Spleen

Splenomegaly

Causes of enlarged spleen:

1- Blood disease:
a) Hemolytic anemia
b) Leukemia
c) Polycythemia
2- Infectious:

- Septicemia (acute splenic swelling)

- Typhoid fever

- Subacute bacterial endocarditis

- Granulomas: TB, syphilis, sarcoidosis

- Parasitic: bilharziasis, malaria, leishmaniasis

3- Neoplasia: malignant lymphoma, secondaries

4- Tissue deposits: amyloidosis
5- Circulatory disturbance:
a) CHF
b) Portal hypertension
6- Storage diseases: lipid storage, glycogen storage diseases

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 Spleen
Bilharzial splenomegaly:

Definition:

Enlarged spleen associated with advanced bilharzial hepatic

fibrosis

Pathogenesis:

1- Early:

Hyperplasia of the splenic reticuloendothelial cells (littoral cells)

in response to bilharzial antigens

2- Chronic venous congestion of the spleen:

Due to portal hypertension resulting in progressive

enlargement of the spleen

Pathological features:

Grossly:

- Size : markedly enlarged

- Consistency: firm

- The capsule: is thick and greyish white due to fibrosis

- Subcapsular hemorrhage and accentuated splenic notch are

found

- The cut surface shows dark brown color and pinpoint white
spots of Atrophic lymphoid follicles

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 Spleen
Microscopic picture:

- The capsule and trabeculae are thickened due to fibrosis

- Dilated sinusoids with interstitial hemorrhage (hemosiderin)

- Pressure atrophy of lymphoid follicles and hyalinosis of center

arterioles

- Fibroblastic proliferation forming fibro-siderotic modules

(Gandy-Gumna modules)

Effects of bilharzial splenomegaly:

1- Pressure effect: compression of surrounding organs

2- Hypersplenism (wild spleen): destruction of all blood

elements (pancytopenia)

Hypersplenism:

- Enlargement of spleen→ sequestration of large number of

RBCs → anemia

platelets→ thrombocytopenia

leukocytes →leucopenia

- Activation of macrophages→ fibrosis

- Splenectomy results in a marked improvement

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 Spleen
Acute splenic swelling:

Splenic enlargement in case of septicemia

Pathological features:

- Spleen ➔ moderately enlarged and soft in consistency

- Red pulps ➔ soft and congested

- White pulps ➔ necrotic

- The splenic tissue are infiltrated by neutrophils

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