Focal and diffuse splenomegalies and FNA

Focal

• Hodgkin’s lymphoma
• Large-cell, non-Hodgkin’s lymphomas
• Primary neoplasms and cysts
• Metastases
• Tuberculosis

Miliary or diffuse

• Infections
• Congestive splenomegaly
• Autoimmune diseses
• Small-cell, non-Hodgkin lymphomas
• Histiocytoses
• Multiple myeloma
• Myeloproliferative syndromes
• Leukemias
• Hemolitic anemias
• Amyloidosis

Fine needle cytology

FNC has to be performed using 23-25 gauge needle; the sub-costal approach is preferable. The patient has to be prepared and invited to hold the breath upon insertion of the needle and during aspiration; a US guide helps reach the target. Few quick movements back and forth may be performed in aspiration. Smears, microscopic evaluation and management of the material have been described above. After the FNC, US control should be performed and the patient should rest in bed, possibly with ice packs on the splenic area for a few hours.