Spleen

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Triage

  1. The Hematopathologist on call should be contacted (4659 or 2-1314) for advice on triage/grossing.
  2. 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.
  3. Weigh, measure (3D), describe capsule, and photograph if specimen is not macerated.

Gross

  1. Look for lymph nodes in the splenic hilum, dissect out, and submit after formalin fixation for histology.
  2. 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.
  3. 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.
  4. 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

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