Published online Feb 27, 2024. doi: 10.4240/wjgs.v16.i2.616
Peer-review started: November 8, 2023
First decision: December 6, 2023
Revised: December 18, 2023
Accepted: January 25, 2024
Article in press: January 25, 2024
Published online: February 27, 2024
Processing time: 108 Days and 22.2 Hours
The overlap of imaging manifestations among distinct splenic lesions gives rise to a diagnostic dilemma. Consequently, a definitive diagnosis primarily relies on his
A 41-year-old female, with a history of pulmonary tuberculosis, was admitted to our hospital with multiple indeterminate splenic lesions. Gray-scale ultrasonography demonstrated splenomegaly with numerous well-defined hypoechoic ma
Percutaneous US-guided coaxial CNB is an excellent and safe option for obtaining precise splenic tissue samples, as it significantly enhances sample yield for exact pathological analysis with minimum trauma to the spleen parenchyma and sur
Core Tip: Multiple splenic lesions caused by infection, lymphoma, sarcoid, metastasis and infarction may have similar imaging features. The overlapping imaging characteristics of splenic lesions cause a diagnostic dilemma. Consequently, a definitive diagnosis primarily relies on histological results. We describe a case of multiple indeterminate splenic lesions and confirmed the diagnosis with an ultrasound (US)-guided coaxial core needle biopsy (CNB). US-guided CNB is a safe and efficient puncture technique providing valuable diagnostic information and patient treatment guidance.
- Citation: Pu SH, Bao WYG, Jiang ZP, Yang R, Lu Q. Percutaneous ultrasound-guided coaxial core needle biopsy for the diagnosis of multiple splenic lesions: A case report. World J Gastrointest Surg 2024; 16(2): 616-621
- URL: https://www.wjgnet.com/1948-9366/full/v16/i2/616.htm
- DOI: https://dx.doi.org/10.4240/wjgs.v16.i2.616
Multiple splenic lesions can be caused by a variety of benign or malignant diseases, including infection, primary tumor, and metastasis[1]. Non-specific characteristics on imaging frequently pose a diagnostic dilemma[2,3]. Histological exa
A 41-year-old female was admitted to our hospital with focal splenic lesions discovered during routine abdominal ultrasonography as a part of health checkup.
The patient was in good health and did not report any discomfort.
One year ago, the patient was admitted to the tuberculosis (TB) medical unit due to recurrent fever and cough, and was diagnosed with pulmonary TB. Subsequently, 2HRZE/7HRE (strengthening period: Isoniazid 300 mg, rifampicin 450 mg, pyrazinamide 0.75 g, ethambutol 0.75 g, once a day, given for 2 months; consolidation period: Isoniazid 300 mg, rifam
Patient and family histories were negative.
The patient did not complain of any abdominal pain or distension.
Carbohydrate antigen 125 was mildly elevated, and other tumor markers including alpha-fetoprotein, carcinoembryonic antigen, and carbohydrate antigen 199 were within the normal range. Other biochemical results were unremarkable.
Grayscale US demonstrated splenomegaly with numerous well-defined hypoechoic masses (Figure 1A). Color Doppler imaging indicated no significant blood flow signals within these lesions (Figure 1B). Contrast-enhanced US (CEUS) sh
The differential diagnoses based on clinical and radiological results included splenic tuberculosis, fungal infection, metastasis, lymphoma and hemangioma. For further diagnostic analyses, the US-guided coaxial CNB for histological diagnosis was performed by a doctor with over 5 years of experience in interventional US. Platelet count and pro
Histological analysis showed no evidence of malignancy, but the proliferation of fibrous tissue and hyaline degeneration were observed in some areas. Granulomas were noted in focal areas, accompanied by peripheral lymphoid hyperplasia involving infiltration of neutrophils, monocytes, and plasma cells (Figure 4). Immunohistochemistry revealed CD20+ and CD3+ cells, in addition to some CD8+ cells. Acid-fast and methenamine silver stain did not reveal any pathogens. No mycobacterium TB DNA fragments were observed in the TB-quantitative real-time polymerase chain reaction. These findings supported the diagnosis of chronic granulomatous inflammation with necrosis, but did not exclude specific infections (TB).
The patient opted for follow-up observation and underwent regular conventional US for ongoing monitoring.
Follow-up US 6 months later revealed that the lesions found on the initial examination were unchanged. The patient is presently in good physical condition without any discomfort.
Multiple splenic lesions caused by infection, lymphoma, sarcoid, metastasis and infarction may have similar imaging features[1]. The overlapping imaging characteristics of splenic lesions cause a diagnostic dilemma[2,3]. Hence, there is a need for confirmation by tissue biopsy. The US-guided coaxial CNB is considered a valuable technique for obtaining ample tissue for definitive diagnosis and to reduce puncture-related complications[8,9].
Spleen tissue samples can be obtained by splenectomy or percutaneous biopsy[4]. Splenectomy is an invasive tech
Percutaneous biopsy is performed under US or CT guidance. US guidance is sometimes preferred over CT due to real-time guidance and no radiation risk. US-guided coaxial CNB demonstrates a high diagnostic accuracy, reduces complications and provides a specific therapeutic direction for patients[7,13-15]. The coaxial technique has had a positive impact on percutaneous image-guided biopsy since its introduction. The outer cannula is inserted into the spleen, and on the one hand, specimen collection yields can be improved using the same path by making slight adjustments to the angle of the introducer needle; on the other hand, changes in tissue cutting length can be achieved by adjusting the degree to which the introducer needle protrudes the outer cannula[16]. Adequate tissue samples ensure comprehensive pathological ana
US-guided coaxial CNB for the diagnosis of multiple splenic lesions is rarely performed clinically, and this case report provides a direction for clinical patient management and treatment. However, we lack the support of corresponding research data, which may not be very convincing.
US-guided coaxial CNB is a safe and efficient puncture technique for the diagnosis of multiple splenic lesions. It not only provides valuable diagnostic information but guides patient treatment based on histological analysis.
Thank Bao WYG, Jiang ZP and Lu Q for their suggestions on revising the draft.
Provenance and peer review: Unsolicited article; Externally peer reviewed.
Peer-review model: Single blind
Specialty type: Gastroenterology and hepatology
Country/Territory of origin: China
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P-Reviewer: Eysselein VE, United States S-Editor: Qu XL L-Editor: A P-Editor: Qu XL
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