Gastrosplenic fistula occurring in lymphoma patients: Systematic review with a new case of extranodal NK/T-cell lymphoma

Table 1 Summary of the 27 cases of gastrosplenic fistula occurring in lymphomas

Ref.	Diagnosis	Sex/age	Size of lymphoma	Disease status	Presentation	Diagnostic modality	Intervention/therapy	Outcome
Bubenik et al[1] (1983)	Diffuse histiocytic lymphoma	Male/58	Not available	Post-CTx	Nonspecific LUQ discomfort	CT abdomen followed by	Splenectomy, gastric greater	Uneventful post-operative period; no further details
						endoscopy of upper GI tract	curvature resection, distal pancreatectomy
Hiltunen et al[2] (1991)	Gastric DLBCL	Male/36	Not available	Post-CTx	Hematemesis, splenomegaly	CT abdomen followed by endoscopy	Laparotomy without details	Followed-up over 3 yr
Blanchi et al[3] (1995) case 1	Splenic DLBCL	Male/62	Not available	Initial presentation	Left abdominal pain and fever	Endoscopy of upper GI tract followed by CT abdomen	Resection of spleen, tail of pancreas, and involved stomach	At 6 mo after the operation, the patient was in complete remission after CTx
Blanchi et al[3] (1995) case 2	Splenic DLBCL	Male/45	Not available	Initial presentation	Epigastric pain and weight loss	Endoscopy of upper GI tract followed by CT abdomen	No further details.	No further details
Carolin et al[4] (1997)	Gastric DLBCL	Male/46	Not available	Initial presentation	Epigastric pain, fatigue, weight loss and splenomegaly	Endoscopy of upper GI tract followed by CT abdomen	Laparotomy, but no further details.	No further details
Bird et al[5] (2002)	Splenic DLBCL	Male/36	Not available	Initial presentation	Hematemesis, melena, fatigue, weight loss and splenomegaly	Endoscopy of upper GI tract followed by CT abdomen	Splenic artery embolization, near total gastrectomy and splenectomy	Disease-free after three cycles of CTx; no further details
Choi et al[6] (2002)	Splenic DLBCL	Male/24	Not available	Initial presentation	LUQ pain and constitutionals symptoms (splenic mass)	CT abdomen followed by endoscopy of upper GI tract/biopsy	CTx followed by splenectomy, gastric wedge resection, and distal pancreatectomy	Not available
Yang et al[7] (2002)	Gastric and splenic DLBCL	Male/21	Not available	Initial presentation	LUQ pain, fatigue, weight loss, fever, and splenomegaly	CT abdomen followed by endoscopy of upper GI tract	Splenectomy, gastric wedge resection, and distal pancreatectomy	After surgery, the patient underwent CTx
Puppala et al[8] (2005)	DLBCL	Female/66	Not available	Initial presentation	LUQ pain	CT abdomen oral contrast	CTx	Died after 2 mo of Ctx
Kerem et al[9] (2006)	DLBCL	Male/57	10 cm × 7 cm × 2 cm in the stomach and 8 cm × 5 cm × 4 cm in the spleen	Initial presentation	Abdominal pain, epigastric tenderness and splenomegaly	CT abdomen followed by PETCT and endoscopy of upper GI tract	Splenectomy, proximal gastrectomy, esophagojejunostomy, proximal pyroloplasty followed by CTx	Uneventful post-op period; underwent chemotherapy.
Al-Ashgar et al[10] (2007)	Hodgkin’s lymphoma-(nodular sclerosis)-IIIS	Female/16	Not available	Initial presentation	LUQ pain, constitutional symptoms and splenomegaly	Endoscopy of upper GI tract, barium swallow, CT abdomen	Laparoscopic surgical repair followed by seven cycles CTx	Alive and in remission after 1 yr
Aribaş et al[11] (2008)	DLBCL	Male/25	Not available	Post-CTx	Abdominal pain, weight loss, fever, chill and splenomegaly	CT cystography followed by USG	Gastric wedge resection, fistulectomy and splenectomy	Discharged after a month and died 2 mo later due to progression of lymphoma and infection due to pancreatic and gastric fistulas
Palmowski et al[12] (2008)	DLBCL	Male/56	15 cm of spleen	After three cycles of CTx	Fever and signs of acute infection (splenic mass)	CT abdomen	Splenectomy with partial gastric resection	Finished six cycles of CTx
Seib et al[13] (2009)	Hodgkin’s lymphoma	Male /49	3.6-cm splenic mass	Relapsed post-CTx	LUQ pain and constitutional symptoms (splenic mass)	CT abdomen	Partial gastrectomy and fistulectomy	Died after 5 mo
Moran et al[14] (2009)	DLBCL	Male/35	5.4 cm × 5.3 cm of gastrosplenic mass	Initial presentation	LUQ pain and constitutional symptoms	CT abdomen followed by endoscopy of upper GI tract	Abscess drainage; splenectomy, total gastrectomy, Roux-en-Y esophagojejunostomy followed by CTx	Received CTx after surgery; no further details available
Maillo et al[15] (2009)	Splenic DLBCL	Female/76	Not available	Initial presentation	Massive hematemesis, fever and fatigue (splenic abscess)	CT abdomen followed by endoscopy of upper GI tract	splenectomy, partial gastrectomy, diaphragmatic primary repair, drainage chest tube and a feeding tube jejunostomy	At 2 mo later the patient developed a pulmonary infection and died because of multi-organic failure
García et al[16] (2009)	Gastric DLBCL	Male/76	Not available	Initial presentation	Epigastric pain, weight loss and splenomegaly	CT abdomen followed by endoscopy of upper GI tract	Total gastrectomy, splenectomy and distal pancreatectomy	Remained asymptomatic at the 36-mo follow-up, no further details
Khan et al[17] (2010)	Gastric DLBCL	Female/43	18.9 cm × 10 cm × 8.6 cm of splenic mass	Initial presentation	Upper abdominal pain and constitutional symptoms (splenic mass)	Endoscopy of upper GI tract followed by CT	CTx	Complete remission after two cycles of CTx; no further details
Rothermel et al[18] (2010)	Splenic DLBCL	Male/74	Not available	Initial presentation	Fever, chill and weight loss	Endoscopy of upper GI tract followed by CT	Splenectomy, stapled gastric-sleeve resection	After surgery, the patient underwent CTx; good prognosis for long-term survival
Dellaportas et al[19] (2011)	Splenic DLBCL	Male/68	Not available	Initial presentation	Hematemesis (splenic mass)	Endoscopy of upper GI tract followed by CT abdomen	Surgical en bloc resection followed by chemotherapy	Post-CTx on follow up
								No details available
Jain et al[20] (2011)	DLBCL	Male/55	Not available	Post-CTx	Progressive weakness, fatigue, melena and splenomegaly	CT abdomen followed by endoscopy of upper GI tract	Splenectomy and partial gastrectomy	Received CTx after surgery; no further details available
Ding et al[21] (2012)	DLBCL	Male/62	7 cm of splenic segment	Initial presentation	LUQ pain with constitutional symptoms and splenomegaly	CT abdomen followed by endoscopy of upper GI tract	Splenectomy, gastric wedge resection, and distal pancreatectomy followed by CTx and RT	Well at follow up; no further details available
Favre Rizzo et al[22] (2013)	Gastric DLBCL	Male/55	Not available	Initial presentation	Hematemesis, epigastric pain, weight loss and splenomegaly	CT abdomen	Partial gastrectomy, splenectomy and distal pancreatectomy	After surgery; no further details available
Senapati et al[29] (2014)	DLBCL	Male/57	Splenomegaly of 15 cm	Post-CTx	No symptom but splenomegaly	PET/CT followed by endoscopy of upper GI tract	Refused any surgical intervention	Lost to follow-up
Gentilli et al[23] (2016)	Gastric DLBCL	Female/66	7.5 cm × 3 cm of splenic mass	Post-CTx	Weakness, fatigue, weight loss and splenomegaly	Endoscopy of upper GI tract followed by CT	Gastric wedge resection, splenectomy	Discharged after surgery; no further details
Sousa et al[24] (2016)	Gastric DLBCL	Male/52	Not available	Post-CTx	Hematemesis	Endoscopy of upper GI tract	Total gastrectomy, splenectomy, distal pancreatectomy	Patient was lost to follow-up after discharge
Present case	NK/T cell lymphoma	Male/50	11 cm × 5 cm × 13 cm of spleen	Post-CTx	LUQ pain, nausea, vomiting and splenomegaly	CT abdomen	Gastric wedge resection and splenectomy	At 3 mo later, gastric perforation occurred and the patient expired due to sepsis

CT: Computed tomography; CTx: Chemotherapy; DLBCL: Diffuse large B-cell lymphoma; GI: Gastrointestinal; LUQ: Left upper quadrant; PET: Positron emission tomography; RT: Radiation therapy; USG: Ultrasonography.