Recommendations for gross examination and sampling of surgical specimens of the spleen

O’Malley, Dennis P.; Louissaint, Abner; Vasef, Mohammad A.; Auerbach, Aaron; Miranda, Roberto N.; Brynes, Russell K.; Fedoriw, Yuri; Hudnall, S. David

doi:10.1016/j.anndiagpath.2015.06.004

Cited by 6 publications

(8 citation statements)

References 39 publications

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“…Concurrent with contemporary guidelines and standard clinical practice, 12 all surgical specimens of the spleen removed during surgery are uniformly sent for pathology review irrespective of the clinical setting and indication for splenectomy. However, an emerging body of literature indicates that in designated clinical scenarios, namely trauma-related splenectomy, the diagnostic yield and therapeutic gain in terms of change in medical care are for the most part minor.…”

Section: Discussionmentioning

confidence: 99%

Association of Preoperative Clinical, Laboratory, Imaging, and Pathologic Data With Clinically Beneficial Pathology Among Routine Splenectomy Specimens

et al. 2021

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IMPORTANCE Previous studies have shown that uniform pathologic review of all splenectomy surgical specimens reveals new clinically actionable diagnoses only in a minority of cases.OBJECTIVE To examine whether the aggregate of clinical, laboratory, imaging, and pathologic preoperative data is associated with a clinically beneficial pathologic study for routine splenectomy surgical specimens. DESIGN, SETTING, AND PARTICIPANTSThis single-center retrospective cohort study included all patients who underwent splenectomy from January 1, 2013, through December 31, 2018, at a single center. Clinical, imaging, and pathologic data were extracted from the institution's electronic medical records system. Data analysis was conducted from June to November 2020. EXPOSURES Undergoing splenectomy for trauma or diagnostic or therapeutic indications. MAIN OUTCOMES AND MEASURES Spleen pathology study resulting in a new medical diagnosis or change in medical management. RESULTS Overall, 90 patients (53 [59%] men) with a median (range) age of 59 (19-90) years underwent splenectomy for therapeutic purposes in 41 patients (45%), trauma in 24 patients (27%), diagnostic purposes in 15 patients (17%), and combined therapeutic and diagnostic purposes in 9 patients (10%). In 14 patients (15%) a new malignant neoplasm was found, and in 8 patients (9%), a new nonneoplastic medical condition was diagnosed. A new pathologic diagnosis resulted in change in medical management in 16 patients (18%). In patients without a prior diagnosis of cancer, 41 of 56 pathology biopsies (73%) were found to be normal whereas in 7 biopsies (13%), a new diagnosis of a hematologic malignant neoplasm was revealed (P < .001). Patients with clinical splenomegaly were significantly more likely to have a new pathologic diagnosis of cancer compared with patients without splenomegaly (15 of 26 [58%] vs 4 of 64 [7%]; P < .001). In 39 of 43 patients (91%) with normal presurgery imaging studies, normal spleen pathology was revealed, whereas in 14 of 17 patients (82%) with abnormal imaging studies, a new hematological malignant neoplasm was diagnosed following pathologic review of the spleen specimen (P < .001). Patients with gross abnormalities on macroscopic examination had a significantly increased likelihood of a hematological cancer diagnosis (17 of 40 [43%]) and a solid cancer diagnosis (4 [10%]) compared with patients with grossly normal specimens (4 of 49 [8%]; P < .001). CONCLUSIONS AND RELEVANCEIn this cohort study, routine pathologic review of spleen specimens was clinically beneficial in patients with splenomegaly, abnormal imaging results, a prior diagnosis of cancer, and with grossly abnormal spleens.

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Section: Discussionmentioning

confidence: 99%

Association of Preoperative Clinical, Laboratory, Imaging, and Pathologic Data With Clinically Beneficial Pathology Among Routine Splenectomy Specimens

et al. 2021

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“…In spite of many years of research into the origins and characteristics of lymphomas favoring the spleen, the participation of the oldest type described to preferably involve this site, hairy-cell lymphoma, remains a mystery. Lymphoma and splenic B-cell marginal zone, its most recently described variants, have been widely investigated, but their actual relationship with splenic marginal zone normal B-cells remains controversial 4,15 .…”

Section: Types Of Lymphoma That Infiltrate the Spleenmentioning

confidence: 99%

Splenic diffuse large B-cell lymphoma. Case report

Cruz-Benítez¹,

Pérez-Reyna²,

González-Müller³

2022

GAMO

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Lymphomas are defined as a solid tumor of the lymphoid tissue, of malignant biological behavior, and with great diversity of clinical and histological forms. It originates in lymph nodes in 35% of cases or in the lymphoid tissue of the parenchyma of the original organ in 65% of cases. Lymphomas are classified into two major groups: Hodgkin's disease and non-Hodgkin's lymphomas (NHL). The spleen may be involved in a wide variety of lymphomas; in some cases they infiltrated said organ as part of a broad diffusion of a base node other particular lymphoma. Splenectomy with liver biopsy and biopsy of the para-aortic lymph node is the treatment of choice for splenic lymphoma. In patients with low-grade NHL confined to the spleen, complete remission of the associated haematological abnormality may reach approximately seven months after splenectomy. Postoperative adjuvant therapy depends on the clinical stage of the disease.

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“…A pesar de muchos años de investigación en los orígenes y características de los linfomas favoreciendo el bazo, el tipo más antiguo descrito preferencialmente la participación de este sitio, leucemia de células peludas, sigue siendo un misterio. El linfoma y la zona marginal de células B esplénicas su más recientemente variantes descritas han sido ampliamente investigados, pero su verdadera relación con las células B normales de la zona marginal esplénica sigue siendo controvertido 4,15 .…”

Section: Tipos De Linfoma Que Infiltran El Bazounclassified

Linfoma esplénico difuso de células grandes estirpe B. Reporte de caso

Cruz-Benítez¹,

Pérez-Reyna²,

González-Müller³

2022

GAMO

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Resumen Los linfomas se definen como un tumor sólido del tejido linfoide, de comportamiento biológico maligno y con gran diversidad de formas clínicas e histológicas. Se origina en los ganglios linfáticos en un 35% de los casos o en el tejido linfoide del parénquima del órgano original en un 65% de los casos. Los linfomas se clasifican en dos grandes grupos: los tipo Hodgkin (LH) y los no-Hodgkin (LNH). El bazo puede estar implicado por una amplia variedad de linfomas; siendo que en algunos casos se infiltraron a dicho organo como parte de una amplia difusión de un nodo de base u otro linfoma particular. La esplenectomía con biopsia hepática y biopsia de la cadena ganglionar paraaórtica constituye el tratamiento de elección para el linfoma esplénico. En pacientes con LNH de bajo grado confinado al bazo, la remisión completa de la alteración hematológica asociada puede alcanzarse aproximadamente a los siete meses de la esplenectomía. La terapia adyuvante posoperatoria depende del estadio clínico de la enfermedad. (creativecommons.org/licenses/ by-nc-nd/4.0/).

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Recommendations for gross examination and sampling of surgical specimens of the spleen

Cited by 6 publications

References 39 publications

Association of Preoperative Clinical, Laboratory, Imaging, and Pathologic Data With Clinically Beneficial Pathology Among Routine Splenectomy Specimens

Association of Preoperative Clinical, Laboratory, Imaging, and Pathologic Data With Clinically Beneficial Pathology Among Routine Splenectomy Specimens

Splenic diffuse large B-cell lymphoma. Case report

Linfoma esplénico difuso de células grandes estirpe B. Reporte de caso

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