Silverman J F, Geisinger K R, Raab S S, Stanley M W
Department of Pathology, East Carolina University School of Medicine, Greenville, North Carolina 27858-4354.
Acta Cytol. 1993 Mar-Apr;37(2):158-62.
Splenic fine needle aspiration (FNA) biopsy has been used mainly in Europe to diagnose nonneoplastic systemic diseases. A few reports have described FNA biopsy of the spleen for the diagnosis of lymphoma. There is a definite paucity of North American reports concerning FNA biopsy for metastatic disease involving the spleen; that probably is a reflection of both the relative infrequency of splenic metastases and concern about potential hemorrhagic complications of the procedure. We report a series of 11 FNA biopsies of the spleen in patients with known carcinoma or hematologic malignancies. The FNA biopsies were performed on eight males and three females with a median age of 45 years and a range of 6-77 years. Six patients had a known hematopoietic malignancy at the time of aspiration (five non-Hodgkin's lymphoma, one acute myelogenous leukemia [AML]). The one patient with Hodgkin's disease had an FNA biopsy of the spleen as part of the initial workup; cytologic impression was atypical lymphoid cells with granulomas suggestive of Hodgkin's disease, which was confirmed by splenectomy. Four patients with carcinoma (two testicular, one lung, one ovarian) had FNA biopsies for the evaluation of splenic nodules; FNA biopsy confirmed metastatic carcinoma in three of these patients. In the entire series splenic FNA biopsy documented malignancy in 6 of the 11 patients. The one patient with AML had Aspergillus identified in the splenic aspirate, while granulomatous inflammation with yeast consistent with Candida was seen in a patient with non-Hodgkin's lymphoma. One aspirate demonstrated abscesses without recognizable organisms, and another showed extensive necrosis in a patient with testicular choriocarcinoma. Only one hemorrhagic complication was noted following splenic biopsy. Our experience demonstrates that FNA biopsy of the spleen is a useful and safe procedure in evaluating infectious and neoplastic splenic masses in patients with hematopoietic malignancies and carcinoma.
脾脏细针穿刺抽吸活检（FNA）主要在欧洲用于诊断非肿瘤性全身性疾病。有少数报告描述了通过脾脏FNA活检来诊断淋巴瘤。关于FNA活检用于诊断累及脾脏的转移性疾病，北美地区的报告确实很少；这可能反映了脾脏转移相对少见，以及对该操作潜在出血并发症的担忧。我们报告了一系列11例已知患有癌或血液系统恶性肿瘤患者的脾脏FNA活检病例。FNA活检对8名男性和3名女性进行，中位年龄45岁，年龄范围为6至77岁。6例患者在穿刺时已知患有造血系统恶性肿瘤（5例非霍奇金淋巴瘤，1例急性髓性白血病[AML]）。1例霍奇金病患者在初始检查时进行了脾脏FNA活检；细胞学印象为非典型淋巴细胞伴肉芽肿，提示霍奇金病，脾切除证实了这一诊断。4例癌患者（2例睾丸癌、1例肺癌、1例卵巢癌）因评估脾脏结节而进行FNA活检；其中3例患者经FNA活检确诊为转移性癌。在整个系列中，11例患者中有6例经脾脏FNA活检证实为恶性肿瘤。1例AML患者的脾脏抽吸物中发现曲霉菌，1例非霍奇金淋巴瘤患者可见与念珠菌相符的肉芽肿性炎症伴酵母。1例抽吸物显示有脓肿但未发现可识别的微生物，另1例睾丸绒毛膜癌患者显示广泛坏死。脾脏活检后仅记录到1例出血并发症。我们的经验表明，脾脏FNA活检在评估造血系统恶性肿瘤和癌患者的感染性和肿瘤性脾脏肿块方面是一种有用且安全的操作。
