Case Study

Lymphoma diagnosed on FNA in the spleen and liver of a 9 year old MN English Pointer

A 9-year-old MN English Pointer was presented for decreased appetite, weight loss, lethargy, and halitosis. Physical examination findings were generalized muscle wasting and slightly pale mucous membranes. The only abnormality on urinalysis was trace proteinuria; UPC showed borderline proteinuria. Abnormalities on CBC were anemia and thrombocytopenia. The patient was treated with Prednisone pending an ultrasound.

Sonographic Differential Diagnosis

The appearance of the spleen is most consistent with hypersplenism and reactive hyperplasia deriving from splenic white or red pulp. However, early infiltrative disease, such as lymphoma or mast cell neoplasia can, at times, present in this manner. US-guided FNA is best in this case in order to ensure only reactive hyperplasia is present.

Image Interpretation

The liver was swollen in contour with thickened gallbladder. The common bile duct was normal. A minor amount of ascites was noted. The spleen was uniformly enlarged with relatively uniform parenchyma without evidence of masses. The capsule was mildly swollen.

DX

Lymphoma in both spleen and liver

Outcome

A doxycycline trial was recommended for the patient. Before treatment was started the patient died at home.

Comments

When infiltrative disease is a possibility for spleen and liver it is very useful to the cytologist to have cytology from both organs. If similar neoplastic cell populations are present in both spleen and liver, as was the case in this patient, then the diagnosis tends to be more definitive as opposed to diagnosing simple splenic “lymphoid hyperplasia, potential lymphoma” when receiving only splenic aspirates in cases such as these.