Abstract:

Follicular lymphoma (FL) is an indolent non-Hodgkin lymphoma characterized by painless lymph node enlargement over several years. It is relatively rare for FL to present with ascites as the main symptom. Moreover, the laboratory test results of such patients are often atypical, making it difficult to distinguish from other peritoneal metastatic diseases. This paper reports a case of a patient with a history of endometrial tumor who did not complete the chemotherapy course as prescribed and was lost to follow-up 2 months after surgery. The patient presented with progressive abdominal distension. Ultrasound showed a large amount of ascites in the abdominal cavity. Enhanced CT of the whole abdomen reported multiple enlarged lymph nodes in the retroperitoneum and mesentery, and nodular thickening of the peritoneum and greater omentum. No tumor cells were found in the ascitic cytology examination. A laparoscopy exploration was performed, and the final postoperative pathology confirmed FL. The patient has completed chemotherapy of rituximab plus bendamustine for 6 cycles, and no recurrence has been observed so far. When patients with a history of abdominal malignancies present with peritoneal lesions, especially in the presence of lymph node enlargement, even if lymphoma cannot be clearly diagnosed by imaging, in addition to considering the metastasis of the primary tumor, hematological malignancies should be included in the differential diagnosis system.

Key words: Lymphoma, follicular, Ascites, Peritoneal neoplasms, Diagnosis, Therapy