GPR: 2019 - Week 29

From MGH Learn Pathology

Clinical history

42M with mitral valve endocarditis presented with abdominal pain and a 400g spleen


GPR19-21 -Pic1.jpg


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GPR19-21 -Pic1.jpg

 
Splenic infarct
  • Wedge-shaped lesion corresponding to vascular distribution (capsule = base, apex = artery)
  • Well-circumscribed
  • Initially pale (necrosis, inflammation)
  • Hyperemic rim (necrosis, macrophages)
  • Tan-firm (fibroblast repair and scar)
 

GPR19-21 -ddx1.jpg

 

Sclerosing Angiomatoid Nodular Transformation

  • Benign (vascular lesion)
  • Single central mass with stellate sclerosis
  • Well-demarcated from surrounding spleen
  • Tan-white cut surfaces with areas of entrapped red pulp
  • Peripheral nodularity
 

GPR19-21 -ddx2.jpg

 

Diffuse Large B-Cell Lymphoma

  • Mass-forming lesion (usually distinct, can either be solitary or multiple)
  • Background of non-neoplastic spleen
  • Well-circumscribed, nodular with tan-white to fleshy cut surfaces
  • Central necrosis and hemorrhage
  • Generally associated with splenomegaly and lymphadenopathy
 

GPR19-21 -ddx3.jpg

 

Splenic Marginal Zone Lymphoma

  • Diffuse process
  • Numerous miliary small white nodules
  • Associated with splenomegaly and lymphadenopathy
 
  • Abner Louissaint, MD, PhD
  • Pathology Assistants
  • MGH Pathology Residents
  • Abner Louissaint, MD, PhD
  • Pathology Assistants
  • MGH Pathology Residents
  • GPR Quiz

    Clinical history

    42M with mitral valve endocarditis presented with abdominal pain and a 400g spleen


    GPR19-21 -Pic1.jpg


    Registered users must be logged in to access the interactive quiz.

    Answer[edit]


    GPR19-21 -Pic1.jpg

     
    Splenic infarct
    • Wedge-shaped lesion corresponding to vascular distribution (capsule = base, apex = artery)
    • Well-circumscribed
    • Initially pale (necrosis, inflammation)
    • Hyperemic rim (necrosis, macrophages)
    • Tan-firm (fibroblast repair and scar)
     

    DDx1[edit]


    GPR19-21 -ddx1.jpg

     

    Sclerosing Angiomatoid Nodular Transformation

    • Benign (vascular lesion)
    • Single central mass with stellate sclerosis
    • Well-demarcated from surrounding spleen
    • Tan-white cut surfaces with areas of entrapped red pulp
    • Peripheral nodularity
     

    DDx2[edit]


    GPR19-21 -ddx2.jpg

     

    Diffuse Large B-Cell Lymphoma

    • Mass-forming lesion (usually distinct, can either be solitary or multiple)
    • Background of non-neoplastic spleen
    • Well-circumscribed, nodular with tan-white to fleshy cut surfaces
    • Central necrosis and hemorrhage
    • Generally associated with splenomegaly and lymphadenopathy
     

    DDx3


    GPR19-21 -ddx3.jpg

     

    Splenic Marginal Zone Lymphoma

    • Diffuse process
    • Numerous miliary small white nodules
    • Associated with splenomegaly and lymphadenopathy
     

    Acknowledgments

    • Abner Louissaint, MD, PhD
    • Pathology Assistants
    • MGH Pathology Residents
  • Abner Louissaint, MD, PhD
  • Pathology Assistants
  • MGH Pathology Residents

  • This week's Gross Pathology Roundup was presented by Lena D. Stuart, MD on Mon, Jul 15, 2019.This week's Gross Pathology Roundup was presented by Lena D. Stuart, MD on Mon, Jul 15, 2019.