Spectrum of Disease Entities in Splenectomy Specimen

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Professor, Consultant Pathologist, American Board Certified Pathologist, Fellow College of American Pathologists. Areas of interest Fine Needle Aspiration Cytology, Cytology, Cancer, Ethics, Islam, Humanity

Spectrum of Disease Entities in Splenectomy Specimen

Ahmareen Khalid, Anwar Ul Haque and Lubna Naseem
Department of Pathology, Pakistan Institute of Medical Sciences, Islamabad.

Introduction: We report here our results of Pathological assessment of 35 splenectomy cases.
Purpose of Study: To evaluate the subtle morphological change which is often missed due to lack of experience &
knowledge.
Material and Methods: It was a non-interventional descriptive study, carried out in the Pathology department of PIMS. All
available splenectomy, slides were reviewed from a period of Jan 2004 to April 2007. Slides were reviewed by two
histopathologists & one hematologist.
Results: On re-examination there was change in 65% (n: 35) cases. Malaria was the most often missed diagnosis. In 31%
(n: 11) cases malaria was suspected due to blackish-brown pigment in the macrophages. Out of these in 27% (n: 3) definite
schizonts were seen and hence malarial spleen was confirmed. Littoral cell Hyperplasia was found in 20% (n: 7) cases which
was previously diagnosed as Idiopathic Thrombocytopenic purpura in 2 cases ,congested Spleen in 4 cases and Littoral
hyperplasia in 1 case. Extramedullary hemopoiesis has been in seen in 17% (n: 6) cases which were previously diagnosed as
congested spleen in 4 cases, consistent with Thallasemia in 1 case and 1 case of essentially normal Spleen. Malignancy was
picked up in 6% (n: 2) cases which were missed in initial examination.
Conclusion: Spleen still lingers as useless and “vestigial” organ in the minds of surgeons and the pathologists despite its very
vital immunophysical defense activities. The spleen are too often removed before giving a therapeutic trial of proper
antimalarial drugs in “ idiopathic thrombocytopenia “ and idiopathic splenomegaly .Possibility of malignancy is also missed
often .Inadequate history and rather very cursory examination of splenic section results in missing vital diagnosis.
Unnecessary splenectomies must be avoided while pathologist must examine this very precious organ very carefully. Needless
to say that many of the diagnosis attained on splenic sections could have been obtained on FNAC of Spleen.
Key words: Spleen, Malaria, Littoral cell Hyperplasia. Histopathological examination of Spleen.

         

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