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. 2021 Jan;9(1):E96-E101.
doi: 10.1055/a-1287-9577. Epub 2021 Jan 1.

Usefulness of endoscopic ultrasound-guided fine needle aspiration for splenic parenchyma in patients suspected of having primary splenic malignant lymphoma

Fumitaka Niiya  1 , Yuichi Takano  1 , Tetsushi Azami  1 , Takahiro Kobayashi  1 , Naotaka Maruoka  1 , Nobuyuki Kabasawa  2 , Hiroshi Harada  2 , Tomoko Norose  3 , Nobuyuki Ohike  3 , Masatsugu Nagahama  1
Affiliations

Usefulness of endoscopic ultrasound-guided fine needle aspiration for splenic parenchyma in patients suspected of having primary splenic malignant lymphoma

Fumitaka Niiya et al. Endosc Int Open. 2021 Jan.

Abstract

Background and study aims The diagnosis of malignant lymphoma (ML) is sometimes difficult, especially in patients with primary splenic malignant lymphomas (psML) which have no lymph nodes capable of acting as the biopsy target. We carried out endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for "splenic parenchyma" in patients suspected of having a psML, even without any obvious neoplastic lesions in the spleen. Patients and methods A retrospective study using medical records was conducted of eight patients suspected of having a psML that received EUS-FNA for the splenic parenchyma between January 2016 and January 2019. Data analyzed included clinical background, EUS-FNA procedure (puncture needle/route), diagnostic ability (pathological/flow cytometry [FCM]), and complications. Results EUS-FNA was performed from the stomach in all eight cases, and no patients had complications. As a result of splenic parenchymal biopsy found on EUS-FNA, 75 % of patients (6/8) were histologically diagnosed with MLs, monoclonality of B-cells was identified in all cases (8/8) with FCM, and all patients (8/8) were definitively diagnosed with psMLs. Conclusion EUS-FNA for "splenic parenchyma" is useful for patients with spML, even if they have no obvious neoplastic lesions in the spleen.

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Conflict of interest statement

Competing interests The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
A 69-year-old man with thrombocytopenia accompanied by fever and weight loss and was referred to the Hematology Department for suspected malignant lymphoma (Case 2 in the tables). a Computed tomography shows marked splenomegaly. However, there is no enlarged lymph nodes in the body nor is there an obvious neoplastic lesion in the spleen. Primary splenic malignant lymphoma was suspected. b Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was carried out on the splenic parenchyma. c Histology of bone marrow biopsy shows three types of hematopoietic cells, but no clear blastic cell proliferation.
Fig. 2
Fig. 2
Histology of EUS-FNA shows atypical lymphoid cells with relatively large nuclei were found to aggregate (Case 2 in the tables). These cells were positive for expression of CD20 on immunohistological staining. The patient was finally diagnosed with primary splenic malignant lymphoma (diffuse large B-cell lymphoma).
See this image and copyright information in PMC

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