Spleen: An Organ Full of Mystery and its Mysterious Pathologies!

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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

Spleen: An Organ Full of Mystery and its Mysterious Pathologies!

Anwar Ul Haque
Department of Pathology, Pakistan Institute of Medical Sciences, Islamabad.
The spleen is also known as Organ of Galen,
a great anatomist of Greek Era and the organ is
regarded as “Organ full of mystery” ! Although
recognized as one of the important sites of
extramedullary hemopoiesis in embryonic and fetal
life, it was treated almost as vestigial organ in adult
life! With slightest injury to it or its blood supply,
spleen was removed and thrown into dust bin! The
pathologists also did not examine spleen meticulously;
to them it appeared like a organ composed and
comprised of white and red pulps with blood filling
the sinusoids and that’s about it. When I was a
first year of resident of pathology in Des Moines,
Iowa, USA, two cases one after the other, gave me a
shock.1 First was an adult healthy man who had
stormy course after a trivial trauma and quickly died
despite all aggressive management. He had full blown
Waterhouse-Fredricksen syndrome i.e. Disseminated
Intravascular Coagulation (DIC) with pneumococcal
septicemia and bilateral adrenal hemorrhages. His
past history was significant that he had splenectomy
after motorbike accident 13 years prior to this episode.
Then a few months afterward I saw a woman
who presented with pneumococcal septicemia and
had lost all her twenty fingers and toes. Fortunately
she survived after these rather massive amputations.
Her past history was significant because she had
had splenectomy due to bicycle trauma 22 years
back. These two episodes sensitized me with the
importance of spleen and dire life long consequences
of missing it.2 We then carried out experiments on
Sprague-Dawley rats and found similar findings of
Waterhouse Fredricksen Syndrome!3


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