden Malignancy: EUS-Guided Biopsy Safely Diagnoses Splenic Lymphoma After a Year-Long Delay Due to Benign Misinterpretation of Imaging Results, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.