GPR: 2020 - Week 50

From MGH Learn Pathology

Clinical history

67 year old male with history of cirrhosis, squamous cell carcinoma of the lung, and HIV infection. Spleen (285 g) examined at autopsy.


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Hyaline Perisplenitis
  • Also known as “sugar icing spleen”
  • Common incidental autopsy finding
  • Capsule of the spleen becomes nodular, thickened and fibrotic with irregular tan plaques of collagen
  • Associated with cirrhosis/portal hypertension
  • Spleen usually enlarged
  • Splenic parenchyma uninvolved
  • Convex surface usually more severely affected than the concave, medial aspect
 

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Mycobacteriosis

  • Multiple gray-white nodules with caseation (cheesy, white, soft material)
  • Granulomas may be large macronodules or multiple small nodules (miliary)
  • Spleen size ranges from normal to markedly enlarged
 

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Sclerosing angiomatoid nodular transformation

  • Benign vascular lesion of spleen that may represent a reaction to inflammation, tumors, or hemorrhage
  • Single central mass with coalescing red-brown nodules at periphery and sclerotic center
  • Well-demarcated from surrounding splenic parenchyma which is grossly unremarkable
  • Tumor diameter range: 3-17 cm
  • ~ 50% of cases are in spleen of normal weight (< 200 g )
  • Rarely can be multiple masses
 

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Metastatic carcinoma

  • Metastases to spleen are relatively uncommon. Intraparenchymal metastasis is due to hematogenous spread.
  • Direct extension of tumor from adjacent organ is more common
  • Range from solitary or multiple large nodules of varying sizes to small, uniform nodules located in red &/or white pulp in a miliary pattern
  • Most common primary sites are ovary (60% of splenic metastases), lung (20%), skin malignant melanoma (16%), colorectum (2%), renal cell carcinoma (~ 2%), and stomach
  • In lung cancer with splenic mets: small cell carcinoma is most likely to metastasize to spleen and squamous cell carcinoma least likely
 
Thank you to the following individuals for taking gross photos that were used in this presentation:
  • Dr. Alexander Subtelny
  • Dr. Diane Brackett
  • Dr. Will Jeck
  • Joshi S, Bankar M, Kagal A, Rane S, Bharadwaj R, Phadke M. Splenic Tuberculosis– A rare case report. Internet Journal of Medical Update 2007 Jul-Dec;2(2):38-41
  • Spleen: miliary tuberculosis. Welcomecollection.org.
  • Swami et al., J Cytol Histol 2018

This week's Gross Pathology Roundup was presented by Michael Marshall MD, PhD on 2020-12-07.