"Wandering Spleen" With Lymphomatous Involvement

Area of Science:

• Nuclear Medicine
• Radiology
• Oncology

Background:

• Wandering spleen is a rare congenital anomaly due to ligamentous laxity, causing splenic malposition.
• Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG PET/CT) is crucial for lymphoma staging.
• Accurate spleen localization is vital for interpreting FDG PET/CT findings in lymphoma patients.

Purpose of the Study:

• To report the initial staging 18 F-FDG PET/CT findings in a Hodgkin lymphoma patient with a wandering spleen.
• To highlight the utility of FDG PET/CT in identifying splenic involvement in cases of splenic malposition.
• To demonstrate the role of SPECT/CT in confirming splenic localization.

Main Methods:

• Initial staging 18 F-FDG PET/CT was performed on a female patient diagnosed with Hodgkin lymphoma.
• Imaging revealed an absent spleen in the normal anatomical position and hypermetabolic activity in a pelvic mass.
• Selective spleen SPECT/CT was utilized for confirmation of splenic malposition and involvement.

Main Results:

• The 18 F-FDG PET/CT demonstrated an absent spleen in the expected location.
• Intense, heterogeneous hypermetabolism was observed in a pelvic mass, raising suspicion for wandering splenic involvement.
• Subsequent SPECT/CT confirmed the spleen's presence in the pelvis, consistent with a wandering spleen.

Conclusions:

• FDG PET/CT can identify splenic malposition and potential involvement in lymphoma staging.
• Wandering spleen should be considered in the differential diagnosis when the spleen is not visualized in its usual location during staging.
• SPECT/CT provides valuable confirmation for spleen localization in complex cases.