GPR: 2019 - Week 29

• GPR Quiz
• Answer
• DDx1
• DDx2
• DDx3
• Acknowledgments

Clinical history

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

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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)

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

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

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

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

Answer

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

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

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

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

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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.