Practical Applications in Immunohistochemistry: An Immunophenotypic Approach to the Spleen.

CONTEXT.­: Even though immunohistochemistry is routinely used by pathologists, evaluation of immunohistochemistry in splenic lesions remains difficult for many. Classification of benign and splenic lesions often requires a combination of hematoxylin-eosin evaluation, immunophenotyping, and sometimes molecular testing. Immunohistochemical staining is essential in evaluating many splenic lesions, and requires an understanding of the normal compartments of the spleen. OBJECTIVE.­: To address different immunohistochemical features used for identification and subclassification of different lesions of the spleen, as well as in the normal compartments of the spleen. DATA SOURCES.­: The information outlined in this review article is based on our experiences with a variety of spleen cases, on the current World Health Organization classification of hematopoietic and lymphoid tumors, and on a review of English-language articles published during 2018. CONCLUSIONS.­: Features for phenotyping normal spleen as well as a variety of splenic lesions, including littoral cell angioma and splenic marginal zone lymphoma, are discussed. Suggested immunopanels are provided to assist in the diagnosis of different lesions of the spleen.

Cistos esplênicos não-parasitários / Non-parasitic splenic cysts

Este artigo apresenta uma revisão geral do tema, com ênfase em conceitos atuais e no manejo das situações clínicas em questão, em especial a conceitos referentes ao tratamento. Também é feita uma revisão extensa quanto à etiologia e seguimento dos pacientes com cisto esplênico não parasitário. São citadas informações derivadas dos principais estudos clínicos publicados na literatura médica atual.

This article gives an overview of the topic, with emphasis on current concepts and management of the clinical situations in question, in particular the concepts related to treatment. An extensive review of the etiology and monitoring of patients with non-parasitic splenic cysts is also made. These reports are derived from major clinical studies published in the current medical literature.

Non-parasitic splenic cysts.

This article gives an overview of the topic, with emphasis on current concepts and management of the clinical situations in question, in particular the concepts related to treatment. An extensive review of the etiology and monitoring of patients with non-parasitic splenic cysts is also made. These reports are derived from major clinical studies published in the current medical literature.

[Relationship between the phenotypes and functions of peripheral blood dendritic cells and the different spleen deficiency syndrome types in patients with chronic hepatitis B].

OBJECTIVE: To study the phenotypes and functions of dendritic cells (DCs) derived from peripheral blood monocytes of chronic hepatitis B (CHB) patients with different traditional Chinese medicine (TCM) syndrome types, and to explore the relationship between TCM syndrome type and DC functions. METHODS: Sixty CHB patients were included in this study. All the CHB patients were divided into spleen deficiency and liver stagnation, spleen deficiency and dampness-heat and deficiency of both spleen and kidney groups according to TCM syndrome diagnosis standard. There were 20 cases in each group, and ten healthy people were included as normal control. The volunteer's peripheral blood was collected for monocyte separation, biochemical test and hepatitis B virus DNA loads detection. DCs were induced and isolated from peripheral blood monocytes, and then the expressions of surface markers CD80, CD86, CD1a and HLA-DR were detected by flow cytometric analysis method. Interleukin-10 (IL-10) production of the DCs was quantified by enzyme-linked immunosorbent assay. RESULTS: The proliferation of DCs in the CHB patients was slower than that in the healthy volunteers (P<0.05). The expressions of DC surface molecules such as CD80, CD86, and CD1a were obviously decreased in the CHB patients as compared with those in the healthy volunteers (P<0.05). More over, expressions of DC surface molecules were different among CHB patients with different TCM syndrome types. The positive expressions of CD80, CD1a, and HLA-DR in the CHB patients with spleen deficiency and liver stagnation were obviously higher than those in the CHB patients with deficiency of both spleen and kidney (P<0.05), and the CD1a expression in the CHB patients with spleen deficiency and dampness-heat was higher than that in the CHB patients with deficiency of both spleen and kidney (P<0.05). In DC culture supernatant, the IL-10 concentration of the CHB patients with deficiency of both spleen and kidney was higher than that of the CHB patients with spleen deficiency and liver stagnation (P<0.05), and the IL-10 concentrations of the CHB patients with different TCM syndrome types were higher than that of the healthy volunteers (P<0.05). CONCLUSION: During the pathogenic course of CHB, the phenotypes and functions of DCs are different in CHB patients with different TCM syndrome types. It suggests that there is a correlation between TCM syndrome type and body immunity function.

Cytopathological and histopathological diagnosis of canine splenic disorders.

OBJECTIVES: To determine (1) the common types of canine splenic disorders, and the breeds affected, that are diagnosed by cytopathological and histopathological examination in Sydney, Australia and (2) the accuracy of cytopathological examination compared with histopathological examination for the diagnosis of canine splenic disorders. DESIGN: 69 cytopathological and 51 histopathological diagnoses of canine splenic disorders presented to the Veterinary Pathology Diagnostic Services, The University of Sydney during 2006 and 2007 were tabulated and analysed; 17 cases examined both cytopathologically and histopathologically during 2001-07 were also analysed. RESULTS: The most common cytopathological diagnoses were benign disorders of growth, vascular disturbances and necrosis (29%), followed by no abnormalities detectable (28%), malignant neoplasms (20%), equivocal diagnoses (20%) and inflammatory disorders (3%). The most common breeds were Kelpie crosses and mixed breeds. The most common histopathological diagnoses were benign disorders of growth, vascular disturbances and necrosis (49%), followed by malignant neoplasms (43%) and inflammatory disorders (8%). The most common breeds were German Shepherd Dogs, Boxers and Maltese Terriers. Cytopathological and histopathological diagnoses were in complete agreement in 59% of cases, partial agreement in 29% and disagreement in 12%. CONCLUSION: Benign disorders of growth, vascular disturbances and necrosis were the most commonly diagnosed canine splenic disorders, both cytopathologically and histopathologically. Kelpie crosses presented most frequently for cytopathological examination. German Shepherd Dogs were the most common breed diagnosed histopathologically with haemangiosarcoma. Although cytopathological and histopathological splenic examinations are complementary for diagnosis, this study has shown a high correlation for complete and partial agreement between the two.

Total splenic vein thrombosis after laparoscopic splenectomy: a possible candidate for treatment.

BACKGROUND: Portal or splenic vein thrombosis (PSVT) is a common disorder after laparoscopic splenectomy (LS). Splenomegaly is a well-known risk factor for PSVT. However, no treatment strategy for PSVT has been established. METHODS: Thirty-three consecutive patients who had undergone LS and postoperative imaging surveillance were examined. PSVT was classified according to the site of thrombosis. We evaluated patient background, operative factors, and clinical symptoms. RESULTS: Spleen weight of patients with PSVT (n = 17, median 218 g) was greater than that of patients without PSVT (n = 16, median 101 g). Seven patients developed thrombosis involving the entire splenic vein (total splenic vein thrombosis), and 4 of them had clinical symptoms (fever >38 degrees C and/or abdominal pain). The incidence of clinical symptoms was significantly more frequent in patients with than without total SVT. Operation time, blood loss, and spleen weight were also significantly greater in patients with total SVT. Multiple logistic regression analysis demonstrated spleen weight was the strongest predictor of PSVT and total SVT. CONCLUSION: Patients with total SVT have greater risk factors for PSVT and frequently have clinical symptoms. They are candidates for anticoagulation therapy.

Study on the pathophysiologic basis of classification of 'spleen' deficiency in chronic gastritis.

BACKGROUND: Most of the studies on traditional Chinese medicine (TCM) 'spleen' deficiency syndrome in the recent 30 years were conducted only on the basis of single functional index, neglecting the study on the pathophysiologic internal relationship between spleen deficiency syndrome and gastric diseases in modern medicine. But it was at the subcellular molecular biological level that we explored the pathophysiologic basis of classification of spleen deficiency in chronic gastritis by detecting the bioactive substances in gastric mucosa nuclei and mitochondria. METHODS: By means of optical microscope, scanning electron microscope (SEM), transmission electron microscopy (TEM) and histochemical staining, we conducted histopathological, subcellular ultrastructural analysis and nuclei and mitochondrial ultrastructural analysis of gastric mucosa of 188 spleen deficiency patients and of 42 voluntary blood donors. At the same time, bioactive substances were measured by means of X-ray energy dispersive analysis system (EDAX) image analysis system, radioimmunoassay method and chemiluminescence method. RESULTS: The content of cAMP, superoxide dismutase (SOD), Zn and Cu in gastric mucosa, and the content of Zn and Cu in mitochondria decreased progressively in order of groups: healthy control (HC), spleen Qi deficiency without organic lesion (F-SQD), spleen Yang deficiency without organic lesion (F-SyangD), disease without symptoms group, spleen Qi deficiency with organic lesion (G-SQD), spleen Yang deficiency with organic lesion (G-SyangD), spleen Yin deficiency (SyinD) and spleen deficiency with Qi stagnation (SDQS), chronic spleen deficiency gastritis (CSG) and chronic atrophic gastritis (CAG); decreased in order of HC, intestinal metaplasia (IM)Ia, IMIb, IMIIa and IMIIb, P < 0.05. The content of DNA, Zn and Cu in nuclei progressively increased in order mentioned above, P < 0.05. CONCLUSIONS: The quantitative changes of gastric mucosal cAMP, SOD, Zn, Cu, of mitochondrial Zn, Cu and of nuclear DNA, Zn and Cu are not only the substance base on which the lesion of gastric mucosa tissue structure occurs, but also the substance base on which spleen deficiency is classified. G-SQD and G-SyangD were more likely to be found in low-grade or middle-grade CSG and CAG, while SyinD and SDQS in middle-grade or high-grade CSG, CAG and IMIIb.

Study on the pathological basis of classification of spleen deficiency in chronic gastritis.

BACKGROUND: Spleen in Traditional Chinese Medicine (TCM) is not actually the spleen in the anatomic sense designated in western medicine because its functions basically belong to the physiological category of digestive system in modern medicine, and it represents a macroscopic concept of digestion, absorption and nutrition metabolism. Spleen deficiency syndrome refers to the clinical phenomena such as hypofunction of digestion, absorption and nutrition metabolism. By integrating TCM with modern medicine, this paper is intended to explore the pathological basis of classification of spleen deficiency in chronic gastritis. METHOD: By means of optical microscope, scanning electron microscope (SEM), transmission electron microscope (TEM) and histochemical staining, we conducted histopathological and subcellular ultrastructural (nuclei and mitochondrial) analysis of gastric mucosa of 188 patients of spleen deficiency, and that of 42 voluntary blood donors without clinical symptoms. RESULTS: The gastric mucosa of patients with spleen Qi deficiency (SQD) and spleen yang deficiency (SyangD) could either be affected by organic lesion (type G-occurring on the basis of chronic superficial gastritis (CSG), chronic atrophic gastritis (CAG)) or unaffected (type F-chiefly belonging to functional indigestion); spleen yin deficiency (SyinD) and spleen deficiency with Qi stagnation (SDQS) both occurred on the basis of CSG and CAG; and the degree of mucosa inflammatory cells infiltration, the degree of decrease in glands propria, and the incidence of IMIIb in CSG and CAG were more serious than those of G-SQD and G-SyangD, P < 0.05 - 0.01. CONCLUSION: Spleen deficiency syndrome is likely to occur on the basis of organic lesion of gastric mucosa (disease with symptoms of both CSG or CAG and spleen deficiency symptoms), as well as on the basis of inorganic lesion of gastric mucosa (nondisease with symptoms, which is, despite spleen deficiency symptoms, there is no CSG or CAG). Besides, the clinical phenomenon of disease without symptoms (despite CSG or CAG, there is no spleen deficiency symptoms) occurres because of such factors as genetic diathesis and compensation. The lesion degree of CSG or CAG and the incidence of IMIIb of SyinD and SDQS are more serious than those CSG and CAG of G-SQD and G-SyangD.

Nonparasitic splenic cysts: pathogenesis, classification, and treatment.

BACKGROUND: Nonparasitic splenic cysts (NPSCs) are uncommon lesions of the spleen, many being reported in anecdotal fashion. Early classifications of this disorder have been based on the presence or absence of an epithelial lining, indicating either a congenital or traumatic etiology. This criterion has led to confusion and mistaken reporting because the lining alone is not a reliable criterion. STUDY DESIGN: Over a 28-year period, the author has observed and studied 23 patients with NPSC. Special attention has been given to the role of trauma in the history, the nature (or absence) of a cyst lining, the gross pathology, and the preferred method of treatment. RESULTS: NPSC present as lesions with a very characteristic gross appearance and lining. The trabeculated interior can be lined with epidermoid, transitional, or mesothelial epithelium. Desquamation of the lining can lead to a spurious diagnosis, but careful search usually discloses the lining remnant. Although most NPSC in this series were treated by open partial splenectomy, the more recent approach by laparoscopic techniques offers great promise. CONCLUSIONS: A new classification of NPSC is offered, based on characteristic gross findings. NPSC are of congenital origin, with a lining derived from mesothelium. Trauma does not play a primary role in pathogenesis. Cysts that are symptomatic or over 5 cm in diameter should be removed by partial splenectomy or near-total cystectomy "decapsulation," either by the open or laparoscopic approach.

[Fibrous splenic hamartoma: imaging features]. / Imagerie d'un hamartome splénique de type fibreux.

Splenoma or splenic hamartoma is a rare primary splenic tumor most often incidentally discovered. The authors report the case of a splenic hamartoma, developed in an asymptomatic man and imaged by US, CT and MRI. This tumor which measured 7 cm in diameter, was hypoechoic with posterior hardening of the ultrasound beam, and not much vascularized as demonstrated by Duplex and color Doppler examination. The tumor MR imaging showed hyperintensity on T1-weighted and hypointensity on T2-weighted. The final diagnosis was not established until the histologic examination of the splenectomy specimen was performed. Histopathologically, the tumor corresponded to a fibrous type of splenic hamartoma. The atypical imaging features which led to splenectomy were probably related to the fibrous component of the hamartoma.

Representación ecográfica de las alteraciones esplénicas / Ultrasound in splenic disease

Ilustramos los hallazgos más frecuentes encontrados como alteraciones de la estructura y tamaño del bazo durante el examen ecográfico del abdomen, en pacientes adultos. Se evaluaron las alteraciones en la forma, tamaño y ecogenicidad del mismo. El diagnóstico se hizo en base al aspecto ecográfico, antecedentes clínicos, evolución y confirmación biópsica en los casos que así lo requirieron. Las lesiones benignas fueron levemente superiores a las malignas. Presentaron una variedad ecográfica similar los hematomas, quistes complicados, infartos y abscesos. Prácticamente casi todas las lesiones malignas fueron hipoecogénicas, siendo el linfoma el hallazgo más frecuente. La ecografía demostró ser sensible en la detección de alteraciones en la estructura esplénica, pero poco específica

Familial nonparasitic splenic cysts.

Only three times the occurrence of splenic cysts in siblings has been reported. This is the first report of a nonparasitic splenic cyst in mother and daughter. This improbable coincidence may perhaps give a better insight in the histogenesis of splenic cysts. A practical classification of nonparasitic splenic cysts is presented.

Splenic abscess--presentation, diagnosis, and treatment.

Splenic abscess is an unusual entity. In the last 30 years at the Johns Hopkins Hospital, only 11 patients have been treated for clinically overt splenic abscess. Generally presenting with fever, leukocytosis, and left-sided upper abdominal pain in the setting of generalized sepsis, the majority had a distant source of bacteremia or an underlying defect in splenic architecture or function. Prior to 1970, diagnosis was one of exclusion, and delay in treatment was frequent. Recently, diagnosis has been facilitated by splenic scintiscans, ultrasonography, and computerized axial tomography. These techniques now afford earlier, objective evidence of splenic involvement. Although splenectomy controls local splenic suppuration, the ultimate prognosis rests on the underlying process predisposing the patient to development of splenic infection.

[Non-parasitic cysts of the spleen: report on two cases and ultrastructural findings in one of them (author's transl)]. / Kystes non parasitaires de la rate. A propos de deux observations dont une avec étude ultra-structurale.

Two cases are reported of non-parasitic cysts of the spleen of the simple epithelial type. The pathogenic mechanism of such cysts is discussed and illustrated by ultrastructural findings in one of the cases. The wall of this cyst was mesothelial in nature. This observation is in favour of the inclusion of mesothelial tissue in the spleen, a hypothesis suggested in the published literature by several authors.