Only 1/4 of honeycomb pattern of the feline spleen is lymphoma...

Ultrasonographic honeycomb pattern of the spleen in cats: correlation with pathological diagnosis in 33 cases

Manuela Quinci, Silvia Sabattini,and Alessia Diana

Background
The study examines the correlation between the ultrasonographic honeycomb pattern (HCP) of the spleen and pathological diagnoses in cats. HCP is characterized by diffuse parenchymal inhomogeneity with multiple small, well-defined hypoechoic foci. While commonly associated with lymphoma in dogs, the relationship in cats is less well established. The study also evaluates the impact of transducer type on HCP visualization.

Methods
Medical records of 33 cats with splenic HCP identified via abdominal ultrasonography between 2009 and 2017 were retrospectively reviewed. Ultrasonographic findings, including splenic size, shape, margins, and other parenchymal features, were assessed. Cytological or histological evaluations, supplemented by PCR for antigen receptor rearrangements (PARR) in uncertain cases, provided final diagnoses. The performance of high-frequency linear versus micro-convex transducers in detecting HCP was compared.

Results
-Diagnoses: Among the 33 cats, 24% had lymphoma, 45% lymphoid hyperplasia, 18% splenitis, 9% extramedullary hematopoiesis, and 3% histiocytic sarcoma.

-Ultrasonography: Splenomegaly was observed in all lymphoma cases and 60% of non-lymphoma cases. HCP visualization was consistently better with high-frequency linear transducers (100% detection vs. 62.5% with micro-convex transducers).

-Splenic Size and Lymphoma: All cats with normal-sized spleens were diagnosed with benign conditions. Splenic hilar lymphadenopathy was infrequent and not specific to lymphoma.

-Associated Findings: Other abdominal abnormalities, such as renal and hepatic changes, were found in both lymphoma and non-neoplastic conditions.

Limitations
The study's retrospective nature and variability in operator skill may have influenced ultrasound quality. Histological samples were available in only five cases, with most diagnoses relying on cytology and PARR, which have limitations in sensitivity and specificity for feline lymphomas. A standardized imaging protocol was not employed.

Conclusions
HCP in feline spleens is not specific to lymphoma and is often associated with benign lymphoproliferative, inflammatory, or reactive conditions. Cytology or histology, potentially supplemented by PARR, is essential for accurate diagnosis. High-frequency linear transducers are recommended for better visualization of splenic HCP and subtle parenchymal changes.

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