Difference between revisions of "Spleen"

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Spleen (view source)

Revision as of 12:50, 7 September 2016

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→‎Splenic enlargement
(→‎Splenic hamartoma: +Gross image)
 
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[[Image:Gray1188.png|thumb|300px|Spleen.]]
The '''spleen''' is a forgotten organ.
The '''spleen''' is a forgotten organ.


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*White pulp - white blood cells.
*White pulp - white blood cells.
*Marginal zone - between red pulp and white pulp.<ref>{{Ref WMSP|589}}</ref>
*Marginal zone - between red pulp and white pulp.<ref>{{Ref WMSP|589}}</ref>
===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=
=Gross pathology=
 
The [[grossing]] of the spleen is dealt with in [[splenectomy grossing]].
===Overview of classic gross findings===
{| class = "wikitable sortable"
{| class = "wikitable sortable"
! Terminology
! Terminology
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=Splenic enlargement=
=Splenic enlargement=
*Portal hypertension (often due to [[cirrhosis]]).
:''Splenomegaly'' redirects here.''
*[[Portal hypertension]] (often due to [[cirrhosis]]).
*Lymphoma - see below.
*Lymphoma - see below.
*Mononucleosis ([[EBV]] infection).
*Mononucleosis ([[EBV]] infection).
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**[[Budd-Chiari syndrome]] (AKA hepatic vein obstruction).
**[[Budd-Chiari syndrome]] (AKA hepatic vein obstruction).
**Splenic vein thrombosis.
**Splenic vein thrombosis.
*Congestive heart failure.
*[[Congestive heart failure]].
*[[Acute splenitis]].


===Red pulp malignant===
===Red pulp malignant===
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=Specific disorders=
=Specific disorders=
==Splenic laceration==
{{Main|Splenic laceration}}
==Hyaloserositis of the spleen==
==Hyaloserositis of the spleen==
*[[AKA]] ''sugar-coated spleen''.
*[[AKA]] ''sugar-coated spleen''.
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**Hyaline material = pink acellular crap on a [[H&E stain]].
**Hyaline material = pink acellular crap on a [[H&E stain]].


Images:
====Images====
*[http://commons.wikimedia.org/wiki/File:Spleen_hyaloserositis_-_intermed_mag.jpg Hyaloserositis - intermed. mag. (WC)].
<gallery>
*[http://commons.wikimedia.org/wiki/File:Spleen_hyaloserositis_-b-_high_mag.jpg Hyaloserositis - high mag. (WC)]
Image:Spleen_hyaloserositis_-_intermed_mag.jpg | Hyaloserositis - intermed. mag. (WC)
Image:Spleen_hyaloserositis_-b-_high_mag.jpg | Hyaloserositis - high mag. (WC)
</gallery>


==Mononucleosis==
==Mononucleosis==
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==Littoral cell angioma==
==Littoral cell angioma==
:For ''angioma'' see ''[[vascular malformations]]''.
:For ''angioma'' see ''[[vascular malformations]]''.
*[[AKA]] ''littoral cell angioma of the spleen''.
{{Main|Littoral cell angioma}}
===General===
Features:<ref name=pmid15329769>{{Cite journal  | last1 = Tan | first1 = YM. | last2 = Chuah | first2 = KL. | last3 = Wong | first3 = WK. | title = Littoral cell angioma of the spleen. | journal = Ann Acad Med Singapore | volume = 33 | issue = 4 | pages = 524-6 | month = Jul | year = 2004 | doi =  | PMID = 15329769 | url=http://www.annals.edu.sg/pdf200408/V33N4p524.pdf }}</ref>
*Rare.
*Benign.
 
Clinical:<ref name=pmid15329769/><ref name=pmid11547761>{{Cite journal  | last1 = Dascalescu | first1 = CM. | last2 = Wendum | first2 = D. | last3 = Gorin | first3 = NC. | title = Littoral-cell angioma as a cause of splenomegaly. | journal = N Engl J Med | volume = 345 | issue = 10 | pages = 772-3 | month = Sep | year = 2001 | doi = 10.1056/NEJM200109063451016 | PMID = 11547761 | url=http://www.nejm.org/doi/full/10.1056/NEJM200109063451016 }}</ref>
*Pyrexia (fever), splenomegaly, weight loss, solitary hypodense lesion on imaging.
 
Note:
*''Littoral cells'' = line vascular channels of the red pulp.<ref name=pmid15329769/>
**''Littoral'' = related to ''shore''.<ref>URL: [http://www.merriam-webster.com/dictionary/littoral http://www.merriam-webster.com/dictionary/littoral]. Accessed on: 24 July 2011.</ref><ref>URL: [http://dictionary.reference.com/browse/littoral http://dictionary.reference.com/browse/littoral]. Accessed on: 24 July 2011.</ref>
 
===Microscopic===
Features:<ref name=pmid15329769/>
*Anastoming, small vascular channels.
*Cystic spaces.
**May have papillary projections.<ref name=pmid11547761/>
 
DDx:<ref name=pmid15329769/>
*Vascular lesions:
**[[Hemangioendothelioma]].
**[[Angiosarcoma]].
**[[Hemangiopericytoma]].
**[[Splenic hamartoma]].
 
Images:
*[http://www.webpathology.com/image.asp?n=5&Case=382 LCA - low mag. (webpathology.com)].
*[http://www.webpathology.com/image.asp?n=6&Case=382 LCA - high mag. (webpathology.com)].
*[http://commons.wikimedia.org/wiki/File:Littoral_cell_angioma_of_the_spleen_-_very_low_mag.jpg LCA - very low mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Littoral_cell_angioma_of_the_spleen_-_intermed_mag.jpg LCA - intermed. mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Littoral_cell_angioma_of_the_spleen_-_very_high_mag.jpg LCA - very high mag. (WC)].
 
===IHC===
Features:<ref name=pmid15329769/>
*CD68 +ve.
*CD31 +ve
 
Others:
*CD34 -ve.
*Factor VIII +ve.


==Splenic hamartoma==
==Splenic hamartoma==
===General===
{{Main|Splenic hamartoma}}
*Benign.
*Women > men.<ref name=pmid21393931>{{Cite journal  | last1 = Sankar | first1 = S. | last2 = Thanka | first2 = J. | last3 = Jagdishchandrabose | first3 = S. | last4 = Rajendran | first4 = S. | title = Splenic hamartoma: a rare vascular space occupying lesion of the spleen. | journal = Indian J Pathol Microbiol | volume = 54 | issue = 1 | pages = 223-5 | month =  | year =  | doi = 10.4103/0377-4929.77416 | PMID = 21393931 }}</ref>
 
===Gross===
*Red lesion.
*Well-circumscribed.
 
Image:
*[http://commons.wikimedia.org/wiki/File:Spleen_hamartom.jpg Splenic hamartoma (WC)].
 
===Microscopic===
Features:<ref name=pmid19123729/>
*Variable size irregular vascular channels
*Red pulp-like disorganized stroma
*+/-Lymphoid follicles.
 
Images:
*[http://commons.wikimedia.org/wiki/File:Splenic_hamartoma_-_very_low_mag.jpg Splenic hamartoma - very low mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Splenic_hamartoma_-_intermed_mag.jpg Splenic hamartoma - intermed. mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Splenic_hamartoma_-_very_high_mag.jpg Splenic hamartoma - very high mag. (WC)].
 
===IHC===
Features:<ref name=pmid19123729>{{Cite journal  | last1 = Lee | first1 = H. | last2 = Maeda | first2 = K. | title = Hamartoma of the spleen. | journal = Arch Pathol Lab Med | volume = 133 | issue = 1 | pages = 147-51 | month = Jan | year = 2009 | doi = 10.1043/1543-2165-133.1.147 | PMID = 19123729 }}
</ref>
*CD8 +ve endothelial cells.


==Splenic infarct==
==Splenic infarct==
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==Follicular dendritic cell tumour==
==Follicular dendritic cell tumour==
*Abbreviated ''FDCT''.
*[[AKA]] ''follicular dendritic cell sarcoma''.
*[[AKA]] ''follicular dendritic cell sarcoma'' (abbreviated ''FDCS''),<ref name=pmid17515347>{{Cite journal  | last1 = Leipsic | first1 = JA. | last2 = McAdams | first2 = HP. | last3 = Sporn | first3 = TA. | title = Follicular dendritic cell sarcoma of the mediastinum. | journal = AJR Am J Roentgenol | volume = 188 | issue = 6 | pages = W554-6 | month = Jun | year = 2007 | doi = 10.2214/AJR.04.1530 | PMID = 17515347 }}</ref> ''dendritic reticulum cell sarcoma'', (???) ''follicular dendritic cell neoplasm''. (???)
{{Main|Follicular dendritic cell sarcoma}}
===General===
*Very rare.
*Behave like a low-grade sarcoma.<ref name=pmid9606805>{{Cite journal  | last1 = Perez-Ordoñez | first1 = B. | last2 = Rosai | first2 = J. | title = Follicular dendritic cell tumor: review of the entity. | journal = Semin Diagn Pathol | volume = 15 | issue = 2 | pages = 144-54 | month = May | year = 1998 | doi =  | PMID = 9606805 }}</ref>
*Reported association with [[Castleman disease]] (hyaline-vascular type).<ref name=pmid9606805/>
 
===Microscopic===
Features:<ref name=pmid9606805/>
*Oval or spindle-shaped cellular & nuclear morphology.
*Variable architecture (sheets, fascicles, whorles, storiform pattern).
*Nuclei:
**Small nucleoli.
**Clear or dispersed chromatin.
*Multinucleated cells.
*Interspersed small lymphocytes - '''distinctive feature'''.
*+/-Necrosis.
*+/-Marked nuclear atypia.
*+/-Abundant mitoses.
 
Images:
*[http://www.ajronline.org/content/188/6/W554/F7.expansion FDCS (ajronline.org)].<ref name=pmid17515347/>
*[http://www.webpathology.com/image.asp?case=391&n=1 DRCS (webpathology.com)].
*[http://path.upmc.edu/cases/case55/dx.html FDCT - several crappy images (upmc.edu)].
*[http://path.upmc.edu/cases/case399.html FDCS - several images (upmc.edu)].
 
===IHC===
Features:<ref name=pmid9606805/>
*CD21 +ve.
*CD35 +ve.
*Ki-M4p +ve
*Ki-FDRC1p +ve.
*Vimentin +ve.
 
*S-100 +ve/-ve.
*Muscle-specific actin +ve/-ve.
*EMA +ve/-ve.


==Hepatosplenic T-cell lymphoma==
==Hepatosplenic T-cell lymphoma==
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*CD8 -ve.
*CD8 -ve.
*NK cell-associated antigens +ve:<ref name=pmid9191001/>
*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.
**[[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>
*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.
**Perforin, granzyme B, TIA-1, Fas ligand.
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==Myelolipoma of the spleen==
==Myelolipoma of the spleen==
{{Main|Myelolipoma}}
{{Main|Myelolipoma}}
==Immune thrombocytopenic purpura==
{{Main|Immune thrombocytopenic purpura}}
Spleens are removed for this.
==Splenogonadal fusion==
{{Main|Splenogonadal fusion}}


=See also=
=See also=
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[[Category:Haematopathology]]
[[Category:Haematopathology]]
[[Category:Spleen]]
Michael
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