Difference between revisions of "Spleen"

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Spleen (view source)

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


==Splenic enlargement==
=Normal histology=
*Portal hypertension (e.g. cirrhosis).
*Capsule.
*Lymphoma:
*Red pulp - [[red blood cells]].
**[[Hairy cell leukemia]].
*White pulp - white blood cells.
**[[Splenic marginal zone lymphoma]].<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>
*Marginal zone - between red pulp and white pulp.<ref>{{Ref WMSP|589}}</ref>
**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>
 
*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>


==Hyaloserositis==
==Lymphoid neoplasms of the spleen==
*Properly referred to as ''hyaloserositis 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; also known as ''sugar-coated spleen''.<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>
#[[Diffuse large B-cell lymphoma]] (DLBCL).
*Importance: ''none'' - benign.
#[[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]].


Image(s):
====Images====
*[http://en.wikipedia.org/wiki/File:Spleen_hyaloserositis_-_intermed_mag.jpg Hyaloserositis (WC)].
<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==
: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}}


==Littoral cell angioma of the spleen==
==Hepatosplenic T-cell lymphoma==
*Abbreviated ''HSTL''.
===General===
===General===
Features:<ref name=annals200408>URL: [http://www.annals.edu.sg/pdf200408/V33N4p524.pdf http://www.annals.edu.sg/pdf200408/V33N4p524.pdf]. Accessed on: 18 May 2011.</ref>
*Rare.
*Rare.
*Benign.
*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=annals200408/>
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>
*Anastoming, small vascular channels.
*Small cell lymphoma/Intermediate cell lymphoma.
**+/-"Folded" nuclei.
 
DDx:
*[[Hairy cell leukemia]].
 
Images:
*[http://www.webpathology.com/image.asp?n=14&Case=378 HSTL - low mag. (webpathology.com)].
*[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==
=See also=
*[[Haematopathology]].
*[[Haematopathology]].
*[[Liver pathology]].
*[[Liver pathology]].


==References==
=References=
{{reflist|2}}
{{reflist|2}}


==External links==
=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]]
Michael
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