Diagnosis of Splenic Lymphoma by Endoscopic Ultrasound Guided Fine Needle Aspiration: A Case Report and Review of the Literature

Abstract

Introduction. Splenic tumor is usually found as an incidental finding on CT of abdomen. Traditionally, ultrasound (US) or computed tomography (CT) guided biopsies were employed for the purpose of sampling; however they have been reported to have a complication rate of 5.3%. Endoscopic ultrasound-fine needle aspiration (EUS-FNA) has been recently utilized for the purpose of sampling splenic tumors. In literature there are 7 reported instances where splenic lymphoma was diagnosed using EUS-FNA. We present a case of follicular B cell lymphoma of the spleen diagnosed using EUS-FNA. Case Report. 58-year-old female presented to her primary care physician for left upper quadrant abdominal pain for one week. Physical exam was significant for left upper quadrant tenderness. Her laboratory tests were within normal limits. She underwent CT scan of abdomen which revealed approximately 5 cm × 5 cm mass in spleen. EUS-FNA of the spleen revealed a large hypoechoic, heterogeneous, well-demarcated mass measuring 54.7 mm × 43.0 mm. Fine needle aspiration was performed, and the sample was submitted for cytology and flow cytometry. Flow cytometry revealed a lambda monotypic population of B cells displaying dim CD19 and CD10. Diagnosis of B cell non-Hodgkin low grade follicular lymphoma was made. Conclusion. Endoscopic ultrasound with fine needle aspiration is a very rare but safe, reliable method of diagnosis of splenic lymphomas.

Endoscopic ultrasound-guided tissue acquisition for splenic lesions: A systematic review and meta-analysis of diagnostic test accuracy

“…In this analyze, we got a discouraging false-negetive rate of 9.84% (6 of 61 cases). Uma et al [ 29 ] considered false positive rates were not affected by sampling techniques and they were especially higher in lymphoma patients. However, the pooled DOR in our study expressed that the odds of developing disease for the people with a positive results are more than eight times greater than for the people with a negtive results.…”

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

“…We found 42 cases in PubMed from 2003 to 2018 in which patients underwent EUS-FNA for splenic tumors. Among them, we examined nine cases with a diagnosis of ML 13 14 15 16 17 18 . The median age of subjects was 60 (age 41–83), including five males and four females.…”

An international, multi-institution survey on performing EUS-FNA and fine needle biopsy

“…Traditionally, ultrasonography- or computed tomography-guided biopsies are employed for tissue sampling; EUS-FNA has been recently utilized for sampling splenic tumors. [ 17 ]…”