Diagnostic pitfalls in fine needle aspiration biopsy of the spleen

Laparoscopic Approach to Primary Splenic Cyst: Case Report and Review of the Literature

Splenic cysts are rare benign lesions of the spleen, often asymptomatic and incidentally discovered during imaging studies. While many splenic cysts remain asymptomatic and do not require intervention, surgical management becomes essential in cases of symptomatic cysts, large cysts, or when malignancy cannot be ruled out. Laparoscopic surgery has emerged as a minimally invasive and effective approach for treating splenic cysts, offering advantages such as shorter hospital stays, reduced postoperative pain, and faster recovery. In this case report, we describe our experience with laparoscopic surgery for a symptomatic splenic cyst in a young patient.

Effect of needle gauge on pain and specimen quality of ultrasound-guided fine needle sampling without aspiration of the canine spleen

Modifications of splenic parenchyma are common ultrasonographic findings in dogs. Splenic fine needle aspiration (FNA) is a rapid, safe procedure, routinely performed in veterinary institutions. However, 22-gauge (G) needle usually reported is selected according to general practice and the most appropriate needle size to be used remains unclear. The aim of this prospective, single-center, methods comparison study was to assess the effect of needle size on cytologic specimens' evaluation and animal welfare during the procedure. Dogs underwent ultrasound-guided splenic FNA using 23, 25, and 27G needles. Needles were compared based on initial and then detailed cytologic evaluation. The initial evaluation assessed overall cellularity, cell preservation, hemodilution, and detailed cytologic evaluation referred to exhaustive splenic components. Welfare evaluation was performed based on a scoring system. A total of 54 dogs were included in this study with 54 of 54 welfare evaluations and 35 of 54 cytologic evaluations by one or two European College of Veterinary Clinical Pathology-certified cytologists. The final cytologic diagnosis was unchanged regardless of the needle size. For the initial evaluation, 23G needles provided significantly higher cellularity than the 27G needles. For detailed cytologic evaluation, only the richness in mesothelial cells and stroma was affected by needle size. Pain induced by the procedures was considered low using 23, 25, and 27G needles with the 27G needle producing the least adverse reactions. Findings from the current study supported using needle gauges smaller than the previously published standard 22G needle for spleen ultrasound-guided fine needle nonaspiration in dogs. Due to higher cellularity and lower pain scores, authors recommend the use of 23G needles with a nonaspiration technique.

Fine needle aspiration and core needle biopsy of the spleen: A case series illustrating current practices and challenges

INTRODUCTION

Splenic fine needle aspiration (FNA) and core needle biopsies (CNB) are rare specimen types, potentially avoided due to clinical concern for hemorrhagic complications. The safety and utility of splenic FNA, the role of rapid onsite evaluation (ROSE), as well as the diagnostic utility of CNB versus FNA have not been recently reviewed.

MATERIALS AND METHODS

A 10-year retrospective review was performed of percutaneous image-guided FNA and CNB of the spleen. Clinical indications, outcomes, ROSE findings, and final diagnoses were reviewed and correlated.

RESULTS

Forty-four specimens from 39 patients were identified. The commonest indication for biopsy was a radiographic mass found during assessment for patient complaint (45%, 20/44), evaluation for malignancy (primary or metastatic) (39%, 17/44), and incidentally (16%, 7/44). Malignant diagnoses were rendered in 10 cases, 80% hematolymphoid and 20% nonhematolymphoid. Thirty-one cases were nonneoplastic and identified as infectious/inflammatory processes 39%, cysts 10%, vascular lesions 13%, benign splenic elements 22%, accessory or atrophic spleen 10%, and extramedullary hematopoiesis 6%. The nondiagnostic rate was 7%. Cases with subsequent splenectomy showed 100% specificity and 86% sensitivity. The concordance of ROSE and final interpretation was 90% within the neoplastic category. Finally, the significant complication rate was 6.8% with no bias to occurrence following FNA or CNB.

CONCLUSIONS

This series affirms the safety and efficacy of splenic FNA and CNB by complication rates comparable to prior studies and high rate of concordance. The diagnostic accuracy may be further improved by ROSE, and CNB in cases reliant on staining and tissue architecture.

Using contrast-enhanced ultrasound to guide a successful biopsy of a splenic sarcomatoid carcinoma

Introduction

Splenic lesions are uncommon and frequently cause a diagnostic dilemma, often with non-specific findings on both ultrasound and cross-sectional imaging with histological confirmation necessary. To reduce patient morbidity, primarily from haemorrhage and to increase diagnostic yield, precise imaging and biopsy targeting are needed.

Case

We present a case of an indeterminate complex splenic lesion, with areas of necrosis which required histological diagnosis. Contrast-enhanced ultrasound-guided percutaneous core needle biopsy was undertaken to provide real-time imaging guidance, increasing viable lesion targeting and helping to avoid areas of necrosis.

Conclusion

Contrast-enhanced ultrasound guidance of the percutaneous core needle biopsy allowed increased operator confidence in lesional targeting accuracy and reduced the number of passes required for biopsy, simultaneously maximising histological yield and minimising patient morbidity.

Death within 30 days of fine needle aspiration: Post-mortem confirmation of FNA diagnoses and the contribution of FNA to patient mortality

BACKGROUND

Fine needle aspiration (FNA) diagnoses are usually confirmed via surgical pathology or via evaluation of clinical outcomes. However, such confirmation may not occur for patients who die shortly after FNA, and autopsy may be a useful quality assessment tool in these cases. Also, there is little data investigating the relationship between FNA and mortality. We sought to demonstrate the autopsy as a quality assessment tool for the FNA and assess the contribution of FNA to mortality in patients who die soon after the procedure.

METHODS

A search of our database was performed from 1992 to 2016 for patients who were autopsied after dying within 30 d of an FNA. Concordance between findings from FNA, autopsy, and any intervening surgical pathology material was determined. Finally, a subjective determination of the likelihood that FNAs contributed to deaths was made by reviewing autopsy reports. The contribution was categorised as either "unlikely", "possible", or "probable".

RESULTS

Fifty-eight patients (average age = 58 y) met the search criteria. Thirty-six (62%) patients had malignancies. Surgical pathology material was obtained concurrently or following FNA in 20 cases (34%). There was 73% concordance between FNA and autopsy findings, which compares to 80% concordance between FNA and surgical pathology diagnoses. The FNA was determined to be at least possibly contributory to death in 7/58 cases (3 cases designated as "probable," and 4 as "possible").

CONCLUSION

Autopsy can be used to validate FNA diagnoses and, like surgical pathology, confirms that FNA diagnoses are mostly accurate. However, in a small number of patients, FNA can precipitate death.

Endoscopic/Endobronchial Ultrasound-Guided Fine Needle Aspiration and Ancillary Techniques, Particularly Flow Cytometry, in Diagnosing Deep-Seated Lymphomas

Evaluation of deep-seated lymphomas by fine-needle aspiration (FNA) can be challenging due to their reduced accessibility. Controversy remains as to whether FNA and ancillary techniques can be used to diagnose deep-seated lymphomas reliably and sufficiently for clinical management. Most published studies are favorable that endobronchial ultrasound (EBUS)/endoscopic ultrasound (EUS)-FNA plays an important role in the diagnosis of deep-seated lymphomas. The addition of ancillary techniques, particularly flow cytometry, increases diagnostic yield. While subclassification is possible in a reasonable proportion of cases, the reported rates of successful subclassification are lower than those for lymphoma detection/diagnosis. The diagnostic limitation exists for Hodgkin's lymphoma, grading of follicular lymphoma, and some T-cell lymphomas. The role of FNA in deep-seated lymphomas is much better established for recurrent than primary disease. It remains unclear whether the use of large-sized-needle FNA or a combination of core needle biopsy and FNA improves subclassification. It is important for cytopathologists to have considerable understanding of the WHO lymphoma classification and develop a collaborative working relationship with hematopathologists and oncologists. As EUS/EBUS-FNA techniques advance and sophisticated molecular techniques such as next- generation sequencing become possible, the role of FNA in the diagnosis of deep-seated lymphomas will possibly increase.

Real-time contrast enhanced ultrasound imaging of focal splenic lesions

OBJECTIVE

To investigate the imaging features of focal splenic lesions (FSLs) on contrast-enhanced ultrasound (CEUS).

METHODS

Thirty two patients with FSLs proved by pathology were retrospectively analyzed. CEUS was performed using intravenous bolus injection of 2.4 ml sulfur hexafluoride-filled microbubble contrast agent and real time scanning. There were hemangioma (n=7), lymphoma (n=8), true cyst (n=3), infarction (n=4), hematolymphangioma (n=2), metastasis tumor (n=2), and one for each of the following entities extramedullary hemopoiesis, hamartoma, tuberculosis, Langerhans' cell histiocytosis, inflammatory pseudotumor and myxofibrosarcoma.

RESULTS

Among 21 benign lesions, 4 infarctions and 3 cysts presented non-enhancement throughout CEUS scanning, and the other 14 lesions displayed various enhancement levels with 6 (42.9%) hyper-enhancement, 2 (14.3%) iso-enhancement and 6 (42.9%) hypo-enhancement in arterial phase and 11 (78.6%) hypo-enhancement, 1 (7.1%) iso-enhancement and 2 (14.3%) hyper-enhancement in late phase, respectively. The enhancement pattern included 9 (64.3%) homogeneous, 4 (28.6%) heterogeneous and 1 (7.1%) rim-like enhancement. As for the malignant FSLs, all the lesions became completely or extensively hypo-enhancement during the late phase no matter their vascularity during arterial phase.

CONCLUSIONS

The CEUS features reported in this series may enrich the knowledge for CEUS characterization of FSLs.