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 Table of Contents  
LETTER TO THE EDITOR
Year : 2012  |  Volume : 1  |  Issue : 3  |  Page : 167-168

Splenic tuberculosis diagnosed by endoscopic ultrasound-guided fine needle aspiration


1 Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India
2 Department of Cytology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India
3 Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India

Date of Web Publication6-Sep-2013

Correspondence Address:
Surinder Singh Rana
Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.7178/eus.03.010

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How to cite this article:
Rana SS, Bhasin DK, Rao C, Barwad A, Dey P, Sampath S, Mittal BR, Singh K. Splenic tuberculosis diagnosed by endoscopic ultrasound-guided fine needle aspiration. Endosc Ultrasound 2012;1:167-8

How to cite this URL:
Rana SS, Bhasin DK, Rao C, Barwad A, Dey P, Sampath S, Mittal BR, Singh K. Splenic tuberculosis diagnosed by endoscopic ultrasound-guided fine needle aspiration. Endosc Ultrasound [serial online] 2012 [cited 2019 Nov 16];1:167-8. Available from: http://www.eusjournal.com/text.asp?2012/1/3/167/117739

[From the Editor] Although splenic tuberculosis (TB) without systemic symptoms might not be very rare in some area, the case of splenic TB confirmed by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is not really described in recent literature. There's no doubt that EUS-FNA is an accurate, safe, and minimally invasive approach for differential diagnosis of splenic lesions. Therefore, the authors give us an important clue. When we encounter a similar case, some examinations for detecting TB and EUS-FNA should be considered.

A 39-year-old male patient presented with left upper quadrant abdominal pain, anorexia and weight loss of 3 months. Clinical examination was unremarkable. His laboratory investigations revealed normal hemogram, coagulation profile, and liver and renal function tests. Mantoux test and human immunodeficiency virus (HIV) serology were non-reactive. Chest X Ray as well as abdominal ultrasound was unremarkable. A positron emission tomographic scan with computed tomography fusion (PET-CT) scan showed focal hypodense lesions in spleen with intense [18]F]-Fluoro-Deoxy-Glucose (FDG) tracer uptake (SUV Max = 8.6). After an informed consent, endoscopic ultrasound (EUS) examination was done which showed mediastinal lymphadenopathy as well as multiple hypoechoic lesions in the spleen [Figure 1]. EUS-guided fine needle aspiration (FNA) of the subcarinal lymph node as well as the splenic lesions was done using a 22-G needle (EchoTip, Wilson-Cook, Winston-Salem, North Carolina, USA) [Figure 1]. The cytological examination of mediastinal lymph nodes showed non-caseating epithelioid granulomas and stain for acid fast bacilli (AFB) was negative. The cytological examination of splenic lesion aspiration showed caseous epithelioid granulomas and AFB [Figure 2]. He was started on 4-drug anti-tubercular therapy (ATT) and had gradual improvement in his symptoms.
Figure 1: Endoscopic ultrasound (EUS): Focal hypoechoic lesions in spleen and EUS-guided fine needle aspiration (FNA) done from splenic lesions.

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Figure 2: Microphotograph shows epithelioid cell granuloma (May Grunwald Giemsa × 480). Inset: Acid fast bacilli (Ziehl Neelsen stain × 1200).

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Splenic tuberculosis (TB) in an immunocompetent individual is very rare and poses a difficult diagnostic dilemma. The radiological investigations including ultrasound and contrast-enhanced computed tomography (CECT) have been reported to be useful for its diagnosis. The radiological findings reported are single or multiple focal lesions, splenic abscess, calcifications, and isolated splenomegaly.[1] However, splenic abscess, lymphoma, or metastasis to spleen can closely mimic splenic TB and therefore histopathological diagnosis is essential for proper management. Ultrasound-guided FNA has been shown to be useful for diagnosis of splenic lesions.[2] EUS also provides good images of the spleen through the gastric wall and in difficult situations especially inaccessible splenic lesions that are located closely to hilum. EUS-FNA has been reported to be useful modality for cytopathological diagnosis of splenic lesions.[3],[4],[5] In addition, the ability to sample lesions with larger-gauge trucut biopsy needles increases the diagnostic yield of EUS-guided sampling by allowing histopathological examination.[4],[5]

 
  References Top

1.Sharma SK, Smith-Rohrberg D, Tahir M, et al . Radiological manifestations of splenic tuberculosis: A 23-patient case series from India. Indian J Med Res 2007; 125: 669-78  Back to cited text no. 1
    
2.Handa U, Tiwari A, Singhal N, et al . Utility of ultrasound-guided fine-needle aspiration in splenic lesions. Diagn Cytopathol 2011, Sep 26. [Epub ahead of print]  Back to cited text no. 2
    
3.Fritscher-Ravens A, Mylonaki M, Pantes A, et al . Endoscopic ultrasound-guided biopsy for the diagnosis of focal lesions of the spleen. Am J Gastroenterol 2003; 98: 1022-7  Back to cited text no. 3
    
4.Eloubeidi MA, Varadarajulu S, Eltoum I, et al . Transgastric endoscopic ultrasound-guided fne-needle aspiration biopsy and fow cytometry of suspected lymphoma of the spleen. Endoscopy 2006; 38: 617-20.  Back to cited text no. 4
[PUBMED]    
5.Iwashita T, Yasuda I, Tsurumi H, et al . Endoscopic ultrasound-guided fine needle aspiration biopsy for splenic tumor: a case series. Endoscopy 2009; 41: 179-82.  Back to cited text no. 5
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