Auto text: “Insert Spleen”
- The Hematopathologist on call should be contacted (4659 or 2-1314) for advice on triage/grossing.
- Look up the patient’s relevant history in EPIC. Splenectomies can be performed for a variety of conditions both benign and malignant, and knowing the reason can be helpful.
- Benign conditions: Immune thrombocytopenic purpura.
- Malignant conditions: Lymphomas, myeloproliferative neoplasms (polycythemia vera, essential thrombocythemia, primary myelofibrosis), hairy cell leukemia.
- Storage diseases/histiocytic disorders: May require special fixatives, so discuss this with the heme attending.
- Weigh, measure (3D), describe capsule, and photograph if specimen is not macerated.
- Look for lymph nodes in the splenic hilum, dissect out, and submit after formalin fixation for histology.
- Using a long blade, slice the entire spleen into thin (3 mm) slices, and inspect carefully for nodules.
- If the cut surface is unremarkable without nodules: Take 1 section each of the following areas: hilar spleen, uninvolved parenchyma, and capsule.
- If parenchymal nodules/masses are noted:
- Note the size range, locations (hilar, parenchymal, capsular… etc), and approximate number.
- Photograph a representative cut surface.
- Make a touch preparation of the nodule(s), stain 1-2 touch preps with Giemsa stain and leave 1-2 touch preps unstained.
- Take 2-3 sections of the nodules for histology (fix in formalin).
- Additionally, take 1 section each of the following areas: hilar spleen, uninvolved parenchyma, and capsule.
- Based on the clinical history, the attending may ask for additional preparations:
- Make touch preparations, stain 1-2 touch preps with Giemsa stain, and leave 1-2 touch preps unstained.
- Submit a small piece (0.5-1 cubic cm) for flow cytometry in a tube of RPMI (red top).
- Submit a small piece (0.5-1 cubic cm) for cancer cytogenetics in a tube of RPMI+PenStrep (orange top).
- Snap freeze a piece for additional studies, or lymphoma bank.
- The remainder of the spleen may be fixed in formalin in the container in which it was received.
Spleen – Nodules of Diffuse Large B Cell Lymphoma