< | up | >
Spleen sub-capsular hemorrhage (4112)
Spleen sub-capsular hemorrhageclosed
 Type:
spleen		 Sender:
mona_rashed 		2007-11-19 17:17
INCTR - EBMWG Hematopathology Online
Male patient 33 years old presented at the emergency department with left hypochondrial pain; splenectomy was done for sub-capsular hemorrhage.  
Pls how to interpret this case? Thanks.  
Gallery:
Annotations » Add comment (Login)
diane.c.farhi
2007-11-19 19:55
[comment sent by email]
Was it really right hypochondrial pain, as opposed to left, where the
 
spleen is? Was there any history of trauma to the area of the spleen? If
 
not, then the differential includes the usual causes of splenic
 
hemorrhage, including malignancy. I can't make anything out in the
 
photos to help me with the differential diagnosis. Given the age, I
 
would suggest evaluation for EBV infection. This produces subintimal and
 
subcapsular infiltrates of mixed lymphoid cells, including immunoblasts
 
and plasmacytoid cells.
 
tzankov
2007-11-20 08:16
There are many artifacts on these pictures, particularly due to thick sections and wrong dehydration..., but nevertheless I do not see any evidence of EBV infection or septic conditions. please add more focussed photographies.
anpo
2007-11-24 21:38
The photos are not good but the general structure of the spleen seems to be preserved. Maybe there was a haemangioma in the spleen that ruptured? How did the area nearest haemorrhage look like?
hurwitz
2007-11-25 22:54
I agree that the quality of the histology is not optimal for interpretation.  
I also miss some minimal clinical information regarding trauma preceeding the rupture and macroscopic findings such as size if the spleen, and appearances of the area near the rupture.  
I share the impression of my colleges that the general microscopic architecture is well preserved. Splenic sinusoids seem to dilated (image--017), as often seen in subcapsular areas close to a the rupture.  
To conclude the case:  
The submitted images do not show any evidence of a pathologic process in the spleen to explain the subcapsular hermorrhage and rupture.  
There is no evidence of malignancy.
mona_rashed
2007-12-04 17:48
Dr. Nina ; thank u very much for your conclusive comment on this case. this case have a recent history of trauma prceeding the spleenic rupture,that was moderately enlarged also the case is portal hypertensive.
hurwitz
2007-12-11 17:35
Thanks Mona, for the additional information, now the case is clear.
» Add comment (Login)
Last modified: 2007-11-19 17:17:15