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[[Image:Gray1188.png|thumb|300px|Spleen.]] | |||
The '''spleen''' is a forgotten organ. | The '''spleen''' is a forgotten organ. | ||
== | =Normal histology= | ||
*Capsule. | |||
*Red pulp - [[red blood cells]]. | |||
*White pulp - white blood cells. | |||
*Marginal zone - between red pulp and white pulp.<ref>{{Ref WMSP|589}}</ref> | |||
*Mononucleosis (EBV infection). | ===Images=== | ||
<gallery> | |||
Image:Splenic_hamartoma_-_very_low_mag.jpg | Normal spleen (left) and splenic hamartoma (right). H&E stain. (WC) | |||
</gallery> | |||
==Sign out== | |||
===Micro=== | |||
Sections show unremarkable splenic parenchyma. The nodules of white pulp are well-spaced and have germinal center formation. The red pulp has a normal vascularity and does not appear to be expanded. No nuclear atypia is apparent. | |||
=Gross pathology= | |||
The [[grossing]] of the spleen is dealt with in [[splenectomy grossing]]. | |||
===Overview of classic gross findings=== | |||
{| class = "wikitable sortable" | |||
! Terminology | |||
! Etiology | |||
! Description | |||
! Other | |||
|- | |||
|Ruptured spleen | |||
| trauma | |||
| hemorrhagic, capsule disrupted | |||
| possible assocations [[mononucleosis]], medical procedure - esp. colonoscopy,<ref name=pmid22889306>{{Cite journal | last1 = Aubrey-Bassler | first1 = FK. | last2 = Sowers | first2 = N. | title = 613 cases of splenic rupture without risk factors or previously diagnosed disease: a systematic review. | journal = BMC Emerg Med | volume = 12 | issue = 1 | pages = 11 | month = Aug | year = 2012 | doi = 10.1186/1471-227X-12-11 | PMID = 22889306 }}</ref> others | |||
|- | |||
|"Lardaceous spleen"<ref name=Ref_Klatt91>{{Ref Klatt|91}}</ref> | |||
| [[amyloidosis]] | |||
| waxy, pale, grey | |||
| also see ''sago spleen'' | |||
|- | |||
|"Sago spleen" | |||
| [[amyloidosis]] | |||
| nodular, tapioca-like appearance | |||
| also see lardaceous spleen | |||
|- | |||
|[[Splenic infarct]] | |||
| vascular occulsion | |||
| wedge shaped -- periphery | |||
| - | |||
|- | |||
|} | |||
Images: | |||
*[http://www.pathguy.com/lectures/sagolard.gif Amyloidosis of the spleen - schematic (pathguy.com)]. | |||
*[http://commons.wikimedia.org/wiki/File:Tapioca_pudding-3.jpg Tapioca pudding (WC)]. | |||
=Splenic enlargement= | |||
:''Splenomegaly'' redirects here.'' | |||
*[[Portal hypertension]] (often due to [[cirrhosis]]). | |||
*Lymphoma - see below. | |||
*Mononucleosis ([[EBV]] infection). | |||
*[[Hemophagocytic syndrome]].<ref name=pmid20127750>{{Cite journal | last1 = Maakaroun | first1 = NR. | last2 = Moanna | first2 = A. | last3 = Jacob | first3 = JT. | last4 = Albrecht | first4 = H. | title = Viral infections associated with haemophagocytic syndrome. | journal = Rev Med Virol | volume = 20 | issue = 2 | pages = 93-105 | month = Mar | year = 2010 | doi = 10.1002/rmv.638 | PMID = 20127750 }} | *[[Hemophagocytic syndrome]].<ref name=pmid20127750>{{Cite journal | last1 = Maakaroun | first1 = NR. | last2 = Moanna | first2 = A. | last3 = Jacob | first3 = JT. | last4 = Albrecht | first4 = H. | title = Viral infections associated with haemophagocytic syndrome. | journal = Rev Med Virol | volume = 20 | issue = 2 | pages = 93-105 | month = Mar | year = 2010 | doi = 10.1002/rmv.638 | PMID = 20127750 }} | ||
</ref> | </ref> | ||
== | ==Lymphoid neoplasms of the spleen== | ||
* | Lymphomas of the spleen in order of prevalence - in a series of 115 cases:<ref name=pmid22924843>{{Cite journal | last1 = Shimizu-Kohno | first1 = K. | last2 = Kimura | first2 = Y. | last3 = Kiyasu | first3 = J. | last4 = Miyoshi | first4 = H. | last5 = Yoshida | first5 = M. | last6 = Ichikawa | first6 = R. | last7 = Niino | first7 = D. | last8 = Ohshima | first8 = K. | title = Malignant lymphoma of the spleen in Japan: a clinicopathological analysis of 115 cases. | journal = Pathol Int | volume = 62 | issue = 9 | pages = 577-82 | month = Sep | year = 2012 | doi = 10.1111/j.1440-1827.2012.02844.x | PMID = 22924843 }}</ref> | ||
*Capsule of the spleen is white - resembles sugar-coating | #[[Diffuse large B-cell lymphoma]] (DLBCL). | ||
#[[Splenic marginal zone lymphoma]] (SMZL).<ref name=pmid20350661>{{Cite journal | last1 = Bennett | first1 = M. | last2 = Schechter | first2 = GP. | title = Treatment of splenic marginal zone lymphoma: splenectomy versus rituximab. | journal = Semin Hematol | volume = 47 | issue = 2 | pages = 143-7 | month = Apr | year = 2010 | doi = 10.1053/j.seminhematol.2010.01.004 | PMID = 20350661 }}</ref> | |||
#[[Follicular lymphoma]]. | |||
#Splenic B-cell lymphoma, unclassifiable. | |||
#[[Peripheral T-cell lymphoma]], not otherwise specified. | |||
Less common lymphoid neoplasms of the spleen: | |||
*[[Hairy cell leukemia]]. | |||
*Splenic diffuse red pulp small B cell lymphoma.<ref name=pmid20677173>{{cite journal |author=Baseggio L, Traverse-Glehen A, Callet-Bauchu E, ''et al.'' |title=Relevance of a scoring system including CD11c expression in the identification of splenic diffuse red pulp small B-cell lymphoma (SRPL) |journal=Hematol Oncol |volume=29 |issue=1 |pages=47–51 |year=2011 |month=March |pmid=20677173 |doi=10.1002/hon.957 |url=}}</ref> | |||
==DDx by compartment== | |||
===White pulp malignant=== | |||
*[[Diffuse large B-cell lymphoma]]. | |||
*[[Splenic marginal zone lymphoma]]. | |||
*[[Follicular lymphoma]]. | |||
===Red pulp benign=== | |||
*[[Polycythemia rubra vera]] (AKA polycythemia vera). | |||
*Outflow obstruction. | |||
**[[Cirrhosis]]. | |||
**[[Budd-Chiari syndrome]] (AKA hepatic vein obstruction). | |||
**Splenic vein thrombosis. | |||
*[[Congestive heart failure]]. | |||
*[[Acute splenitis]]. | |||
===Red pulp malignant=== | |||
*[[Hairy cell leukemia]]. | |||
*Acute leukemia.<ref name=Ref_WMSP_596>{{Ref WMSP|596}}</ref> | |||
*[[Hepatosplenic T-cell lymphoma]]<ref name=Ref_WMSP595>{{Ref WMSP|595}}</ref> (e.g. Hepatosplenic γδ T-cell lymphoma). | |||
=Specific disorders= | |||
==Splenic laceration== | |||
{{Main|Splenic laceration}} | |||
==Hyaloserositis of the spleen== | |||
*[[AKA]] ''sugar-coated spleen''. | |||
===General=== | |||
*Benign. | |||
*Common [[autopsy]] finding. | |||
===Gross=== | |||
*Capsule of the spleen is white - resembles sugar-coating.<ref>URL: [http://www.drugs.com/dict/sugar-coated-spleen.html http://www.drugs.com/dict/sugar-coated-spleen.html]. Accessed on: 1 September 2010.</ref> | |||
===Microscopic=== | |||
*[ | Features: | ||
*Hyaline material adherent to splenic capsule. | |||
**Hyaline material = pink acellular crap on a [[H&E stain]]. | |||
====Images==== | |||
<gallery> | |||
Image:Spleen_hyaloserositis_-_intermed_mag.jpg | Hyaloserositis - intermed. mag. (WC) | |||
Image:Spleen_hyaloserositis_-b-_high_mag.jpg | Hyaloserositis - high mag. (WC) | |||
</gallery> | |||
==Mononucleosis== | ==Mononucleosis== | ||
===General=== | ===General=== | ||
*[[EBV]] infection. | *[[EBV]] infection. | ||
*Massive splenic enlargement. | *+/-Massive splenic enlargement. | ||
Clinical: | |||
*Monospot test +ve. | |||
===Microscopic=== | ===Microscopic=== | ||
Features: | Features: | ||
*Atypical lymphoid cells. | *Atypical lymphoid cells. | ||
**Abundant basophilic cytoplasm. | |||
**Cells indented by adjacent RBCs on blood smears.<ref name=utah_endo>URL: [http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/hpfrm.html http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/hpfrm.html]. Accessed on: 4 December 2011.</ref> | |||
Images: | |||
*[http://library.med.utah.edu/WebPath/jpeg5/HEME013.jpg Mononucleosis (med.utah.edu)].<ref name=utah_endo>URL: [http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/hpfrm.html http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/hpfrm.html]. Accessed on: 4 December 2011.</ref> | |||
*[http://path.upmc.edu/cases/case37.html Mononucleosis - several images (upmc.edu)]. | |||
===Flow cytometry=== | |||
*CD8 >>> CD4.<ref>URL: [http://path.upmc.edu/cases/case37/gross.html http://path.upmc.edu/cases/case37/gross.html]. Accessed on: 2 January 2012.</ref> | |||
==Littoral cell angioma | ==Littoral cell angioma== | ||
:For ''angioma'' see ''[[vascular malformations]]''. | :For ''angioma'' see ''[[vascular malformations]]''. | ||
{{Main|Littoral cell angioma}} | |||
==Splenic hamartoma== | |||
{{Main|Splenic hamartoma}} | |||
==Splenic infarct== | |||
*[[AKA]] ''splenic [[infarct]]ion''. | |||
*[[AKA]] ''infarction of the spleen''. | |||
===General=== | |||
Classic textbook causes:<ref name=pmid20928991>{{Cite journal | last1 = Lawrence | first1 = YR. | last2 = Pokroy | first2 = R. | last3 = Berlowitz | first3 = D. | last4 = Aharoni | first4 = D. | last5 = Hain | first5 = D. | last6 = Breuer | first6 = GS. | last7 = Osler | first7 = W. | title = Splenic infarction: an update on William Osler's observations. | journal = Isr Med Assoc J | volume = 12 | issue = 6 | pages = 362-5 | month = Jun | year = 2010 | doi = | PMID = 20928991 | URL = http://www.ima.org.il/imaj/dynamic/web/ArtFromPubmed.asp?year=2010&month=06&page=362 }}</ref> | |||
*Septic embolus due to [[bacterial endocarditis]]. | |||
*[[Sickle cell disease]]. | |||
Usual causes:<ref name=pmid20928991/> | |||
*Hematologic malignancy. | |||
*Intracardiac thrombus. | |||
*Bacterial endocarditis. | |||
Clinical:<ref name=pmid20928991/> | |||
*Left upper quadrant pain ~ 1/3 of cases. | |||
*Fever ~ 1/3 of cases. | |||
*Leukocytosis ~ 1/2 of cases. | |||
===Gross=== | |||
*Classically wedge-shaped; triangular on section. | |||
**The base of the triangle runs along the surface. | |||
**The apex points to the obstructed vessel that lead to the infarct. | |||
===Microscopic=== | |||
:''See [[necrosis]]''. | |||
=Weird stuff= | |||
*Dendritic cell tumours.<ref name=Ref_WMSP_596>{{Ref WMSP|596}}</ref> | |||
**Interdigitating dendritic cell tumour. | |||
**Follicular dendritic cell tumour. | |||
==Follicular dendritic cell tumour== | |||
*[[AKA]] ''follicular dendritic cell sarcoma''. | |||
{{Main|Follicular dendritic cell sarcoma}} | |||
==Hepatosplenic T-cell lymphoma== | |||
*Abbreviated ''HSTL''. | |||
===General=== | ===General=== | ||
*Rare. | *Rare. | ||
* | *Prognosis: poor. | ||
Subtypes:<ref name=webpath_HSTL/> | |||
#''Hepatosplenic γδ T-cell lymphoma''. | |||
#*May be written ''Hepatosplenic gamma/delta T-cell lymphoma''. | |||
#''Hepatosplenic αβ T-cell lymphoma''. | |||
#*May be written ''Hepatosplenic alpha/beta T-cell lymphoma''. | |||
Clinical triad: | |||
#Hepatosplenomegaly. | |||
#Cytopenias ([[anemia]], thrombocytopenia). | |||
#Sinusoidal tropism. | |||
===Microscopic=== | ===Microscopic=== | ||
Features:<ref name= | Features:<ref name=Ref_WMSP595>{{Ref WMSP|595}}</ref><ref name=webpath_HSTL>URL: [http://www.webpathology.com/image.asp?case=378&n=15 http://www.webpathology.com/image.asp?case=378&n=15]. Accessed on: 22 December 2011.</ref> | ||
* | *Small cell lymphoma/Intermediate cell lymphoma. | ||
* | **+/-"Folded" nuclei. | ||
DDx: | |||
*[[Hairy cell leukemia]]. | |||
Images: | Images: | ||
*[http://www.webpathology.com/image.asp?n= | *[http://www.webpathology.com/image.asp?n=14&Case=378 HSTL - low mag. (webpathology.com)]. | ||
*[http://www.webpathology.com/image.asp? | *[http://www.webpathology.com/image.asp?case=378&n=15 HSTL - high mag. (webpathology.com)]. | ||
===IHC=== | |||
Features:<ref name=Ref_WMSP595>{{Ref WMSP|595}}</ref> | |||
*CD4 -ve. | |||
*CD8 -ve. | |||
*NK cell-associated antigens +ve:<ref name=pmid9191001/> | |||
**[[CD56]],<ref name=pmid15458516>{{Cite journal | last1 = Niitsu | first1 = N. | last2 = Kohri | first2 = M. | last3 = Togano | first3 = T. | last4 = Nakamine | first4 = H. | last5 = Nakamura | first5 = S. | last6 = Iwabuchi | first6 = K. | last7 = Higashihara | first7 = M. | title = Development of hepatosplenic gammadelta T-cell lymphoma with pancytopenia during early pregnancy: a case report and review of the literature. | journal = Eur J Haematol | volume = 73 | issue = 5 | pages = 367-71 | month = Nov | year = 2004 | doi = 10.1111/j.1600-0609.2004.00300.x | PMID = 15458516 }}</ref> CD11c, CD16. | |||
*Effector proteins +ve.<ref name=pmid9191001>{{Cite journal | last1 = Salhany | first1 = KE. | last2 = Feldman | first2 = M. | last3 = Kahn | first3 = MJ. | last4 = Peritt | first4 = D. | last5 = Schretzenmair | first5 = RD. | last6 = Wilson | first6 = DM. | last7 = DiPaola | first7 = RS. | last8 = Glick | first8 = AD. | last9 = Kant | first9 = JA. | title = Hepatosplenic gammadelta T-cell lymphoma: ultrastructural, immunophenotypic, and functional evidence for cytotoxic T lymphocyte differentiation. | journal = Hum Pathol | volume = 28 | issue = 6 | pages = 674-85 | month = Jun | year = 1997 | doi = | PMID = 9191001 }}</ref> | |||
**Perforin, granzyme B, TIA-1, Fas ligand. | |||
==Myelolipoma of the spleen== | |||
{{Main|Myelolipoma}} | |||
==Immune thrombocytopenic purpura== | |||
{{Main|Immune thrombocytopenic purpura}} | |||
Spleens are removed for this. | |||
==Splenogonadal fusion== | |||
{{Main|Splenogonadal fusion}} | |||
=See also= | |||
*[[Haematopathology]]. | *[[Haematopathology]]. | ||
*[[Liver pathology]]. | *[[Liver pathology]]. | ||
=References= | |||
{{reflist|2}} | {{reflist|2}} | ||
=External links= | |||
*[http://www.rcsed.ac.uk/journal/vol47_1/47100010.html Atraumatic rupture of the spleen in adults (rcsed.ac.uk)]. | *[http://www.rcsed.ac.uk/journal/vol47_1/47100010.html Atraumatic rupture of the spleen in adults (rcsed.ac.uk)]. | ||
[[Category:Haematopathology]] | [[Category:Haematopathology]] | ||
[[Category:Spleen]] |
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