Fine-needle aspiration biopsy for the primary diagnosis of lymphoproliferative disorders involving the spleen: One institution's experience and review of the literature

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.

Diagnostic pitfalls in fine needle aspiration biopsy of the spleen

“…Lymphoma is the most commonly encountered diagnosis with an average diagnostic accuracy of 67% for cytomorphology alone and 78% when flow cytometry is added to the diagnostic work up. 16,17,20 Although these reports only indicate the percentage of correct diagnosis, we report a similar percentage with an accuracy of 87% (sensitivity of 94%, specificity of 84%, and positive predictive value of 79%). In most reports, primary vascular lesions of the spleen are the major source of diagnostic pitfalls 12 as well as sampling error and neoplasms with extensive necrosis.…”

“…In most reports, primary vascular lesions of the spleen are the major source of diagnostic pitfalls 12 as well as sampling error and neoplasms with extensive necrosis. 17 A list of diagnostic pitfalls identified in our study is illustrated in Table IV. In this study, the most common malignant neoplasm involving the spleen was lymphoma, which is consistent with previously reported studies. 5,11,14,17,20,21 In the largest multi-center study investigating splenic lesions, large cell lymphoma was the most common type of non-Hodgkin's lymphoma involving the spleen.…”

“…17 A list of diagnostic pitfalls identified in our study is illustrated in Table IV. In this study, the most common malignant neoplasm involving the spleen was lymphoma, which is consistent with previously reported studies. 5,11,14,17,20,21 In the largest multi-center study investigating splenic lesions, large cell lymphoma was the most common type of non-Hodgkin's lymphoma involving the spleen. 21 Similarly, large B-cell lymphoma was the most common type encountered in our institution.…”

“…Other institutions have similarly reported a steady increase in the use of this procedure. 11,16,17 Over the 9-year range of this study, the majority of specimens (36/41) were obtained within the past 3 year. The primary reason for the procedure was assessment of metastatic malignancy to the spleen.…”

Percutaneous Image-guided Biopsy of the Spleen: Systematic Review and Meta-Analysis of the Complication Rate and Diagnostic Accuracy

“…Several more recent publications have reported much lower complication rates with smaller needle diameters (18 gauge or smaller) ( 5,6,16 ). Diseases that commonly affect the spleen can pose a diagnostic challenge to the clinician, radiologist, and pathologist, and the reported diagnostic accuracy of splenic biopsy varies, ranging between 84% and 90% ( 5,14,(16)(17)(18)(19)(20)(21).…”