Abstract

An 18-year-old student was evaluated for generalized lymphadenopathy with unexplained weight loss. Diffuse large B cell lymphoma was confirmed by pathologic examination of the neck lymph nodes. Further systemic evaluation by computed tomography disclosed extensive submental, subaxillary, mediastinal, and paraaortic lymph node enlargement and a tumor in the liver as well as a huge spleen with marked diffuse, amorphous calcification (Fig. 1). Laboratory analysis revealed a slightly elevated lactate dehydrogenase level of 769 U/L and normal serum alanine transaminase, alkaline phosphatase, bilirubin, and calcium. The patient reported no prior splenic trauma or chronic granulomatous infection. Viral studies did not yield significant results, except that the patient was a hepatitis B virus carrier. After undergoing six courses of chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone therapy, he experienced complete remission. The follow-up abdominal computed tomographic scan showed a normal-sized spleen with apparent condensing foci of calcification (Fig. 2). The patient remained free of lymphoma at the 7-year follow-up visit.