Thoracic splenosis diagnosed by fine-needle aspiration cytology: a case report

Our plain-English summary of Thoracic splenosis diagnosed by fine-needle aspiration cytology: a case report, by S. Syed, P. Zaharopoulos (Diagnostic Cytopathology, 2001).

The study

• Authors: S. Syed, P. Zaharopoulos
• Journal: Diagnostic Cytopathology
• Published: 2001;25(5):321-4
• Type of article: Case report
• Cited by: 19 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A case of thoracic splenosis diagnosed by fine-needle aspiration (FNA) of subpleural lung lesions is presented. The patient, a 49-yr-old male with a history of gunshot wound to his trunk with splenic rupture and splenectomy several years previously, presented with recent hemoptysis and multiple subpleural solid nodules shown in the left lung field by CT scan. As the possibility of a metastatic malignancy vs. mesothelioma was entertained, an FNA was performed on one of these lesions, revealing lymphoid tissue with abundant vascularity simulating the structure of splenic tissue. In view of this finding, supported by the absence of splenic outline in the CT radiograph, the diagnosis of splenosis was made. This is the fourth reported case of thoracic splenosis in which FNA cytology was utilized for diagnosis, yet the first in which the diagnosis was based exclusively on the FNA cytologic findings. Clinical, pathologic, and diagnostic aspects of this entity are discussed.

Copyright 2001 Wiley-Liss, Inc.

In plain English

This article was a case report about one patient, a 49-year-old man who had coughed up small amounts of blood on and off for two weeks. Several years earlier he had been shot in the left side of his trunk and had his spleen removed in emergency surgery. A CT scan showed multiple nodules, up to 4 cm across, beneath the lining of the left lung. Some looked suspicious for cancer, and doctors considered metastatic cancer versus mesothelioma. A fine-needle sample from one nodule showed benign lymphoid tissue with many small blood vessels resembling spleen tissue. Taking this together with the CT finding of no spleen, the doctors diagnosed thoracic splenosis, which is spleen tissue growing in the chest after injury. No core biopsy was done because of bleeding risk, and the patient was discharged for outpatient monitoring. The authors described this as the fourth reported case of thoracic splenosis using needle cytology, and the first diagnosed on cytology alone. They noted that radioisotope scans, if performed, could have made the needle sample unnecessary. The article does not discuss asbestos exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report
• Who was studied: One 49-year-old man with two weeks of intermittent, limited hemoptysis (coughing up blood). He smoked cigarettes, had hepatitis C, and had a history of a gunshot wound to the left trunk treated by emergency laparotomy with splenectomy several years earlier.
• Main results:
  • CT showed multiple subpleural nodules in the left hemithorax, measuring up to 4 cm in diameter.
  • Before the needle sample, metastatic malignancy versus mesothelioma was considered.
  • The CT-guided fine-needle aspiration of one nodule showed lymphoid tissue with no atypical forms, indicating a benign process. The sample suggested splenic tissue.
  • The diagnosis of splenosis was made from the cytology, together with the CT showing no spleen. Confirmation by core biopsy was not done because of the risk of hemorrhage.
  • The patient was discharged so his lesions could be monitored as an outpatient.
  • The authors described this as the fourth reported case of thoracic splenosis in which FNA cytology was used for diagnosis, and the first diagnosed only on the FNA cytologic findings.
• The authors' conclusion: The authors concluded that FNA can be of use in diagnosing thoracic splenosis. In this case the specimen was adequate enough to permit the diagnosis without ancillary studies.
• Limitations the authors state:
  • The authors noted that radioisotope localization studies, had they been performed, could have eliminated the need for the FNA diagnosis.

Topics

Medical terms in this study, explained in our Lexicon: Fine-Needle Aspiration, Cytology, Hemoptysis, CT Scan, Mesothelioma.

Related studies

• Advantages of thoracic ultrasound-guided fine-needle aspiration biopsy in lung cancer and mesothelioma — M. Sperandeo, L. Dimitri, et al. (2014)
• The potential value of comparative genomic hybridization analysis in effusion-and fine needle aspiration cytology — H. Nagel, H.J. Schulten, et al. (2002)
• Fine-needle aspiration cytology of multicystic mesothelioma — K. Devaney, P.J. Kragel, et al. (1992)
• Rounded atelectasis: diagnosis by fine-needle aspiration cytology — W.T. Miller, P.K. Gupta, et al. (1992)
• Fine needle aspiration cytology of well-differentiated papillary mesothelioma: a case report — Y. Gong, R. Ren, et al. (2005)
• Fine-needle aspiration cytology of localized fibrous tumor of pleura — D. Dusenbery, M.M. Grimes, et al. (1992)

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