Spleen and Thymus, Putthoff

Question 1

functions of the spleen

Answer 1

phagocytosis
Ab production
Hematopoiesis
Sequestration of formed blood elements

Question 2

What are splenectomy patients prone to

Answer 2

infections from S pneumonia, N meninginitis, H influenza

Question 3

Where in spleen do you find Ab secreting plasma cells

Answer 3

red pulp

Question 4

What infections can cause splenomegaly

Answer 4

mononucleosis

Question 5

what type of congestive disorders can cause splenomegaly

Answer 5

cirrhosis, R HF, portal thrombosis

Question 6

how does increased Portal v Pressure lead to splenomegaly

Answer 6

increased deposition of collagen from increased pressure leads to dilation and slowing of blood so more is in spleen and mroe is destoryed

Question 7

what are causes of portal thrombosis

Answer 7

intrahepatic obstructive diseases or carcinomas of the stomach or pancreas

Question 8

what are Sx of splenomegaly

Answer 8

LUQ pressure
abdominal discomfort
thrombocytopenia
anemia
leukopenia

Question 9

What lymphohematogenous disorders are assoc with splenomegaly

Answer 9

non-hodgkin lymphoma and lymphocytic leukemia

myeloproliferative disorders

Question 10

what immune inflammatory proccesses are assoc with splenomegaly

Answer 10

SLE and RA

Question 11

What is nons[ecific acute splenitis

Answer 11

secondary to any blood borne infections
mild splenomegaly
soft and fluctuant
acute congestion red pulp

Question 12

what are the infiltrates composed of in nonspecific acute splenitis

Answer 12

neutrophils, plasma cells and maybe eos

Question 13

Why do the spleens commonly infarct

Answer 13

lacks collarteral blood supply

usually emboli from endocarditis or damage from sickle cell

Question 14

What do splenic infarcts look like

Answer 14

bland pale, wedge shaped and subcapsular

Question 15

Describe neoplasms of the spleen

Answer 15

primary are extremely rare- hemangiomas and lymphangiomas

secondary are assoc with myeloproliferative syndromes or myeloid neoplasms (DLBCL common)

Question 16

What are the congenital problems with spleens

Answer 16

absent- rare assoc with situs inversus
hypoplasia- common
accessory- common

Question 17

what is important to check before providing Tx splenectomy

Answer 17

look for accessory spleen

Question 18

what can cause rupture of spleen

Answer 18

trauma

mono, malaria, typhoid fever, lymphoid neoplasm

Question 19

are chronic spleens with splenomegaly at increased risk of rupturing

Answer 19

no decreased because of all the fibrotic proccesses

Question 20

Describe size of thymus over time

Answer 20

gets bigger than in adulthood shrinks to basicall just fatty fibrotic tissue

Question 21

what can make thymus involute earlier on

Answer 21

severe illness or HIV

Question 22

What cells are found in thymus

Answer 22

epithelial cells
immature T lymphocytes
macrophages, dendritic cells, B lymphocytes, neutrophils, eos, myoid cells

Question 23

what are thymic epithelial cells in the medulla like

Answer 23

densely packed, spindle shaped called hassel corpuscles

keratinized cores

Question 24

what marker stains the medullary epithelial cells in thymus

Answer 24

HLA-DR+

Question 25

describe the cortical thymic epithelial cells

Answer 25

polygonal with lots of cytoplasm

Question 26

what is role of immature T lymphocytes in thymus

Answer 26

go through Ag dep T cell maturation

- and + selection

Question 27

What are the developmental disorders of thymus

Answer 27

Digeorge 22q11 which has severe defects in cell mediated immunity and assoc with hypothyroidism

Question 28

What are thymic cysts

Answer 28

benign usually less than 4 cm and stratified squamous- columnar epithelium
fluid inside is serous or mucinous

Question 29

If you found a cystic thymic mass what do you need to look for

Answer 29

neoplasm

Question 30

What is thymic hyperplasia

Answer 30

thymic follicular hyperplasia of B lymphocytes

Question 31

thymic hyperplasia is common in what other conditions

Answer 31

myasthenia gravis

graves, SLE, RA, scleroderma

Question 32

What are thymomas

Answer 32

tumors of the thymic epithelial cells

Question 33

what do the thymomas look like

Answer 33

lobulated gray-white masses often encapsulated

Question 34

what are the types of thymomas

Answer 34

cytologically benign noninvasive
malignant I/cytologically benign and invasive
malignant II cytologically metastatic

Question 35

where are thymomas usually found

Answer 35

anterosuperior mediastinum, neck, thyroid, pulmonary hilus, posterior mediastinum

Question 36

dist thymomas

Answer 36

> 40 M=F rarely in children

Question 37

what is prognosis of type I bengin but invasive thymoma

Answer 37

minimal invasion with complete excision 5 yr survival >90%

extensive invasion 5 yr survival <50%

Question 38

what are the subtypes of II malignant thymoma

Answer 38

squamous cell carcinoma

lymphoepithelioma

Question 39

lymphoepithelioma thymomas are assoc with what commonly

Answer 39

EBV

Question 40

what do metastatic thymomas look like

Answer 40

fleshy and obviously invasive

Question 41

Sx of thymomas

Answer 41

impingement of mediastinal structures

Question 42

What are thymomas assoc with

Answer 42

myasthenia gravis!

hypogammaglobulinemia, pure red cell aplasia, graves, pernicious anemia, dermatomyositis-polymyositis and cushings

Question 43

which type thymomas are more common assoc with autoimmune

Answer 43

cortical thymomas