Clinical and diagnostic challenges in primary splenic lymphomas: when is splenectomy necessary to differentiate SMZL from DLBCL?

Unexplained splenomegaly warrants consideration of primary splenic lymphoma in the differential diagnosis, even without lymphadenopathy or classic B symptoms, particularly when detected during abdominal imaging for hepatosplenic evaluation.Histopathologic and molecular confirmation is essential, as indolent subtypes (e.g. SMZL) and aggressive subtypes (e.g. DLBCL) may present identically but require fundamentally different treatment approaches.PET/CT-guided diagnostic strategy optimises outcomes by enabling accurate staging, identifying the most metabolically active site for biopsy, and informing the need for splenectomy versus direct systemic therapy.