Dr Imelda Bates of the Liverpool School of Tropical Medicine, UK, and Dr George Bedu-Addo of the Komfo Anokye Teaching Hospital, Ghana, report that B-lymphoproliferative disorders (conditions, such as lymphomas [cancer of the lymph system] that result in increases in B-lymphocytes [a type of white blood cell that makes antibodies]) cause almost a quarter of cases of massively enlarged spleens. Bates and Bedu-Addo examined 221 Ghanaian patients with spleens measuring at least 10 cm, and diagnosed the causes of the disorder by clinical, molecular, and immunological tests.
As expected, the most common cause of enlarged spleens was malaria (hyper-reactive malarial splenomegaly, 91 patients [41%]), but unexpectedly, 48 patients (22%) had B-lymphoproliferative disorders. Distinguishing these disorders is difficult, particularly with limited resources; however, the authors found that malaria was more likely to be the cause in women younger than 40 years without raised absolute counts of lymphocytes.
The authors comment "Our finding of lymphoma as a common cause of massive tropical splenomegaly has major implications for the diagnosis and management of this disorder, particularly when resources are limited".
Contact: Dr Imelda Bates, Disease Control Strategy Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK; T) +44 (0) 151 708 9393; F) +44 (0) 151 707 9193; E) ibates@liv.ac.uk
The Lancet