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Primary splenic lymphoma (PSL) is a rare disease and an improbable cause of splenomegaly or splenic nodules. On the contrary, splenic secondary involvement as part of an advanced lymphoproliferative disorder is more common. The authors present the case of a 49-year-old woman with a primary splenic diffuse large B-cell lymphoma (PS-DLBCL), in which the absence of other organs’ involvement determined an ultrasound-guided biopsy of the spleen to achieve a definitive diagnosis. With this case the authors intend to emphasise the extensive differential diagnosis of splenomegaly, splenic nodules or infiltrates, the usefulness of splenic biopsy in establishing the diagnosis and recall a rare disease, with non-specific presenting symptoms, in which the diagnostic workup is challenging.

Abstract Background Splenic nodules and heterogeneous parenchyma are seen frequently in abdominal ultrasound examinations of dogs, but the clinical importance of these lesions remains unclear. Objectives To determine whether specific ultrasonographic findings correlate with clinically relevant cytologic diagnoses and determine what sonographic features are correlated with these diagnoses. Another objective was to develop a scoring rubric to help clinicians make decisions on whether or not certain ultasonographic findings of the spleen warrant evaluation by fine‐needle cytology. Animals One‐hundred twenty‐five adult client‐owned dogs with ultrasonographically identified splenic nodules, heterogeneous parenchyma, or both. Methods Medical records were retrospectively searched for ultrasound‐guided splenic fine‐needle cytology reports. Ultrasonographic images were assessed for nodule number, size, echogenicity and distal enhancement, degree of splenic heterogeneity, and peritoneal fluid. Dogs were divided into 2 groups: those with clinically important or clinically irrelevant cytologic findings. Potentially useful and discriminatory ultrasonographic findings were identified by statistical analysis, and the most useful findings were used to generate the scoring rubric. Results The clinically important group included 25 of 125 dogs (22 malignancies, 3 suppurative inflammation). Splenic nodules 1‐2 cm in diameter, peritoneal fluid, and >1 targetoid nodule were associated with clinically important cytologic findings. Receiver operator characteristic analysis showed that the scoring rubric was useful for identifying dogs in the clinically important group. Conclusions and Clinical Importance Splenic fine‐needle cytologic findings identified a clinically relevant diagnosis in 20% of dogs, and larger nodule size, number of targetoid lesions, and presence of peritoneal fluid increase the likelihood of detection of clinically important disease.

The spleen is among the most common extranodal sites for Hodgkin and non-Hodgkin lymphomas (NHLs); however, among lymphomas arising from the spleen, primary splenic lymphomas (PSLs) are rare. The group of PSLs includes primary splenic diffuse large B-cell lymphoma (PS-DLBCL), splenic red pulp small B-cell lymphoma, splenic marginal zone lymphoma (SMZL), and a splenic hairy cell leukemia variant. Delineating between the PSL variants can be challenging, especially as fine-needle aspirate and core needle biopsy of the spleen are not routinely offered at most medical centers. Herein, we describe the clinical course of 2 representative patients who presented with non-specific gastrointestinal symptoms, the first who was diagnosed with PS-DLBCL and the second who was diagnosed with SMZL. We review and contrast the clinical presentations, imaging techniques, and laboratory findings of these discrete lymphoma variants and offer strategies on how to delineate between these varied splenic processes. We also examine the use of splenectomy and splenic needle biopsy as diagnostics and, in the case of splenectomy, a therapeutic tool. Finally, we also briefly review treatment options for these varied lymphoma sub-types while acknowledging that randomized trials to guide best practices for PSLs are lacking. [ABSTRACT FROM AUTHOR]

Background: Splenic nodules and heterogeneous parenchyma are seen frequently in abdominal ultrasound examinations of dogs, but the clinical importance of these lesions remains unclear. Objectives: To determine whether specific ultrasonographic findings correlate with clinically relevant cytologic diagnoses and determine what sonographic features are correlated with these diagnoses. Another objective was to develop a scoring rubric to help clinicians make decisions on whether or not certain ultasonographic findings of the spleen warrant evaluation by fine‐needle cytology. Animals: One‐hundred twenty‐five adult client‐owned dogs with ultrasonographically identified splenic nodules, heterogeneous parenchyma, or both. Methods: Medical records were retrospectively searched for ultrasound‐guided splenic fine‐needle cytology reports. Ultrasonographic images were assessed for nodule number, size, echogenicity and distal enhancement, degree of splenic heterogeneity, and peritoneal fluid. Dogs were divided into 2 groups: those with clinically important or clinically irrelevant cytologic findings. Potentially useful and discriminatory ultrasonographic findings were identified by statistical analysis, and the most useful findings were used to generate the scoring rubric. Results: The clinically important group included 25 of 125 dogs (22 malignancies, 3 suppurative inflammation). Splenic nodules 1‐2 cm in diameter, peritoneal fluid, and >1 targetoid nodule were associated with clinically important cytologic findings. Receiver operator characteristic analysis showed that the scoring rubric was useful for identifying dogs in the clinically important group. Conclusions and Clinical Importance: Splenic fine‐needle cytologic findings identified a clinically relevant diagnosis in 20% of dogs, and larger nodule size, number of targetoid lesions, and presence of peritoneal fluid increase the likelihood of detection of clinically important disease. [ABSTRACT FROM AUTHOR]

• Splenosis is an autotransplantation of splenic tissues throughout the body post splenic rupture or splenectomy. • Symptomatic when hematological diseases have recurred. • Abdominal splenosis may rarely be associated with abdominal pain and/or gastrointestinal symptoms. • Further evaluation and treatment is mandatory when bowel obstruction is present. • Treatment consists of resection of problematic splenic nodules. Splenosis, an autotransplantation of splenic tissues in another compartment of the body, is only symptomatic when hematologic diseases have recurred or compression of other adjacent structures have occurred. Therefore, we report a clinical case of a patient with bowel obstruction due to splenosis. A patient with a history of splenectomy, presented to the emergency room for abdominal pain and obstipation, suggesting intestinal obstruction which is also seen on CT scan. During laparotomy, multiple splenic nodules were seen on the mesentery of the small bowel and colon, with vascular bridges between them, resulting in bowel obstruction. Resection of splenic nodules was performed. The post-operative course was uneventful and the patient was discharged a week after. Although very rare, gastrointestinal symptoms may sometimes be described in patients with splenosis. Bleeding or obstruction can occur because of intramural grow or external compression, respectively. Treatment consists of resection of these nodules. Splenosis should always be thought in patients with previous splenic rupture and presenting with incidental nodules seen on imaging, with further investigations when symptoms are present. [ABSTRACT FROM AUTHOR]

Abstract This educational module covers the clinical, radiographic, pathologic, and therapeutic aspects of hepatic sarcoidosis. The single-page case exercise uses the roll-over menu and click button functionality of Articulate Engage '09 software to enable students to work through the case at their own pace, in a nonlinear fashion. Students are able to access case details such as clinical history, physical examination, laboratory data, radiology information, gross pathology, and histopathology data (i.e., annotated and narrated high-magnification images). By allowing students to view additional hidden details in any order, the case is intended to foster clinical decision-making skills. The case exercise includes a series of questions that the student should try to answer before reading the case summary. The case summary details critical learning points and addresses the questions that have been posed to the student.

Systemic cystic angiomatosis (SCA) is a rare disorder, usually involving the visceral organs with incidental detection during its insidious course. On radiography, it can present as multiple cystic lesions. In rare instances, it can present as mixed lesions (lytic, sclerotic) as was the case with our patient. The disease has a better prognosis than most vascular neoplasms involving the bones. We present a rare case of this disease, involving multiple organs, and presenting with an insidious onset., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Sawalgi et al.)

Niemann-Pick type C disease (NPCD) is an autosomal recessive storage lipidosis due to a disorder of cholesterol esterification leading to the accumulation of sphingomyelin and cholesterol in the brain, liver, and spleen. The disease is usually diagnosed when neurological symptoms appear. We report an unusual presentation of NPCD in a young asymptomatic adult with isolated nodular splenomegaly. [ABSTRACT FROM AUTHOR]

Abstract: We report the case of a 53-year-old woman who initially presented with an intermittent dry cough that had lasted for 6 months. An investigation into these symptoms with thoracic computed tomography demonstrated hyperdense shadows in her lungs, and ultrasonography showed the presence of multiple hypoechoic nodules on her spleen. A lung biopsy was then performed, which revealed noncaseating epithelioid cell granulomas. Magnetic resonance imagining of her spleen was performed, which showed low signal intensity. The patient was treated with glucocorticoids, and 3 months later the lesions in her lungs had disappeared completely. Five months later, the lesions in her spleen had disappeared also. However, after 13 months of low-dose prednisone, a miliary pattern was observed on the patient''s chest x-ray, although no lesions were observed in her spleen. Laboratory tests demonstrated that her blood level of angiotensin-converting enzyme had increased to 96 IU/L. The dose of prednisone was then increased, and the lung images returned to normal after 2 months of therapy. [Copyright &y& Elsevier]