Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
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Splenomegally
[transfusion & coagulopathy issues]
  1. Primarily cirrhosis associated:
  2. Primarily non-cirrhotic associated:
    • increased portal pressure etiology:
      • "acute": this would include (1) portal hyper-reverse flow and (2) increased portal pressure that has, as yet, been insufficient to have structural changes that keep such a ruptured spleen enlarged. So, when the blood seeps out, the residual tissue may give an under-impressive degree of "splenomegally" as compared to the in vivo situation prior to rupture [L12-16387?]. It is hard to imagine a way that a normal spleen could rupture without trauma.
      • chronic: [may see Gamma-Gandy bodies (fibrocalcific, iron-rich nodules)]
        • cirrhosis-associated
        • non-cirrhotic-associated
          • hepatoportal sclerosis (HPS) (idiopathic portal hypertension)
          • hemoglobinopathies
      • other:
    • not-increased portal pressure:
      • cellular infiltrates of spleen:
        1. hairy cell leukemia
        2. MDS rarely causes splenomegally unless progresses to leukemia so that leukemiic cellular splenomegally [L09-15620].
        3. lymphoma
          1. systemic hemophagocytic syndrome (SHS)...familial vs. secondary: you see lots of macrophages engulfing hematolymphoid cells).
        4. patients with acute or chronic ITP may enlarge the spleen as macrophages engulf the damaged platelets...remindful of Gauches. The histology is some or all of (1) follicular hyperplasia, (2) plasmacytosis, (3) and ceroid (golden-tan or "sea blue") or usual histiocyte clusters; these histiocytes usually contain some iron positivity; & the appreciation of plasmacytosis can be enhanced with CD138 stain [L04-8363]. Splenectomy helps in chronic ITP, and infusion of platelets and ligation timing is important. Whether the spleen is enlarged or not, the histiocyte clusters are compatible with splenic immuno-consumption of platelets [L12-13472].
      • metabolic/storage or depositional disease in spleen:
        1. amyloidosis
        2. other

References:

(posted 3 November 2004; latest addition 25 March 2013)

 
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