Splenic Specimens Research Articles

Splenic sarcoid reaction mimicking metastases in patients after uterine cancer surgery: a report of two cases

BackgroundTumor-associated sarcoid reactions have been observed with various tumors; however, they have not been reported with uterine cancer. We present two cases of splenic sarcoid reactions that mimicked metastases a few years after uterine cancer surgery.Case presentationCase 1 involved a 67-year-old female patient diagnosed with endometrial cancer (pT1aN0M0, pStage Ia, grade 1). The patient underwent open total abdominal hysterectomy and bilateral salpingo-oophorectomy with pelvic lymphadenectomy. Three years after the initial surgery, computed tomography (CT) and positron emission tomography CT showed multiple splenic masses with increasing numbers and sizes. Splenic metastases were diagnosed, and laparoscopic splenectomy was performed. The histopathological analysis revealed sarcoid reactions in the spleen. Case 2 involved a 47-year-old female patient diagnosed with endometrial cancer (pT1aN0M0, pStage Ia, grade 1). The patient underwent laparoscopic total abdominal hysterectomy and bilateral salpingo-oophorectomy with pelvic lymphadenectomy. Two years after the initial surgery, multiple splenic masses were observed. We performed laparoscopic splenectomy for the splenic metastases. Granuloma formations were identified in the splenic specimen and perisplenic lymph nodes that were removed simultaneously, resulting in a final diagnosis of sarcoid reaction. A review of the lymph nodes at the time of the previous uterine surgery revealed granuloma formation. Other than the presence of splenic masses, no findings suggestive of recurrence were observed in these cases. Uterine cancer and sarcoid reactions progressed without recurrence after splenectomy.ConclusionsTo the best of our knowledge, this is the first report of the late development of splenic sarcoid reactions after uterine cancer surgery. Sarcoid reactions and metastases are difficult to diagnose based on preoperative imaging results. However, reviewing the specimen at the time of the initial resection, the number of lesions, and the clinical findings (other than imaging findings) may aid in the determination of the correct diagnosis.

Giant spleen as a surgical challenge: Case report and literature review

Introduction. According to the guidelines of the European Association of Endoscopic Surgery, any case where the maximum craniocaudal splenic diameter exceeds 20 cm is considered massive splenomegaly. In addition to metabolic, hematological, and hemodynamic problems, enlarged spleen may cause mechanical difficulties due to the pressure to surrounding organs and vascular structures. The aim of this paper is to present the surgical challenges and technique applied in massive splenomegaly, in a patient who had neglected the importance of regular medical checkups. Case outline. We present a 62-year-old male patient who was admitted to hospital for treatment of previously clinically and radiologically verified splenomegaly but who neglected the importance of regular checkups and medical treatment. Splenectomy was performed with a splenic specimen 38 cm in its maximal diameter. Conclusion. Taking into consideration all the possible benefits and possible complications of surgical treatment, including the quality of life of splenectomized patients, comprehensive preoperative assessment should be made, and surgical treatment selectively applied.

Partial splenectomy in children: Long-term reoperative outcomes☆

PurposePartial, or subtotal, splenectomy (PS) has become an accepted alternative to total splenectomy (TS) for management of hematologic disorders in children, but little is known about its long-term outcomes. Here, we present our institutional experience with partial splenectomy, to determine rate of subsequent TS or cholecystectomy and identify if any factors affected this need. MethodsAll patients who underwent partial splenectomy at a single tertiary children's hospital were retrospectively reviewed from 2002 through 2019 after IRB approval. Primary outcome of interest was rate of reoperation to completion splenectomy (CS) and rate of cholecystectomy. Secondary outcome were positive predictor(s) for these subsequent procedures. ResultsTwenty-four patients underwent PS, at median age 6.0 years, with preoperative spleen size of 12.7 cm by ultrasound. At median follow up time of 8.0 years, 29% of all patients and 24% of hereditary spherocytosis (HS) patients underwent completion splenectomy at median 34 months and 45 months, respectively. Amongst HS patients who did not have a cholecystectomy with or prior to PS, 39% underwent a delayed cholecystectomy following PS. There were no significant differences in age at index procedure, preoperative splenic volume, weight of splenic specimen removed, transfusion requirements, preoperative or postoperative hematologic parameters (including hemoglobin, hematocrit, total bilirubin, and reticulocyte count) amongst patients of all diagnoses and HS only who underwent PS alone compared to those who went on to CS. There were no cases of OPSS or deaths. ConclusionPartial splenectomy is a safe alternative to total splenectomy in children with hematologic disease with theoretical decreased susceptibility to OPSS. However, families should be counseled of a 29% chance of reoperation to completion splenectomy, and, in HS patients, a 39% chance of delayed cholecystectomy if not performed prior to or with PS. Further studies are needed to understand predictors of these outcomes.

A Study on Morphometric Dimensions of Human Fetal Spleen at Different Gestational Ages

Introduction:The spleen is the largest hemolymphatic organ of the human body that plays a significant role in Hematopoiesis and immune phagocytosis. Recent studies have emphasized the importance of spleen as hematopoietic organ in fetal period, role in synthesis of immunoglobulins & defense of human body against infections. A thorough knowledge of splenic morphometry and dimensions is vital in comprehending the development of spleen in fetal period.Aim:The aim of the study is to study detailed morphometric analysis human fetal splenic specimens of various gestational ages and compare the findings with earlier studiesSubjects and Methods:The present study included 40 fetal cadaveric spleen and morphometric features i.e.,length, breadth, width and weight of spleen were measured.Results:The average weight of the fetal spleen was 1.98 gm and varied from 0.1 to 5.1 gm. The average length, breadth and width of spleen in prenatal group were 2.21 cm, 1.39 cm and 0.645 cm respectively. In the present study the average weight of the fetal spleen was 1.98 gm and varied from 0.1 to 5.1 gm. There was statistically significant increase in splenic weight till 33 weeks.Conclusion:Knowledge of spleen size at different gestational ages will help in early detection and diagnosis of splenic anomalies, identifying congenital malformations, early diagnosis and prompt treatment of intrauterine infections.

Quantitative analysis of morphometric variations of human spleen - A cadaveric study

The spleen is a largest collection of lymphoid tissue with diverse hemopoietic and phagocytic function. Recent experimental data have clearly defined immunological functions of spleen in innate and adaptive immunity, as a frontline of host defense against various infections. A comprehensive knowledge of splenic anatomical variations and morphometric dimensions is crucial in deciphering the role of spleen in health & infirmity. The aim of the study is to perform detailed morphometric analysis human splenic specimens with relation to age & gender differences and compare the findings with earlier studies. The present study included 40 cadaveric spleen and morphometric features i.e., length, breadth, width and weight of spleen were measured. The average splenic weight observed was 178.5 gm and range was 100 to 300 gm. The average length, breadth and width of spleen were 11.9 cm, 7.33 cm and 3.4 cm respectively. The average splenic volume in the present study was 167.27 cc. There was a significant increase in splenic volume till 40-49 years followed by steady decline. The awareness of the morphology and dimensions of the spleen is of fundamental importance to the hematologists, clinicians, radiologists, prosectors and surgeons while performing surgical procedures on spleen.

A A STUDY OF HISTOLOGY & HISTOGENESIS OF FETAL SPLEEN AT DIFFERENT GESTATIONAL AGES

Introduction: The spleen is a largest collection of lymphoid tissue with peculiar anatomical and physiological features. Spleen plays an important role in fetal hematopoiesis and immunomodulation. The aim of the study is to perform detailed histological analysis of human fetal splenic specimens of various gestational ages and compare the findings with earlier studies.
 Material and Methods: The present study included 40 fetal cadaveric spleen and morphometric features i.e., weight was measured and the sections of the spleen were stained with Haematoxylin and Eosin stain and were observed under compound light microscope
 Results: In the present study the histology of spleens of prenatal group showed the well defined red pulp, venous sinusoids and diffusely spread lymphocytes at 18 weeks of gestation and the organization of lymphoid follicles was noticed at 24-28 weeks. At 32 weeks well defined white pulp was observed and the microscopic architecture of the spleen was similar to the histology of adult spleen.
 Conclusion: A detailed knowledge of splenic morphometric dimensions, Histology and Histogenesis is crucial in deciphering the role of spleen in fetal development and fetal wellbeing.
 Key words: spleen, hematopoietic, microscopic, fetal

Changes in splenic capsule with aging; beliefs and reality

BackgroundResearch describing the splenic capsule and its effect on non-operative management of splenic injuries is limited. The aim of this study is to identify the current beliefs about the splenic capsule thickness and investigate changes in the splenic capsule with age. MethodsTrauma Medical Directors were surveyed on their beliefs regarding splenic capsule thickness changes with age. Thicknesses of cadaveric splenic capsule samples were measured. ResultsThe majority of trauma medical directors (59%) believe the capsule thickness decreases with age. There were 94 splenic specimens obtained. The splenic capsules of infants were thin and had a uniform layer of elastin fibers. With aging, the capsule becomes thick and develops a collagen layer. ConclusionMost trauma directors believe the splenic capsule thickness decreases with age. However, our results demonstrate that the splenic capsule thickness increases during childhood but remains constant in adulthood.

Study on pathogenicity of Pneumocystis and its association with development of chronic obstructive pulmonary disease

To investigate the pathogenicity of Pneumocystis and its association with the development of chronic obstructive pulmonary disease (COPD). The rat model of Pneumocystis pneumonia (PCP) was induced by intraperitoneal injection with dexamethasone, which was confirmed by pathogenic detection. The pathologic changes of rat lung specimens were examined using conventional HE staining, and the expression of inflammatory cells were detected by flow cytometry in bron-choalveolar lavage fluid (BALF) and splenic tissues of the rat model of PCP. In addition, the serum levels of matrix metalloproteinase 8 (MMP-8) and MMP-9 were measured using enzyme-linked immunosorbent assay (ELISA). Fusion and atrophy of alveolar spaces and hyperplasia of lung tissue were seen in the lung specimens of the rat model of PCP, and foam-like alveolar exudates and infiltration of inflammation cells were observed in the alveolar space, while severe infections exhibited consolidation of lung, which was similar to pathological features of COPD. The counts of CD8+ T lymphocytes (t = -7.920 and -12.514, P < 0.01), macrophages (t = -7.651 and -14.590, P < 0.01) and granulocytes (t = -10.310 and -16.578, P < 0.01) significantly increased and the counts of CD4+ T lymphocytes (t = 6.427 and 18.579, P < 0.01) significantly reduced in the BALF and splenic specimens of the rats with PCP relative to those without PCP. In addition, higher serum MMP-8 (t = -8.689, P < 0.01) and MMP-9 levels (t = -7.041, P < 0.01) were measured in rats with PCP than in those without PCP. Pneumocystis infection may be associated with the development and progression of COPD.

The Biological and Hematological Effects of Echinacea purpurea L. Roots Extract in the Immunocompromised Rats with Cyclosporine.

Background:The immune system is the body's defense against foreign organisms and harmful chemicals. Cyclosporine A (CsA) is an immunosuppressant drug widely used. Echinacea purpurea root (EPR) extract is used as an immunostimulant plant.Aim of the Work:The present study aimed at evaluation of the EPR effects against the CsA immunosuppressive rat model.Material and Methods:Thirty-two male Wistar albino rats were randomly divided into control, CsA (immunosuppressive models), CsA + EPR (100 mg/kg/day orally), and CsA + EPR (200 mg/kg/day orally). The biological parameters regarding the food consumption were assessed including feed intake (FI), feed efficiency ratio (FER), and body weights (BW). In addition, the splenic specimens were assessed histopathology. The blood was collected for measuring the blood parameters. All the measured parameters were collected and statistically analyzed. The biological results indicated a significant decrease in BW, FI, and FER in rats treated orally with low and high EPR doses as compared to the control group.Results:The results displayed that the CsA induced a significant decrease in red blood cells (RBCs) and white blood cells (WBCs) count. Histopathologically, CsA induced a marked decrease in the cellularity of the white pulp with congested blood sinusoids of the red pulp together with significant depletion of periarteriolar lymphoid sheath. Both the high and low doses of EPR significantly reversed the altered RBCs and WBCs counts. Histopathologically, both the low and high doses of EPR displayed apparently increase in the periarteriolar area together with the persistence of the congestion of the red pulp blood sinusoids compared to CsA group, indicating partial amelioration of the structural changes.Conclusion:In a nutshell, the current findings revealed that EPR extract ameliorated the hematological changes. However, there was a partial correction of the CsA-induced microscopic changes of the rat spleen.

Sclerosing angiomatoid nodular transformation of the spleen (SANT) in a patient with clear cell carcinoma of the uterus: a case report

BackgroundSclerosing angiomatoid nodular transformation of the spleen is a very rare benign vascular lesion recently described. Usually, sclerosing angiomatoid nodular transformation of the spleen is an incidental finding; the association with malignant tumors is extremely rare. To the best of our knowledge, we report the first case of sclerosing angiomatoid nodular transformation of the spleen associated with uterine clear cell carcinoma.Case presentationA 49-year-old Arabic woman presented to our institute with abdominal pain and distention. An abdominal computed tomographic scan was obtained, which showed a 14-cm uterine malignant tumor and a 4-cm isolated splenic nodule suggesting a metastatic lesion. The tumor was limited to the uterus but did not extend beyond. The patient underwent surgical treatment, and the histopathological examination of the resected uterine and splenic specimens disclosed invasive uterine clear cell carcinoma and sclerosing angiomatoid nodular transformation of the spleen, respectively. The patient had no signs of the disease 17 months after surgical treatment.ConclusionsSclerosing angiomatoid nodular transformation of the spleen is a very rare benign disease with a misleading presentation when associated with a malignant tumor. Pathological assessment of the resected spleen is the only way to achieve the correct diagnosis.

Investigation of parenchymal abdominal organ disease in cats: aiming for the ideal biopsy.

Definitive diagnosis of disease involving the parenchymal abdominal viscera often requires a representative specimen of affected tissue. Methods used to obtain tissue samples range from those that are minimally invasive, such as fine-needle aspiration (FNA), to more invasive techniques such as surgical biopsy. FNA and cytological examination can be a useful diagnostic tool and is commonly used for hepatic, splenic and lymph node specimens. FNA is an easy and cheap procedure that is best suited to diffuse disease and can be performed at low risk to the patient. However, its accuracy and agreement with the histopathological findings vary depending on the underlying disease and it often fails to provide information on parenchymal architecture. Importantly, FNA for cytological examination of the liver has serious limitations when used to identify the primary disease process due to the small sample size obtained. This review is aimed at clinicians undertaking more detailed and specialist investigation of diseases of feline parenchymal abdominal organs and provides practical guidance on the different methods used to obtain hepatic, renal, pancreatic and splenic specimens in cats. The information presented is based on peer-reviewed publications and the clinical experience of the author.

Spontaneous rupture of the spleen caused by a Bacillus infection: Report of a case

We report a case of spontaneous splenic rupture (SSR) caused by a Bacillus species (sp.) infection. A 36-year-old man on warfarin therapy since an aortic valve replacement at the age of 13 was admitted to our hospital with a 3-week history of a high fever. He had been asymptomatic until 4 months previously, when he suffered a cerebral embolism despite adequate oral anticoagulation. Abdominal computed tomography revealed splenic infarctions, which resulted in splenic rupture 2 days later. After embolization of the splenic artery, splenectomy was successfully performed. Pathologic examination revealed splenic infarction, resulting from septic emboli, with associated rupture of the splenic capsule, but no abscess was found. Bacillus sp. was isolated from cultures of arterial blood preoperatively, and the excised splenic specimens, postoperatively. In addition to rupture of the suppurating intrasplenic vessels with hematoma formation, the anticoagulant therapy possibly contributed to distension of the intrasplenic hematoma.

Splenic Follicular Lymphoma

The spleen is frequently involved in B-cell lymphomas other than splenic marginal zone lymphoma. Here we describe a series of follicular lymphoma (FL) cases diagnosed in the spleen, consisting of 32 patients who presented clinically with splenomegaly, and slight or no peripheral lymphadenopathy. The splenic specimen had a micronodular pattern, germinal center cytologic composition, and frequent presence of marginal zone-like cells at the periphery of the nodules. Twenty cases showed absence or only partial/weak bcl2 protein expression, and 12 cases had homogeneous and strong positive bcl2 expression. The incidences of t(14;18)(q32;q21), CD10 expression, low histologic grade, and low proliferative index were significantly more frequent in FL bcl2-positive cases than in FL bcl2-negative cases. Splenic FL cases showed frequent relapses, with an overall survival of 55% at 5 years. No significant differences in survival were found between bcl2-negative and bcl2-positive cases. Splenic FL cases could be divided into 2 main variants: one was similar to classic FL with t(14;18) and CD10 expression, whereas the other was characterized by a higher proliferation index and histologic grade, and was more frequently diagnosed as a disease restricted to the spleen. Recognition of the distinct nature of these tumors should facilitate appropriate studies for determining the best therapy for such cases.

ED‐1 is a marker for activated macrophages and subclinical graft versus host disease in vascularized stem cell transplants

Acute and chronic graft‐versus‐host disease (GVHD) is a major complication of bone marrow transplantation (BMT). Overt histopathological findings of GVHD are well documented. However, histopathology of subclinical GVHD is uncertain. We are studying a new type of BMT that can facilitate tolerance induction without GVHD. We hypothesized that subclinical GVHD may be induced. The model is known as a vascularized bone marrow transplant (VBMT).Lewis‐Brown‐Norway (LBN) rats radiation. Rats then received either a cellular (cBMT, n=5) or VBMT (n=4). After 110 days, splenic histopathology was assessed by H&amp;E staining and digital image analysis.Then splenic specimens were studied using Immunohistochemical staining for ED‐1 macrophage cell surface antigen.Digital image analysis revealed very little hemosiderin present in the control spleens (mean ISI 0.86) and a large amount of hemosiderin in the cBMT spleens (mean ISI 11.75). The VBMT had an intermediate level of hemosiderin (mean ISI 8.27). All groups were significantly different (p&lt;0.05). Qualitatively, it was noted that increased amounts of ED‐1 positive macrophages were present in cBMT spleens and VBMT spleens undergoing subclinical GVHD, compared to normal spleens.Hemosiderin laden and activated macrophages may represent markers for sub‐clinical GVHD due to red blood cell destruction through opsonization associated with graft versus host disease.

Correlation of ultrasonographic appearance of lesions and cytologic and histologic diagnoses in splenic aspirates from dogs and cats: 32 cases (2002–2005)

To determine the accuracy of cytologic diagnosis, compared with histologic diagnosis, in determination of disease in ultrasound-guided fine-needle aspirates of splenic lesions. Retrospective study. Splenic specimens from 29 dogs and 3 cats. Records were searched for dogs and cats that had undergone ultrasound-guided splenic aspiration. Criteria for inclusion were ultrasonographic identification of splenic lesions and cytologic and histologic evaluation of tissue from the same lesion. Cytologic samples were obtained by fine-needle aspiration, and histologic specimens were obtained via surgical biopsy, ultrasound-guided biopsy, or necropsy. Cytologic diagnoses corresponded with histologic diagnoses in 19 of 31 (61.3%) cases and differed in 5 of 31(16.1%) cases, and 1 aspirate was inadequate for evaluation. In 7 of 31 (22.6%) cases, histologic evaluation of tissue architecture was required to distinguish between reactive and neoplastic conditions. On the basis of histologic diagnosis in 14 animals with nonneoplastic conditions, the cytologic diagnosis was correct in 11 cases, not definitive in 2 cases, and incorrect in 1 case. In 17 animals with malignant neoplastic diseases, the cytologic diagnosis was correct in 8 cases, not definitive but consistent with possible neoplasia in 5 cases, and incorrect in 4 cases. Multiple similar-appearing nodules were significantly associated with malignancy, whereas single lesions were more often benign. Ultrasound-guided aspiration of splenic lesions is a minimally invasive tool for obtaining specimens for cytologic evaluation. Although cytologic diagnoses often reflect histologic results, if missampling or incomplete sampling occurs or tissue architecture is required to distinguish between reactive and neoplastic conditions, accurate diagnosis with fine-needle aspiration may not be possible.

Littoral Cell Angioma (LCA) Associated with Liver Cirrhosis

A littoral cell angioma (LCA) is a rare benign vascular tumor of the spleen. A 60-year-old man, with multiple nodules in imaging study and liver cirrhosis graded as Child-Pugh classification class A, was transferred for splenomegaly. A thrombocytopenia was found on hematological evaluation. Because there was no evidence of hematological and visceral malignancy, a splenectomy was performed for a definitive diagnosis. The histological and immunohistochemical features of the splenic specimens were consistent with a LCA. After the splenectomy, the thrombocytopenia recovered to the normal platelet count. There has been no previous report of a LCA combined with liver cirrhosis. Herein, the first case of a LCA in Korea, diagnosed and treated by a splenectomy, is reported.

Elevated serum levels of soluble vascular cell adhesion molecule-1 (sVCAM-1) closely reflect tumour burden in chronic B-lymphocytic leukaemia.

The present study is the first to report elevated serum levels of soluble (s)VCAM-1 in B-cell chronic lymphocytic leukaemia (B-CLL). A large cohort of 106 untreated patients was studied. sVCAM-1 was compared to known prognostic serum markers (soluble (s)ICAM-1; lactate dehydrogenase, LDH; sCD23; thymidine kinase, TK; beta2microglobulin, beta2m). The serum levels of sVCAM-1 reflected tumour burden as expressed by Binet/Rai stages more closely than any other marker. sVCAM-1 also reflected the kinetics of the disease as revealed by lymphocyte doubling time. sVCAM-1 was the only one of the studied markers which showed elevated levels in smouldering disease compared to controls. sVCAM-1, sICAM-1 and sCD23 (but not LDH, TK, beta2m) separated smouldering from non-smouldering B-CLL. Only sICAM-1, sCD23 and TK added independent prognostic information for survival to that of stage and lymphocyte doubling time. The expression of both adhesion molecules was examined in lymph node and splenic specimens. VCAM-1 and ICAM-1 were overexpressed by vascular endothelium and stroma, but the intensity of expression correlated poorly with serum levels of the soluble molecules. In conclusion, serum levels of sVCAM-1 correlated with tumour burden and other prognostic markers in B-CLL. VCAM-1 was overexpressed in tumour tissue as was ICAM-1. sVCAM-1 could prove a valuable marker in younger early-stage patients eligible for therapeutic trials.

Longitudinal studies of chromosomal abnomalities and reticulum cell proliferation in new zealand black mice

A longitudinal study of 40 New Zealand Black (NZB) mice and 20 BALB/c control animals was performed. A significant association was observed between the presence of acquired spleen-cell aneuploidy at some time during life and development of histological evidence of reticulum-cell neoplasia in individual animals. This finding is compatible with the hypothesis that aneuploid clones which arise in the spleens of aging NZBs are at least potentially neoplastic. However, no relationship between histologically neoplastic reticulum cell proliferation and aneuploidy was apparent in single splenic specimens obtained from NZB mice of various ages. This lack of association indicates that failure to detect chromosomal abnormalities on direct study of cells from a tumor cannot be taken as evidence that the neoplastic cells themselves lack such abnormalities.

Removal of abnormal clone of leukaemic cells by splenectomy.

A patient with chronic myelocytic leukaemia positive for the Philadelphia (Ph-1) chromosome underwent splenectomy in the "terminal phase" of his disease. Chromosomal analysis of a marrow aspirate obtained during the operation showed nothing abnormal. Material from the spleen, however, showed the absence of a C chromosome and the presence of a "marker" chromosome in all metaphases examined. The patient did well for almost three years after splenectomy, and serial cytogenetic studies of marrow specimens showed the Ph-1 chromosome to be the only significant abnormality. Six months before death from recurrent blastic transformation aneuploidy was found in a marrow specimen. Subsequently additional abnormalities, including cells with two Ph-1 chromosomes, were detected. The karyotypic abnormalities found in the splenic specimen, however, never recurred.