Splenic B-cell lymphoma/leukemia with prominent nucleoli and spontaneous splenic rupture: a case report and literature review

An 80-year-old man was admitted to our hospital for recurrent chest discomfort and shortness of breath over the past 2 years, with symptoms exacerbated by back pain over the past 3 days. The patient had a history of multiple comorbidities. Physical examination on admission revealed grade III splenomegaly. Peripheral blood tests revealed a white blood cell count of 27.03 × 10⁹/L, a lymphocyte percentage of 62.40%, and an absolute lymphocyte count of 16.87 × 10⁹/L. During hospitalization, the patient's blood pressure suddenly dropped, and he developed shock. Computed tomography scan confirmed a rupture at the upper pole of the spleen, requiring emergency surgical exploration. Intraoperatively, the splenic rupture site was identified, and substantial intraperitoneal hemorrhage was noted. Therefore, total splenectomy was performed. The patient's postoperative recovery was initially uneventful; however, chemotherapy was not administered due to poor physical status. Postoperative pathological examination, bone marrow smear, and flow cytometry analysis confirmed the diagnosis of splenic B-cell lymphoma/leukemia with prominent nucleoli (SBLPN). SBLPN is an extremely rare splenic B-lymphocyte neoplasm, with a small number of cases reported in the current literature.