Splenectomy for splenomegaly over 3,000 cm³ suspected to be hairy cell leukemia Japanese variant

A 56-year-old woman presented with exertional shortness of breath. CT showed a remarkably swollen spleen and peripheral blood revealed atypical lymphocytes. Bone marrow smear and flow cytometry suggested hairy cell leukemia Japanese variant (HCLjv). Three weeks after admission, splenomegaly increased from 2,125 cm³ to 3,207 cm³. Because pancytopenia and abdominal retention had progressed, splenectomy was performed to improve symptoms and obtain a definitive diagnosis. To prevent bleeding and reduce splenic volume, embolization of the splenic artery with balloon catheter was performed preoperatively. Thus splenectomy was performed safely. The operation took 146 minutes and blood loss was 30 ml. Reduced splenic volume with embolization was 2,657 g. Splenectomy was effective in diagnosing this splenomegaly with HCLjv, and it led to the improvement of abdominal retention.