Pathology of the Spleen Flashcards
Splenic cysts
Not commonly seen
Classified as true cysts (rare) or pseudocysts
True cysts – epithelial cell lining; can be further divided into parasitic (hydatid) and non-parasitic
Pseudocysts – from past trauma, infarction, or infection
Splenic haemangioma
Most common benign neoplasm of the spleen
Consists of vascular channels
Mostly singular but can have multiple
Ultrasound presentation:
Well-defined echogenic lesion
Splenic calcifications
Can range from many small calcifications to larger solitary lesions
Splenic granulomatous disease:
Multiple small calcified granulomas
Infective (e.g. splenic TB) and non-infective (e.g. splenic sarcoidosis)
Larger calcifications uncommon – may be caused by hydatid cysts, old infarcts, healed abscesses.
Splenic trauma
Among the most common trauma-related injuries
Classified as either penetrating or blunt trauma
Severity can be objectively classified by a grading system
Splenic rupture
AKA splenic laceration
Most commonly caused by blunt trauma to the abdomen (i.e. MVA, sports, assault)
S&S:
Usually accompanied by other signs of injury from blunt force trauma (i.e. # ribs, # pelvis, bruising)
Pain LUQ but can have referred pain (left chest wall, shoulder – Kehr’s sign)
Treatment depends on severity of injury
Splenic haematoma
Associated with: Splenic trauma Infection Hematologic diseases Neoplasms (haemangiosarcoma, lymphosarcoma) Idiopathic (no causative factor found)
Can be subcapsular or within the parenchyma
Can lead to splenic rupture esp. post trauma
Splenic abscess
Most often seen as a complication of infective endocarditis
Bacterial, fungal, or parasitic origin
Splenic infarct
Blood supply in the splenic artery or one of its branches is compromised
Leads to death of the tissue normally supplied by the artery
Most commonly caused by thromboembolic disease and infiltrative hematologic diseases
Can also occur as a result of trauma, torsion of splenic artery in ‘wandering’ spleen, post-surgery (pancreatectomy, liver tx)
Splenomegaly
Enlarged spleen
Visually well-rounded
Multiple causes: Liver disease Malignancies Autoimmune diseases Infection – acute or chronic Blood disorders Infiltrative disorders
Splenic malignancies
Primary splenic malignancies are rare Most haematological malignancies can affect the spleen: Lymphoma Leukaemia Polycythemia vera Plasma cell malignancies Splenic metastases
Splenic lymphoma
Non-Hodgkin’s lymphoma:
Most common haematological malignancy to affect the spleen
Large B-cell most common type
Ultrasound presentation:
Hypoechoic solid mass/es
Splenomegaly
Splenic leukaemia
Leukaemia cells collect in spleen in some people with CLL
Diffuse disease
Splenomegaly; can lower RBCs to dangerous levels
Treatment - splenectomy
Polycythemia vera
Type of blood cancer – bone marrow over-produces RBCs
Ultrasound presentation:
Enlarged spleen
(Hepatomegaly, ascites, deep vein thromboses)
Splenic infarctions and thromboses are common
Splenic metastases
Rare
Most commonly from carcinomas of the lung, stomach, pancreas, liver, ovaries, and colon; rarely melanoma
Splenic varices
Result of portal hypertension
Common complication of cirrhosis
Ultrasound presentation: Tubular structures (varicose veins) around the hilum of the spleen May also see gastric varices
