Two Cases with Isolated Splenic Sarcoidosis Diagnosed by an Ultrasound-guided Fine-needle Aspiration Biopsy

Abstract

Asymptomatic splenic nodules were detected incidentally in two middle-aged women at an annual checkup. They showed no abnormalities on laboratory tests, but imaging studies revealed splenic nodules. No other localized lesions were found. Splenic nodules were hypoechoic on ultrasonography (US), hypovascular on contrast-enhanced computed tomography, and showed a low intensity on T2-weighted magnetic resonance imaging. We performed US-guided percutaneous aspiration biopsies using 21-gauge needles without complications, including bleeding. Pathological specimens showed noncaseating granulomas, so both patients were diagnosed with isolated splenic sarcoidosis. A US-guided fine-needle aspiration biopsy is a safe and useful method for diagnosing splenic nodules.

Keywords: fine-needle aspiration biopsy; isolated splenic sarcoidosis; ultrasonography.

Figure 1.

Case 1; fat suppressed T2 weighted MRI images at a) January 2014, b) March, 2015, c) January, 2016 and d) May, 2016.

Figure 2.

Case 1; splenic nodules on admission. a) Ultrasonography showed a hypoechoic nodule, 11.2 mm (A) ×11.4 mm (B). Contrast enhanced CT at b) arterial phase and c) equilibrium phase. Plain MRI on d) T1, e) T2 and f) fat suppression T2 weighted images.

Figure 3.

Pathological specimens (Hematoxylin and Eosin staining) obtained by 21-guage needle aspiration biopsies, a) b) case 1 and c) d) case 2. They showed compact epithelioid cell granulomas. Langhans-type multinucleated giant cells were contained in case 1 (arrows), but not in case 2.

Figure 4.

Case 2; splenic nodule on admission. a) Ultrasonography, b) plain CT, contrast enhanced CT at c) early phase and d) late phase, and e) gallium scintigraphy. Plain MRI on f) T1, g) T2 and h) fat suppressed T2 weighted images, and gadolinium enhanced MRI at i) early phase, j) late phase and k) equilibrium phase.