SPLENIC PATHOLOGY

Published on 07/03/2015 by admin

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Last modified 07/03/2015

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CHAPTER 9 SPLENIC PATHOLOGY

Spenunculus / accessory spleens
Splenic ‘cysts’
Splenogonadal fusion

Splenectomy for hypersplenism

Immune thrombocytopenic purpura (ITP)
Hemolytic anemia [congenital (eg spherocytosis) or acquired]
Congestive splenomegaly
Other miscellaneous splenic disease

Storage disease
Infection
Involvement by malignancy
Sickle cell disease
Spleen in immunodeficiency

INTRODUCTION

• Spleen may be involved with many systemic processes

image most are covered in other sections

• Lesions addressed here are those splenic conditions not encountered elsewhere in the text
• In general, splenic pathology forms a small component of most pediatric surgical pathology workload

image spleen may also be removed following trauma

SPENUNCULUS / ACCESSORY SPLEENS (Fig 9.1)

• Often removed as incidental findings

image usually asymptomatic

• May enlarge following splenectomy for other indication
• No specific histological features
image

Fig 9.1 Photomicrograph of a splenunculus, demonstrating an encapsulated nodule of otherwise unremarkable splenic tissue.

SPLENIC ‘CYSTS’

• The majority of nonparasitic splenic cysts in children are squamous lined epidermoid cysts (Czauderna et al 2006)
• Other rarer types include splenic pseudocyst or mesothelial cyst

image hemangioma or lymphangioma are also described

– often diagnosed as ‘cysts’ preoperatively

Pseudocysts

• Dense fibrosis tissue in wall

image no identifiable epithelial lining

• Usually contain blood and necrotic debris

Epithelial cysts (Figs 9.2–9.5)

• Usually solitary
• Usually present in childhood

image incidentally
image mass lesion

• Cyst wall lined by bland epithelium

image squamous
image columnar
image cuboidal

– possibly derived from epithelial inclusions

image

Fig 9.2 Macroscopic photograph of a spleen resected with a simple epithelial cyst; residual clear/yellow fluid is seen.

image

Fig. 9.3

image

Fig. 9.4

image

Figs 9.3–9.5 Photomicrographs of simple epithelial splenic cysts, demonstrating lining which is focally attenuated and predominantly simple squamous in type, with surrounding fibrosis and otherwise normal splenic tissue.

Parasitic

• Echinococcus infection

image rare in UK

SPLENOGONADAL FUSION

• Usually incidental finding
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