Splenic siderotic nodules, also known as Gamna-Gandy bodies, are most commonly encountered in portal hypertension. The pathophysiological process is the result of microhemorrhage resulting in hemosiderin and calcium deposition followed by fibroblastic reaction.
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Epidemiology
Associations
Recognized associations include 4
-
portal hypertension
- per se, or caused by portal or splenic vein thrombosis
- paroxysmal nocturnal hemoglobinuria 7
- sickle cell anemia
- hemolytic anemias 10
- leukemia 10
- lymphoma 10
- patients receiving blood transfusions 10
- acquired hemochromatosis
- diffuse splenic haemangiomatosis
- splenic neoplasms
- cardiac myxomas 8
- hepatosplenic schistosomiasis 5
Pathology
Grossly, Gamna-Gandy bodies are characterized by many well-circumscribed nodules measuring several millimeters, with a dark hemorrhagic center surrounded by a pale inner hyperemic rim and a dark outer rim. This gives an appearance resembling "tobacco flecks". Histologically, there is deposition of hemosiderin and calcium within the connective tissue stroma and vessels with a fibroblastic reaction, leading to microarchitectural distortion.
Radiographic features
Ultrasound
Demonstrates multiple tiny echogenic foci without acoustic shadowing.
CT
Gamna-Gandy bodies appreciable on CT have been reported as high-attenuation foci not distinguishable from splenic granulomas. They are rarely well demonstrated by CT 2.
MRI
Siderotic foci (often less than 1 cm 4) are punctate foci within the spleen. The high magnetic susceptibility effect of hemosiderin typically renders the siderotic foci markedly hypointense on certain sequences. Hence, signal characteristics of the nodules include:
- T2: very low-signal
- GRE/SWI: low-signal (considered the most sensitive sequence for detection of siderotic nodules 1)
