Difference between revisions of "Spleen"

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Spleen (view source)

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→‎Splenic enlargement
 
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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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=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=
:''Splenomegaly'' redirects here.''
*[[Portal hypertension]] (often due to [[cirrhosis]]).
*[[Portal hypertension]] (often due to [[cirrhosis]]).
*Lymphoma - see below.
*Lymphoma - see below.
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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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==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>
*[[Spindle cell lesions]].
 
====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=
Michael
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