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Detection of spleen abscesses facilitates diagnosis of melioidosis in Malaysian children. Int J Infect Dis 2020; 98:59-66. [PMID: 32535300 DOI: 10.1016/j.ijid.2020.06.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES Melioidosis is associated with extremely high case fatality ratios. The aim of this study was to determine whether detection of abdominal visceral abscesses can facilitate diagnosis of melioidosis in children. METHODS We conducted a retrospective analysis of all children who had liver and/or spleen abscesses on abdominal ultrasonography admitted to Bintulu Hospital in Sarawak, Malaysia, from January 2014 until December 2018. RESULTS Fifty-three children had liver and/or spleen abscesses. Spleen abscesses were present in 48 (91%) cases; liver abscesses in 15 (28%). Melioidosis was confirmed by culture in 9 (17%) children; small occult splenic abscesses were present in all cases. In 78% of these cases, the lesions were detected before any positive culture (or serology) results were available. Four (8%) children had bacteriologically-confirmed tuberculosis. Two (4%) had Staphylococcus aureus infection. Of the remaining 38 (72%) culture-negative cases, 36 (95%) had clinical and imaging characteristics similar to that of children with culture-confirmed melioidosis and improved with empirical melioidosis antibiotic therapy. CONCLUSIONS A large number of children in Bintulu Hospital in Sarawak, Malaysia, were found to have spleen abscesses. Melioidosis was the most common etiology identified in these children. Abdominal ultrasonography is extremely useful in facilitating the diagnosis of pediatric melioidosis.
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Sharma S, Singh P, Gupta P, Lal A, Srinivasan R. Primary Splenic Angiosarcoma with Liver Metastasis: A Rare Neoplasm Diagnosed on Fine-needle Aspiration Cytology and Cell Block Immunocytochemistry. J Cytol 2018; 35:114-116. [PMID: 29643660 PMCID: PMC5885599 DOI: 10.4103/joc.joc_148_16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Primary splenic angiosarcoma is a rare malignant vascular neoplasm of mesenchymal origin. The tumor is highly aggressive and has a high metastatic potential. It is usually diagnosed on histopathological examination of splenectomy specimen. Only few cases of angiosarcoma diagnosed by fine-needle aspiration (FNA) cytology alone have been reported in the literature. The cytologic features of angiosarcoma are heterogeneous, however, diagnosis can be suggested by FNA when vasoformative features are present. A 55-year-old female presented with abdominal pain and hepatosplenomegaly. Computed tomography scan revealed a heterogeneous splenic lesion with liver metastases. FNA from the splenic and liver lesions showed moderately pleomorphic tumor cells closely associated with anastomosing vascular channels. Cell block immunocytochemistry (ICC) showed tumor cells positive for CD31, CD34, CD68 as well as for CD99. FNA supplemented by cell block ICC can render a definite diagnosis of primary splenic angiosarcoma with liver metastasis.
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Affiliation(s)
- Saniya Sharma
- Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Priya Singh
- Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Anupam Lal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Radhika Srinivasan
- Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Handa U, Tiwari A, Singhal N, Mohan H, Kaur R. Utility of ultrasound-guided fine-needle aspiration in splenic lesions. Diagn Cytopathol 2011; 41:1038-42. [PMID: 21953852 DOI: 10.1002/dc.21812] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 07/18/2011] [Indexed: 12/20/2022]
Abstract
Indications of fine-needle aspiration (FNA) of spleen have increased as more splenic lesions are detected because of advanced imaging techniques. A retrospective analysis of cytological material of 36 patients on whom ultrasound-guided splenic FNA was performed was done. No complications were noted. There were 16 inflammatory lesions, 12 neoplastic and 8 cases were reported as descriptive either because of scant cellularity, blood only, or normal splenic cytology. Inflammatory lesions included nine cases of acute abscess, five cases of tuberculosis, and one case each of leishmaniasis and infarct. Neoplastic lesions included two benign (benign cyst and inflammatory pseudotumor) and 10 malignant lesions. Among malignant lesions, eight were non-Hodgkin lymphoma (NHL), one suspicious of NHL, and one desmoplastic small round cell tumor. FNA proved to be an effective procedure for reaching a microscopic tissue diagnosis and thus a splenectomy could be avoided in cases where it was not required.
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Affiliation(s)
- Uma Handa
- Department of Pathology, Government Medical College & Hospital, Chandigarh, India
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Han B, Yang Z, Yang T, Gao W, Sang X, Zhao Y, Shen T. Diagnostic splenectomy in patients with fever of unknown origin and splenomegaly. Acta Haematol 2008; 119:83-8. [PMID: 18305380 DOI: 10.1159/000118632] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2007] [Accepted: 12/08/2007] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To review the diagnostic significance, safety and possible risk factors of splenectomy in fever of unknown origin (FUO) with splenomegaly. METHODS The records of 54 patients with FUO and splenomegaly who underwent splenectomy in our hospital in the past 20 years were reviewed retrospectively. Pathologic findings, morbidity, mortality and possible risk factors were analyzed. RESULTS Histologic findings included 29 cases of non-Hodgkin lymphoma, 4 cases of spleen tuberculosis, 3 cases of Hodgkin lymphoma, 1 case of Castleman disease and 2 cases of hemophagocytic syndrome. An etiologic diagnosis was made in 72.2% of the patients undergoing splenectomy. Surgical complications occurred in 25.9% of the patients and 1-month operative mortality was 16.7%. The mortality rate 1 month after surgery was significantly associated with serous cavity effusion (46.2 vs. 7.5%, p = 0.006) and spleen weight >1,500 g (50.0 vs. 9.1%, p = 0.007). There was no significant difference in the mortality rate of the patients with or without jaundice, pancytopenia, elevated serum alanine aminotransferase (ALT) or elevated LDH (p > 0.5). Multivariate analysis revealed serous cavity effusion (odds ratio 21.0; 95% confidence interval 2.2-212.8; p = 0.01) and spleen weight >1,500 g (odds ratio 18.0; 95% confidence interval 1.9-173.8; p = 0.01) as independent risk factors. CONCLUSION Splenectomy is an effective diagnostic modality for FUO presenting with splenomegaly. The presence of serous cavity effusions and spleen weight >1,500 g identifies patients with the greatest operative risk.
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Affiliation(s)
- Bing Han
- Department of Hematology, Peking Union Medical College Hospital, Beijing, China
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Bofinger JJ, Schlossberg D. Fever of unknown origin caused by tuberculosis. Infect Dis Clin North Am 2008; 21:947-62, viii. [PMID: 18061084 DOI: 10.1016/j.idc.2007.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Tuberculosis is an important cause of fever of unknown origin. Travel, age, dialysis, diabetes, birth in a country with a high prevalence of tuberculosis, and immunoincompetence are among the most salient risks. Associated physical findings, radiologic evaluation, and hematologic and endocrinologic abnormalities may provide clues to the diagnosis. Both noninvasive and invasive diagnostic modalities are reviewed. Because diagnosis may be elusive, therapeutic and diagnostic trials of antituberculous therapy should be considered in all patients with fever of unknown origin who defy diagnosis.
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Affiliation(s)
- Jason J Bofinger
- Section of Infectious Diseases, Temple University Hospital, Parkinson Pavilion, Philadelphia, PA 19140, USA
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Mantur BG, Mulimani MS, Bidari LH, Akki AS, Tikare NV. Splenic puncture: diagnostic accuracy and safety in infectious diseases. Int J Infect Dis 2007; 12:446-7. [PMID: 18082440 DOI: 10.1016/j.ijid.2007.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2007] [Accepted: 10/04/2007] [Indexed: 10/22/2022] Open
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Kumar PV, Monabati A, Raseki AR, Arshadi C, Malek-Hosseini SA, Talei AR, Sadeghi E. Splenic lesions: FNA findings in 48 cases. Cytopathology 2007; 18:151-6. [PMID: 17573764 DOI: 10.1111/j.1365-2303.2007.00414.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To study fine needle aspiration (FNA) cytological findings of splenic lesions and assess the role of FNA in the diagnosis of splenomegaly or splenic tumours. METHODS This study consisted of 48 cases, 25 males and 23 females. The ages ranged between 3 and 71 years. Most of these cases were aspirated under ultrasonographic guidance and a small number were also aspirated directly by using a 22- to 23-gauge needles. The smears were stained with Wright-Giemsa and Papanicolaou methods. Special stains were used whenever necessary. RESULTS In this study 14 cases were diagnosed as lymphoma-leukaemia, 7 cases as tuberculosis, 12 cases as kala-azar, 2 cases as hydatid cyst, 3 cases as storage diseases, 3 cases as simple cyst, 2 cases as myeloproliferative disorders, 2 cases as malignant tumours and 3 cases as hamartomas (these were wrongly diagnosed as malignant tumours). CONCLUSION Splenic aspiration is a safe procedure and is very useful in the diagnosis of parasitic and infectious diseases, especially in endemic countries like Iran.
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Affiliation(s)
- P V Kumar
- Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran.
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De Backer AI, Vanhoenacker FM, Mortelé KJ, Vanschoubroeck IJ, De Keulenaer BL, Parizel PM. MRI Features of Focal Splenic Lesions in Patients with Disseminated Tuberculosis. AJR Am J Roentgenol 2006; 186:1097-102. [PMID: 16554586 DOI: 10.2214/ajr.05.0032] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study is to describe the MRI features of focal splenic lesions in patients with disseminated tuberculosis. CONCLUSION Tuberculous focal splenic lesions are small, multiple, and most often associated with splenomegaly. Signal intensities vary on both T1- and T2-weighted images. Two different enhancement patterns are noted: peripheral enhancement and gradual peripheral enhancement with complete fill-in.
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Affiliation(s)
- Adelard I De Backer
- Department of Radiology, Universitair Ziekenhuis Antwerpen, University of Antwerp, B-2650 Edegem, Belgium.
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Ramdall RB, Cai G, Alasio TM, Levine P. Fine-needle aspiration biopsy for the primary diagnosis of lymphoproliferative disorders involving the spleen: One institution's experience and review of the literature. Diagn Cytopathol 2006; 34:812-7. [PMID: 17115435 DOI: 10.1002/dc.20559] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report the fine-needle aspiration (FNA) biopsy findings for the primary diagnosis of lymphoproliferative disorders involving the spleen. We analyzed six cases of primary diagnosed lymphoma involving the spleen and out of these cases, identified one case of primary splenic lymphoma. We explore the potential pitfalls and difficulties encountered in making a primary diagnosis of lymphoma involving the spleen and how the preparation of the specimen for flow cytometric studies and/or cell block for immunohistochemical analysis can greatly aid in making a definitive diagnosis. To the best of our knowledge, this is the first report of T-cell rich B-cell subtype of diffuse large B-cell lymphoma and only the second report of primary splenic lymphoma of the spleen diagnosed by FNA biopsy. An extensive review and analysis of the literature involving FNA biopsy of the spleen is also discussed.
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Affiliation(s)
- Risha B Ramdall
- Department of Pathology, New York University Hospitals Center, Bellevue Hospital Medical Center, 462 First Avenue, New York, NY 10016, USA
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Zeppa P, Picardi M, Marino G, Troncone G, Fulciniti F, Vetrani A, Rotoli B, Palombini L. Fine-needle aspiration biopsy and flow cytometry immunophenotyping of lymphoid and myeloproliferative disorders of the spleen. Cancer 2003; 99:118-27. [PMID: 12704692 DOI: 10.1002/cncr.11011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Flow cytometry (FC) is a useful adjunct to fine-needle aspiration biopsy (FNAB) in the evaluation of lymphoproliferative disorders. The application of FC to FNAB of the spleen (sFNAB) is reported. METHODS Flow cytometry was performed on 18 sFNAB collected over 3 years. The series comprised 10 cases of non- Hodgkin lymphomas (NHL), 2 cases insufficient for diagnosis, 2 cases of reactive hyperplasia (RH), and 4 cases of myeloid metaplasia (MM). FNAB was performed under ultrasound guidance using a 22-gauge needle. One or two passes were sufficient to prepare a conventional smear that was immediately evaluated to select the cases studied and to prepare a cell suspension for FC. The following fluoresceinated antibodies were used: CD3, CD19/kappa/lambda, FMC7/CD23/CD19, Bcl-2, and CD13/HLA-DR. In six cases, cytospins were also prepared for immunocytochemistry and were tested for CD20 (L26), CD45Ro, and kappa and lambda light chain expression. RESULTS Flow cytometry contributed to the diagnosis of all cases of NHL by assessing light chain restriction. The specific subtype was also diagnosed by CD19/CD5 and CD 19/CD10 coexpression in two cases. Flow cytometry quantified the percentage of myeloid cells in MM cases and contributed to the cytologic diagnosis showing a polyclonal light chain expression in RH cases. Immunocytochemistry was effective and concordant in four cases. Patients tolerated the sFNAB well and no complications were reported. Cytologic and FC diagnoses were confirmed by follow-up and by histologic evaluation in cases in which splenectomy was performed for therapeutic purposes. CONCLUSION Flow cytometry applied to sFNAB corroborates the cytologic diagnosis in lymphoid and myeloproliferative disorders of the spleen and allows therapeutic decisions avoiding splenectomy.
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Affiliation(s)
- Pio Zeppa
- Dipartimento di Anatomia Patologica e Citopatologia, Facoltà di Medicina e Chirurgia, Università di Napoli "Federico II," Napoli, Italy
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Abstract
Invasive aspergillosis is a rare but important cause of morbidity and mortality in patients with AIDS. In the majority of patients, invasive aspergillosis involves the lungs. Extrapulmonary involvement with total splenic infarction has not been previously described. We illustrate a patient who developed total splenic infarction and septic emboli to the brain from Aspergillus.
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Affiliation(s)
- F H Miller
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Medical School, 676 North St. Clair Street, Suite 800, Chicago, IL 60611, USA.
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Kumar N, Jain S, Singh ZN. Disseminated histoplasmosis with reactive hemophagocytosis: aspiration cytology findings in two cases. Diagn Cytopathol 2000; 23:422-4. [PMID: 11074651 DOI: 10.1002/1097-0339(200012)23:6<422::aid-dc13>3.0.co;2-f] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Two cases of disseminated histoplasmosis associated with reactive hemophagocytic syndrome are described. The clinical presentation was with prolonged unexplained fever and hepatosplenomegaly. On a strong clinical possibility of tuberculosis, antitubercular treatment was initiated in both patients. Lymph node (case 1), splenic (case 2), and bone marrow aspiration, however, showed sheets of proliferating histiocytes, and intracellular and extracellular histoplasma organisms. Aspiration cytology was thus valuable in establishing the final diagnosis. The patients had a fulminant clinical course and died of hemorrhagic shock within 48 hr of hospital admission before specific therapy could be initiated. Histoplasmosis can mimic tuberculosis clinically. There is a need for an increased awareness of the clinicopathological spectrum of histoplasmosis, especially its rarer manifestations as hemophagocytic syndrome. In suspected cases, aspirations from the lymph node, liver, and spleen can be performed safely and should be utilized for early diagnosis.
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Affiliation(s)
- N Kumar
- Cytopathology Laboratory, Department of Pathology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
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Abstract
Invasive aspergillosis is a rare but important cause of morbidity and mortality in patients with AIDS. In the majority of patients, invasive aspergillosis involves the lungs. Extrapulmonary involvement with total splenic infarction has not been previously described. We illustrate a patient who developed total splenic infarction and septic emboli to the brain from Aspergillus.
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Affiliation(s)
- F H Miller
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Medical School, 676 North St. Clair Street Suite 800, Chicago, IL 60611, USA.
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Mehrotra R, Sharma K. Cytodiagnosis of tuberculosis of the skull by fine needle aspiration cytology: a case report. Pathology 2000. [DOI: 10.1080/pat.32.3.213.215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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