CT and MRI Findings of Focal Splenic Lesions and Ascites in Generalized Lymphatic Anomaly, Kaposiform Lymphangiomatosis, and Gorham-Stout Disease

Objectives: This study aimed to evaluate the CT and MRI findings of focal splenic lesions and ascites in generalized lymphatic anomaly (GLA), kaposiform lymphangiomatosis (KLA), and Gorham-Stout disease (GSD). Material and Methods: Twenty-three patients (10 with GLA, 5 with KLA, and 8 with GSD) who underwent abdominal CT and/or MRI before treatment were included in this study, and their imaging findings were retrospectively evaluated. Results: Focal splenic lesions were observed in nine patients; these lesions were observed frequently in GLA (n = 5; 50%) or KLA (n = 3; 60%) compared with GSD (n = 1; 13%); however, no significant differences were found between the three groups (P = 0.190). On CT images among eight patients (4 with GLA, 3 with KLA, and 1 with GSD) with focal splenic lesions who underwent CT, the number of focal splenic lesions per patient ranged from 2 to 189 (mean, 42) and the maximum diameter of focal splenic lesions ranged from 2 to 39 mm (mean, 8 mm), while more than 30 focal splenic lesions per patient were observed in 2 (50%) GLA and focal splenic lesions with maximum diameters of ≥10 mm were observed in 4 (100%) GLA but not in KLA or GSD. Ascites was observed in five patients; significant differences were observed among KLA (n = 4; 80%), GLA (n = 1; 10%), and GSD (n = 0; 0%) (P < 0.01). Ascites was significantly more frequent in KLA than in GSD (P < 0.05). Conclusion: More than 30 focal splenic lesions per patient and/or focal splenic lesions with maximum diameters of ≥10 mm were observed only in GLA. Focal splenic lesions tended to be less frequent in GSD, whereas ascites tended to be frequent in KLA.

Lesions in 224 spleens of splenectomized dogs and evalution of alternative techniques for previous microscopic diagnosis

ABSTRACT: When detecting a proliferative splenic lesion, veterinarians usually choose splenectomy before a conclusive diagnosis, which can provide a deleterious effect to the dog. The most appropriate would be to perform splenectomy as a therapeutic procedure only in cases with real surgical indication, which can be established after defining microscopic diagnosis and prognosis. The objectives of this study were: to determine the frequency of different types of lesions in spleens of splenectomized dogs in the period of 12 years (2006-2017); determine the representativity of neoplastic lesions (benign and malignant) and non-neoplastic lesions; to evaluate and compare the safety and efficiency of fine needle aspiration biopsy (FNA) and ultrasound-guided Tru-cut needle biopsy for cytological and histopathological diagnosis, respectively, of splenic nodular lesions. In the studied period 224 cases of lesions were found in splenectomized spleens. The frequency of non-neoplastic lesions (50,45%, 113/224) and neoplastic lesions (49,55%, 111/224) was very similar. Among the neoplastic lesions, the malignant ones were more frequent (79,27%, 88/111), and the hemangiosarcoma was the most common (52,25%, 58/111). The possibility of malignant neoplasm was about 74% greater than a benign one. In summary, it was verified that 60.71% (136/224) of the cases corresponded to benign lesions without indication to splenectomy. FNA techniques and Tru-cut biopsy showed a low risk of complications. Regarding the diagnostic efficacy, the FNA obtained 71.43% (15/21) of conclusive diagnoses, 60% (9/15) of which were compatible with the final result of the histopathological evaluation, after splenectomy (gold standard). The Tru-cut biopsy obtained 71.43% (5/7) of conclusive diagnoses and 28.57% (2/7) of inconclusive diagnoses. Among the conclusive one, in 100% of the cases the diagnosis was compatible with the gold standard. Thus, since the possibility of benign splenic lesions in dogs is 1.52 times greater than malignancies, splenectomy should be recommended as a therapeutic procedure only in cases with proven surgical indication, which can be established after definition of microscopic diagnosis and prognosis. The use of FNA and Tru-cut biopsy should be recommended, especially for small and focal splenic lesions, since such techniques are good alternatives for establishing diagnosis previously to splenectomy, which may reduce the number of unnecessary splenectomies. The importance of recommending such techniques is emphasized, especially for dogs with focal splenic lesions smaller than three centimeters.

Common and uncommon features of focal splenic lesions on contrast-enhanced ultrasound: a pictorial review

The characterization of focal splenic lesions by ultrasound can be quite challenging. The recent introduction of contrast-enhanced ultrasound (CEUS) has come to play a valuable role in the field of imaging splenic pathologies, offering the possibility of an ionizing radiation-free investigation. Because CEUS has been incorporated into everyday clinical practice, malignant diseases such as focal lymphomatous infiltration, metastatic deposits, benign cysts, traumatic fractures, and hemangiomas can now be accurately depicted and characterized without the need for further imaging. More specifically, splenic traumatic fractures do not require additional imaging by computed tomography (with ionizing radiation exposure) for follow-up, because splenic fractures and their complications are safely imaged with CEUS. In the new era of CEUS, more patients benefit from radiation-free investigation of splenic pathologies with high diagnostic accuracy.