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Case Report

Gamna-Gandy Bodies
Sonographic Features With
Histopathologic Correlation

Shweta Bhatt, MD, Rochelle Simon, MD,

Vikram S. Dogra, MD

amna-Gandy bodies (GGB) are siderotic nodules present in the spleen.

The most common cause of GGB is portal hypertension (PHT); however,
they can be seen in other conditions such as sickle cell anemia, acquired
hemochromatosis, paroxysmal nocturnal hemoglobinuria, and angiosarcoma. A rare existence in patients with cardiac myxomas has also been described.
Sonographic features of GGB can be mimicked by other conditions such as histoplasmosis, sickle cell disease, and disseminated Pneumocystis carinii infection;
therefore, it is important to recognize this entity. This report presents sonographic
features of GGB in the spleen with histopathologic correlation.

Case Report
Abbreviations
GGB, Gamna-Gandy bodies; MRI, magnetic resonance
imaging; PHT, portal hypertension; TB, tuberculosis

Received July 27, 2006, from the Departments of

Imaging Sciences (S.B., V.S.D.) and Pathology (R.S.),
University of Rochester School of Medicine,
Rochester, New York USA. Manuscript accepted for
publication July 31, 2006.
Address correspondence to Vikram S. Dogra, MD,
Division of Ultrasound, Department of Imaging
Sciences, University of Rochester School of Medicine,
601 Elmwood Ave, Box 648, Rochester, NY 14642
USA
E-mail: vikram_dogra@urmc.rochester.edu

A 45-year-old male patient with a history of alcohol abuse

came to the ultrasound department with abdominal pain
and distension. Sonography of the abdomen revealed the
presence of portal vein thrombosis, with cirrhosis of the
liver and ascites. The spleen showed evidence of multiple
tiny, 1- to 2-mm, echogenic foci, with no posterior shadowing (Figure 1). Follow-up magnetic resonance imaging
(MRI) of the abdomen performed to exclude hepatocellular malignancy as a cause for portal vein thrombosis
showed the presence of multiple tiny hypointense foci in
the spleen on T1- and T2-weighted images (Figure 2),
confirming the presence of iron in these foci, GGB
(siderotic nodules).

2006 by the American Institute of Ultrasound in Medicine J Ultrasound Med 2006; 25:16251629 0278-4297/06/$3.50

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Gamna-Gandy Bodies

parenchyma secondary to congestive splenomegaly, followed by accumulation of hemosiderin and impregnation of collagen and elastic
fibers with iron and calcium.4

Figure 1. Longitudinal gray scale sonogram of the spleen shows multiple tiny
echogenic foci (arrowheads) with no posterior acoustic shadowing.

Discussion
Gamna-Gandy bodies (also known as siderotic
nodules or tobacco flecks) are small, firm nodules of fibrous tissue impregnated with iron pigment (hemosiderin) and calcium salts that occur
chiefly in the spleen but more commonly in conditions such as congestive splenomegaly and
sickle cell anemia. They have also been rarely
reported in cardiac myxomas.13 The GGB in
the spleen are thought to be a result of healed
focal hemorrhages and necrosis in the splenic

Origin of GGB
Gamna-Gandy bodies were first described by
Marini5 in 1902. They were later reported
by Charles Gandy6 (French physician) and Carlo
Gamna7 (Italian physician) in 1905 and 1921,
respectively, giving the eponym to the entity.
Because of the resemblance of the histologic features of GGB to mycelial structures, these lesions
were initially thought by some authors to have a
fungal origin.8,9 The thought was completely discarded after definite microbiologic studies of
GGB were published in 1931.10
Causes of GGB
Portal hypertension is the most common cause
of GGB in the spleen and is seen in about 9% to
12% of these patients.1113 Gamna-Gandy bodies
in the spleen have also been seen in conditions
such as paroxysmal nocturnal hemoglobinuria,14
hemolytic anemia, sickle cell anemia, leukemia,15
and lymphoma,16 in patients receiving blood
transfusions, in angiosarcoma,17 and in acquired
hemochromatosis.18 However, it is not clear
whether GGB in these conditions are a direct
result of the condition themselves or are a result
of underlying PHT. Uncommonly, GGB have also
been reported in other organs besides the spleen,

Figure 2. Axial T1-weighted (A) and T2-weighted (B) magnetic resonance images of the abdomen show multiple hypointense nodules (arrowheads)
in the spleen in both sequences. The magnetic resonance images also show evidence of ascites (asterisks) and a cirrhotic liver (L).

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such as in cardiac myxoma,13 renal cell carcinoma,19 the ovary,20 the liver,21,22 thymoma,23
follicular adenoma of the thyroid,24 and
retroperitoneal lymph nodes.23 Recently,
Kleinschmidt-DeMasters25 described the presence of GGB in many central nervous system
and peripheral nervous system neoplasms, as
well as vascular malformations such as schwannoma of the ulnar nerve, cholesterol granuloma
of temporal bone, pituitary adenoma, cavernous
angioma, and myxopapillary ependymoma.
The pathophysiologic process leading to the
formation of GGB in the spleen as well as the
other extrasplenic sites seems to be the same:
hemorrhage in the parenchyma followed by
scarring of the collagen and elastic fibers and
impregnation with iron and calcium. Tedeschi24
described the morphologic features of GGB and
postulated 4 main components of GGB: (1)
blood vessels with granulomatous vasculitis,
sclerosis, and hyalinization and fragmentation
of elastic fibers; (2) deposits of calcium and
hemosiderin, both in vessels and in intervening
connective tissue stroma; (3) a fibroblastic reaction and infiltration of macrophages with multinucleated foreign body giant cells; and (4)
spheroid, bamboo-shaped, or articulated fibers,
which resemble mycelial structures or parasite
eggs (Figure 3). This peculiar fiber formation
with mycelial structures is considered characteristic of GGB. The eponym Gamna-Gandy
bodies/nodules should be specifically reserved
for such lesions.
Sonographic Features of GGB
On sonography, GGB are seen as punctate, bright
echogenic foci scattered in the parenchyma.12,13,26,27 They may or may not cause acoustic
shadowing posterior to these foci depending on
the amount of calcification present within them.
Portal hypertension may also show the presence
of reflector channels in the spleen, which is actually the sclerotic splenic vein wall secondary to
PHT.26 These channels may be distinguished
from GGB by the presence of flow within them
on color flow Doppler imaging.28
Conditions That Mimic GGB
Punctate hyperechoic foci in the spleen may also
be seen in sarcoidosis,29 histoplasmosis, tuberJ Ultrasound Med 2006; 25:16251629

Figure 3. Histopathologic specimen of the spleen shows darkly stained, spheroid

GGB (arrows) outside the vessel wall at the center. Also shown is diffusely scattered, brown, granular hemosiderin pigment (arrowheads), indicating previous
hemorrhage (hematoxylin-eosin, original magnification 40).

culosis (TB),30 and disseminated P carinii infection.31 The above-mentioned differential conditions can usually be distinguished from GGB by
their clinical history and other distinct findings.
Sarcoidosis is usually seen in African American
female patients. The presence of pulmonary
signs and symptoms in the form of bilateral hilar
lymphadenopathy is the most common presentation. Sarcoidosis of the spleen is very uncommon and usually presents with left upper
quadrant pain secondary to enlargement of the
spleen. A sarcoid is typified by noncaseating
granulomas, with epithelioid cells and Langhans
giant cells.32 Sometimes some of these giant cells
may get calcified (Schaumann bodies) and may
mimic GGB on imaging.
Miliary TB involving the spleen may mimic
GGB on sonography. It may either present as diffuse hypoechoic lesions and a moth-eaten
appearance of the spleen or as solid focal lesions
with bright echogenic areas with or without
shadowing (simulating GGB).33 Fine-needle
aspiration cytologic examination and a clinical
history suggestive of TB (cough with hemoptysis,
low-grade fever, and weight loss) may be helpful
in making the correct diagnosis.
Histoplasmosis is caused by Histoplasma capsulatum, a soil fungus found especially in the
Ohio River Valley (Ohio and Mississippi). It may
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be difficult to distinguish from the abovedescribed TB because of similar symptoms in

both conditions. Spleen involvement usually
occurs in the disseminated form of histoplasmosis (the rarest form of histoplasmosis). Larger
calcifications and more than 6 foci favor the diagnosis of histoplasmosis. Disseminated histoplasmosis is seen almost exclusively in patients with
immune defects. Diagnosis of chronic or disseminated histoplasmosis can be made by culturing
a sample of sputum or other body fluids in the
laboratory to isolate the fungus.
Spouge et al31 described the presence of multiple tiny reflective foci in the spleen as well as the
liver, pancreas, kidneys, and lymph nodes on
sonography, observed in 2 patients with acquired
immunodeficiency syndrome who were being
treated for extrapulmonary P carinii infection
with oral pentamidine. The authors thought that
aerosol pentamidine may put users of this drug
at risk for disseminated P carinii pneumonia.
Role of MRI
The role of MRI in the evaluation of GGB is
known and described as the most sensitive
modality in the detection of GGB.3,12,13,18,22
Sonographic findings of GGB have only been
rarely described in the literature in the past.13,27,34
This was possibly because of the dearth of highfrequency transducers in the past, which are now
easily available. One study in 200026 compared
the diagnostic accuracy of sonography and MRI
in GGB, concluding that sonography was fairly
accurate in the detection of GGB. The study also
showed that sonography had a high positive predictive value (85.7%), thus implying that detection of hyperechoic foci on sonography in the
clinical setting of PHT was sufficient to make a
diagnosis of GGB or siderotic nodules of the
spleen. Since that study, over the past 6 years, the
diagnostic efficacy of sonography in general has
risen considerably. Although there have been no
recent studies on the sensitivity or specificity of
sonography in the detection of GGB, it would not
be wrong to say that the diagnostic accuracy of
sonography has increased reasonably secondary
to the improved technology. Detection of
echogenic foci in the presence of a supportive
clinical history should promptly lead to the diagnosis of GGB on sonography and should spare
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the patient from undergoing additional imaging

such as MRI to further characterize these lesions.
Surprisingly, discussion on GGB has almost disappeared from some of the major pathology35,36
and radiology37 textbooks in the last few years.
Conclusions
In patients with a known history of cirrhosis,
identification of GGB in the spleen on sonographic evaluation is important because it further strengthens the diagnosis of PHT and helps
exclude other etiologies such as miliary TB, histoplasmosis, and disseminated P carinii infection.

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