LEUKEMIC MENINGITIS IN A PATIENT WITH SPLENIC LYMPHOMA WITH VILLOUS LYMPHOCYTES (SLVL) - MENINGITIS AS A POSSIBLE INITIAL MANIFESTATION OF SLVL

Background. Splenic lymphoma with villous lymphocytes (SLVL) is a low grade, non-Hodgkin's lymphoma with a stable or slowly progressive clin ical course. To the authors' knowledge, central nervous system involve ment has not been described previously in patients with SLVL. Methods. Morphologic, immunocytochemical, and immunohistochemical analyses wer e conducted to determine the nature of villous lymphocytes in the peri pheral blood, spleen, and cerebrospinal fluid (CSF) of a patient with massive splenomegaly. Results. A diagnosis of SLVL was made, based on tartrate-resistant acid phosphatase-negative peripheral villous lympho cytosis with CD19(+), CD20(+), HLA-DR(+) phenotypes, and the involveme nt of spleen white pulp with these cells. Mononuclear cells in the CSF showed the same morphologic and immunocytochemical features seen in t he villous lymphocytes in the peripheral blood and spleen. Splenectomy and intrathecal chemotherapy were successful in clearing leukemic cel ls from the CSF. Conclusion. In this patient with SLVL in whom leukemi c meningitis developed, meningitis was found to be a possible initial manifestation of SLVL.