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Splenic fine needle aspiration biopsy in the diagnosis of lymphoreticular diseases. A report of four cases.

Splenic fine needle aspiration biopsy (FNAB) is rarely performed in the United States for several reasons: there is a perception that there is an increased risk of bleeding, and rendering a diagnosis of lymphoma (the most common primary splenic neoplasm) by FNAB is controversial. During a three-year period, we saw 11 cases of splenic FNAB. We present four cases of lymphoreticular neoplasms occurring between 1988 and 1991 in which the spleen was the only or most accessible organ in which to establish a diagnosis by FNAB: one case of small cleaved cell lymphoma, two cases of immunoblastic lymphoma (one T cell, one B cell by immunophenotyping studies) and one case of hairy cell leukemia in which the disease was confined to the spleen. All FNABs were radiologically guided, none of the patients suffered significant complications, and all had specimens sufficiently cellular to establish the diagnosis. Splenic puncture with FNAB may be an important and underutilized procedure for establishing a diagnosis in patients who have undetectable disease at other sites.