case_images: PMC9062873_01
case_images: FDG-PET imaging reveals an avid lesion in the anterior superior pole of the spleen, concerning for recurrent malignant disease. There is no evidence of other lymphadenopathy and the bone marrow did not show abnormal uptake in this or other images.
case_images: tsaco-2022-000928f01.jpg
case_images: PMC9062873_01_tsaco-2022-000928f01.jpg
case_images: F1
case_images: An fluorodeoxyglucose (FDG)-positron emission tomography (PET) scan was notable only for high metabolic activity in the superior pole of the spleen, concerning for recurrent lymphoma (figure 1).
case_images: Surgical specimen after laparoscopic hand-assisted splenectomy.
case_images: tsaco-2022-000928f02.jpg
case_images: PMC9062873_01_tsaco-2022-000928f02.jpg
case_images: F2
case_images: Given concerns for extranodal lymphoma, the spleen was not morselized but instead removed intact through the hand port to preserve the architecture for pathological study (figure 2).
case_images: Natural history of Richter's transformation from chronic lymphocytic leukemia (CLL) to diffuse large B cell lymphoma (DLBCL).
case_images: tsaco-2022-000928f03.jpg
case_images: PMC9062873_01_tsaco-2022-000928f03.jpg
case_images: F3
case_images: Richter's syndrome is a broad term describing transformation of low-grade lymphoproliferative disorders to more aggressive lymphomas, the most common being CLL to DLBCL (figure 3). Richter's transformation is multifactorial, associated with genetic aberrations, immunosuppression, and certain therapies used in the treatment of CLL, namely purine analogs and alkylating agents.