Fine Needle Aspiration of Spleen Lesions: Cytopathologic Analysis of 66 Cases with Clinical and Histological Correlation
Ha T Nishino, Rosemary H Tambouret, Xiaohua Qian. Beth Israel Deaconess Medical Center, Boston; Massachusetts General Hospital, Boston; Brigham and Women's Hospital & Harvard Medical School, Boston, MA
Background: While commonly used in developing countries for evaluation of splenic involvement by infectious or systemic diseases, fine needle aspiration (FNA) of the spleen is rarely performed in North America. Recent increasing awareness of its utility in evaluating splenic lesions is accompanied by improved imaging detection and image-guided sampling techniques. Diagnostic issues arise due to the rarity and variety of the entities in the spleen.
Design: A retrospective review (2004-2011) of 66 splenic FNA samples from two academic centers was performed. FNAs were done under CT, ultrasound, endoscopic ultrasound, or MRI guidance or by direct aspiration during surgery. Clinical data, radiologic features, and follow up histologic/clinical findings were reviewed and correlated.
Results: Sixty-six splenic FNAs were performed on 30 female and 35 male patients ranging in age from 21 to 80 years (mean 51 years). One patient was biopsied twice for evaluation of a large splenic cyst. Thirty-eight (58%) patients had a prior history of malignancy including lymphoma/leukemia (15), carcinoma (16), neuroendocrine tumor (2), melanoma (2), germ cell tumor (2), and sarcoma (2). One patient had a history of both carcinoma and lymphoma. Ten cases were diagnosed as malignant. Of these, 6 were lymphomas, 3 metastatic carcinomas, and 1 histiocytic sarcoma. All 5 suspicious diagnoses were concerning for non-Hodgkin lymphoma. Forty-two (64%) cases were diagnosed as benign including granulomatous inflammation (9), vascular lesion (4), splenic epithelial cyst (3), extramedullary hematopoiesis (2), infection (2), and splenic tissue without specification (22). Five cases were diagnosed as atypical and 4 cases were reported as non-diagnostic. Thirty-seven cases had associated surgical core biopsy and/or resection specimens. There were 3 false negative cases due to sampling error and 1 false positive case due to over interpretation of cellular benign splenic tissue as a mesenchymal neoplasm. There were no complications associated with the FNA procedure.
Conclusions: FNA of splenic lesions is a safe and useful tool to document recurrent lymphoma or metastatic carcinoma. Although more than half of the patients presented with a prior history of malignancy, the majority of the lesions turned out to be benign. Therefore, it is important to be familiar with the spectrum of cytologic findings of this uncommonly aspirated organ to avoid unnecessary splenectomies.
Wednesday, March 21, 2012 1:00 PM
Poster Session VI # 83, Wednesday Afternoon