Spleen and Thymus

Question 1

size of spleen

Answer 1

• 150 gm

- 12 cm in length

Question 2

What pts often auto infarct their spleens?

Answer 2

Sickle cell pts

Question 3

If you have a primary neoplasm of the spleen?

Answer 3

• generally benign and mostly in children

- spleen also often escapes metastasis

Question 4

splenomegaly in younger person. due to EBV. splenic rupture can lead to death

Answer 4

infectious mononucleosis

Question 5

What is the most common cause of enlarged spleens in the U.S.

Answer 5

Congestive states related to portal HTN

Question 6

a condition in which the spleen becomes increasingly active and tends to remove circulating cells or cellular products

Answer 6

hypersplenism

Question 7

What is the correlation between the size of the spleen and severity of cytopenia?

Answer 7

No direct predictable correlation

Question 8

Describe Non specific acute splenitis

Answer 8

• Secondary, reaction to blood born infection
• Mild splenomegaly (200-400 gms)
• Soft and fluctuant
• Acute congestion of red pulp
• infiltrates of neutrophils, plasma cells,

Question 9

Causes of congestive splenomegaly

Answer 9

-Cardiac decompensation . .right side (moderate . . <500 gm)
-Cirrhosis . . massive (1-5 Kg)
0Obstruction of the extrahepatic portal or splenic vein

Question 10

Describe the features of the spleen in congestive splenomegaly

Answer 10

• Thick capsule, cute surface gray-red to deep red
• red pulp is congested in early chronic congestion
• Becomes more fibrous and cellular (often demonstrating hypersplenism) with LONG STANDING CONGESTION and mineral/pigment deposition as well

Question 11

Whorled figures in a thymus

Answer 11

-hassel’s corpuscle

Question 12

cell markers in a Hassel’s corpuscle

Answer 12

• keratin

- HLA-DR

Question 13

Thymic hypoplasia or agenesis accompanied by parathyroid developmental failures

Answer 13

DiGeorge Syndrome

Question 14

What are the consequences of DiGeorge syndrome?

Answer 14

severe deficits in cell-mediated immunity and variable hypoparathyroidism

Question 15

mutation associated with DiGeorge syndrome

Answer 15

-22q11 deletion

Question 16

Describe Thymic cysts

Answer 16

• uncommon, usually <4 cm lesions, typically incidental

- Stratified squamous to columnar epithelium and serous or mucinous contents

Question 17

describe the workup for neoplastic Cyst

Answer 17

-may exhibit cystic features so a symptomatic patient with a cystic thymic lesion should be evaluated for true neoplasia, particularly a lymphoma or a thymoma

Question 18

refers to the appearance of thymic lymphoid follicles containing predominantly B lymphocytes . .the thymus is generally of normal size

Answer 18

Thymic hyperplasia . . better referred to as thymic follicular hyperplasia

Question 19

what condition is thymic hyperplasia most commonly found in

Answer 19

Myasthenia gravis

Question 20

Thymomas are tumors of what

Answer 20

thymic epithelial cells

Question 21

describe a thymoma

Answer 21

• background of non-neoplastic T cells (thymocytes)
• usually >40 years old
• most are in anterosuperior mediastinum

Question 22

What are the 3 types of thymomas?

Answer 22

• benign, non-invasive
• benign but invasive (cancer)
• malignant (thymic carcinoma): squamous cell carcinoma type and lymphoepithelioma type (50% with EBV)