|
|
(18 intermediate revisions by the same user not shown) |
Line 1: |
Line 1: |
| | [[Image:Gray1188.png|thumb|300px|Spleen.]] |
| The '''spleen''' is a forgotten organ. | | The '''spleen''' is a forgotten organ. |
|
| |
|
Line 7: |
Line 8: |
| *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== | | ===Images=== |
| <gallery> | | <gallery> |
| Image:Splenic_hamartoma_-_very_low_mag.jpg | Normal spleen (left) and splenic hamartoma (right). H&E stain. (WC) | | Image:Splenic_hamartoma_-_very_low_mag.jpg | Normal spleen (left) and splenic hamartoma (right). H&E stain. (WC) |
| </gallery> | | </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 |
Line 47: |
Line 53: |
|
| |
|
| =Splenic enlargement= | | =Splenic enlargement= |
| | :''Splenomegaly'' redirects here.'' |
| *[[Portal hypertension]] (often due to [[cirrhosis]]). | | *[[Portal hypertension]] (often due to [[cirrhosis]]). |
| *Lymphoma - see below. | | *Lymphoma - see below. |
Line 77: |
Line 84: |
| **[[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=== |
Line 102: |
Line 110: |
| **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== |
Line 129: |
Line 139: |
| ==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== |
Line 232: |
Line 177: |
|
| |
|
| ==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.
| |
| | |
| DDx:
| |
| *[[Histiocytic sarcoma]].<ref name=pmid17324277>{{Cite journal | last1 = Alexiev | first1 = BA. | last2 = Sailey | first2 = CJ. | last3 = McClure | first3 = SA. | last4 = Ord | first4 = RA. | last5 = Zhao | first5 = XF. | last6 = Papadimitriou | first6 = JC. | title = Primary histiocytic sarcoma arising in the head and neck with predominant spindle cell component. | journal = Diagn Pathol | volume = 2 | issue = | pages = 7 | month = | year = 2007 | doi = 10.1186/1746-1596-2-7 | PMID = 17324277 | url = http://www.diagnosticpathology.org/content/2/1/7 }}</ref>
| |
| | |
| 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== |
Line 307: |
Line 214: |
| *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. |
Line 313: |
Line 220: |
| ==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= |
Line 325: |
Line 239: |
|
| |
|
| [[Category:Haematopathology]] | | [[Category:Haematopathology]] |
| | [[Category:Spleen]] |