Cysts of the spleen

pathological diffrential of cyst in spleen

1. •According to etiology, the splenic cysts can be of two types: Parasitic
or non-parasitic.

• Based on the presence of surface epithelium, the non-parasitic cyst
are divided as true or false (pseudocyst).

• A new classification based on the true pathogenesis of cyst divides
non-parasitic splenic cysts as congenital, neoplastic, traumatic, and
degenerative

2. •A review study has observed the prevalence of non-parasitic
splenic cysts to be congenital in 82%, traumatic in 15%, and of
hamartomatous origin in 3% cases.

•Male to female ratio was one.

•Median age of presentation was 11 years.

•Abdominal pain was the main complaint in 46% cases.

•Forty seven (47%) of the cysts were diagnosed incidentally.

3. splenic cysts
parasitic
non
parasitic
splenic
cysts
Pseudocysts
Hematoma(
post
trauma)
Vascular
Infarction
Peliosis
Inflammator
y ((abcess
True cysts
Epithelial
cysts
(epidermoid
)
Mesothelial
Stratified
squamous
Mucinousl
transitional
Neoplastic
Benign
(hemangioma-
lymphangioma
)
Malignant
(primary-
metastasis)

4. scout view of CT SCAN showing a
calcified cystic lesion in the spleen
pathological specimen of calcified hydatid
cyst and spleen .Egg shell of the cyst was
typical of hydatid cyst .Notice impression
of vascular markings on spleen
•Occurs in residents of areas of the world where the parasite (Echinococcus) is
endemic (e.g., Greece).
•Adults are most commonly affected.

5. •Often multilocular
● Hepatic or peritoneal cysts
commonly present
● Granular wall with small granules in
cyst contents
•Fibrous wall
● Daughter cysts or brood capsules
contain parasites with scolices
● Inflammatory reaction is present

6. Hydatid membrane with scolices
Microphotograph showing a closer
look at scolices and hooks. Inset
shows high power view of hook (H and
E, ×400

7. True cysts
-Most true primary cysts are epithelial in
origin and have embryonic inclusion of
epithelial cells from adjacent structures
-are mainly seen in children or young adults.
-They are usually solitary, but can be multiple.
-They have lining which differs according to the type.
Non parasitic splenic cysts

8. A, Outer aspect.
B, Inner surface. Notice the white
trabeculation

9. In this example of pseudocyst, Fibrous wall without epithelial lining.
histiocytes are prominent adjacent to the lumen of the cyst, and there is a
cellular stroma around it.

10. Gross photo of a resected spleen.
Two subcapsular hemorrhagic
nodules are present on the cut
surface
Microscopic photo showing multiple blood lakes,
cysts or pools.
-blood spaces concentrated mainly on prephery
of white pulp follicles (CD8, CD68 +)
( H&E stain. 4X magnification.)

11. In this photo one can see an abscess
occupying a large portion of the spleen.
The cavity was filled with pus, some of
which is still visible.

Incised specimen showing single
splenic abscess

12. •Primary cysts are also known as epithelial cysts in British literature
and epidermoid cysts in American literature

•Occurs in children to young adults; no gender predominance

•Rare lesions of spleen

● Unrelated to trauma

● Most likely of mesothelial derivation but may be stratified
squamous, cubical to columner or transitional
•Usually asymptomatic unless infected

● Not known if these are congenital developmental abnormalities or
the result of abdominal trauma with mesothelial entrapment in the
spleen

13. thin-walled, semitranslucent,
filled with clear or yellowish
fluid or gelatinous contents
The cyst is lined by an
attenuated mesothelial cell
layer

14. Cut section of the spleen
showing cyst with typical coarse
trabeculation in the inner wall
Microscopy of the cyst wall
shows the stratified squamous
lining epithelium.

15. Multiple splenic cysts with stratified
squamous epithelium
Cyst lining is CEA+

17. Splenectomy specimen showing
mucinous cysts of variable sizes
displacing most of the
parenchyma.
Intrasplenic mucinous cyst lined by a
single layerof well-differentiated
mucinous epithelium (H & E).

19. Benign malignant
hemangioma
Hemangioma/
angiomatosis
Littoral cell
angioma
lymphangioma primary
angiosarcoma
Lymphoma
secondary

20. is the most common primary tumor of the spleen.It is often of the
cavernous variety.

Most frequent in young to middle-aged adults with no sex predilection

 Usually asymptomatic

Symptoms and abnormalities reported include
— Abdominal discomfort
— Hypersplenism with cytopenias
— Consumption coagulopathy (disseminated intravascular coagulation)

21. Gross Pathology

● Single, sometimes multiple

● Spleen normal to moderately enlarged

● well circumscribed but not encapsulated

● Reddish-purple and spongy

● Secondary changes may include infarct or fibrosis

● Angiomatosis is diffuse replacement of the spleen by angiomatous
tissue

22. Hemangioma. Cut surface. In addition to the dilated vessels and cystic
spaces, there are pale, spongy tumor nodules around
dilated vessels. The intervening parenchyma looks normal.

23. Microscopic picture of hemangioma
•Capillary or cavernous

•Vascular spaces lined by single layer of bland endothelial cells, without mitoses

•Thrombosis and infraction can be seen

•When organized, infarcted hemangioma may resemble leiomyoma
● CD34, CD31, and factor VIII positive

● CD8, CD68, and Ki-67 negative

24. The dilated blood vessels of the tumor
are lined by bland looking
endothelium.
Diffuse involvement of spleen by
benign vascular tumor
(‘angiomatosis’).

25. •Rare
● Occurs at any age and in either sex
● May cause splenomegaly and hypersplenism
•varies in size from minute foci to large nodules almost completely
replacing the splenic tissue
ImmunohistochemistrySpecial Stains and
● Reticulin: annular fibers around vascular spaces
● Occasional PAS-positive cytoplasmic globules
● Distinctive phenotype: CD31, CD68, CD21, and CD163 positive;
•negative for CD8 and CD34;
•may also express S-100 protein

26. Single or multiple spongy,
purplish-black,
wellcircumscribed nodules
 Rarely may replace the
whole organ
 Sometimes is only vaguely
multinodular; in other
cases, it may appear
subdivided into lobules by
bands of fibrosis
Numerous hemorrhagic lesions with a
lobular configuration are seen

27. •Pleomorphic vascular spaces:
from slitlike to dilated and
cystic
● Lined by tall endothelial cells
with large vesicular hopnailed
Nuclei, some of which show
hemophagocytosis
● Papillary projections
protruding into the vascular
spaces
● Tumor cells can exfoliate into
the lumen
● No significant cellular atypia,
and mitotic activity
is low
● Lacks solid areas and necrosis
The vascular spaces are lined by plump
cells with the appearance of sinus lining
(‘littoral’) cells

29. Mostly occurs in children
● Grossly indistinguishable
from hemangioma
● Gross cyst formation is
common
● Spaces contain
proteinaceous material,
lymph, and cholesterol
clefts (not blood)
● D2-40, CD31, and factor
VIII positive; CD34 usually
negative
splenic cavernous lymphangioma reveals a
9.5×6.8×9 cm-sized mass composed of
various-sized cysts with internal
hemorrhage

31. •is the most common malignant primary nonlymphoid tumor of the spleen.
● Although it can occur at any age, it is most common in elderly patients; no sex
predominance
•It may present as a well-defined hemorrhagic nodule or involve the spleen
diffusely, and may lead to spontaneous rupture of the organ.
•It may also be accompanied by microangiopathic anemia, thrombocytopenia,
and consumption coagulopathy.

• As in other sites, there are cases of angiosarcoma of spleen that have
developed many years following the insertion of a foreign body (gauze sponge).
•Prognosis is poor: hematogenous metastases to liver and lung

32. •Splenomegaly, often
marked (weight > 1000 g)
● Single or multiple
hemorrhagic and necrotic
masses
● Sometimes diffuse
infiltration, blending with
splenic red pulp
In this case of splenic angiosarcoma, most of
the organ is replaced by a neoplacharacterized
by a mixture of spongy and solid areas
with extensive necrosis and hemorrhagesstic
proliferation.

33. ● Irregular anastomosing
vascular channels or solid
masses partially or largely
occluding vascular spaces
● Cells may be flattened,
spindled, polygonal, epithelioid,
or small and poorly
differentiated; may form
papillary projections that
protrude into vascular spaces
● Cytologic atypia varies from
slightly prominent endothelial
cells with slight hyperplasia,
pleomorphism, and occasional
mitoses to anaplastic cells with
numerous mitoses, associated
with areas of hemorrhage and
necrosis
Pleomorphic neoplastic endothelial cells with a
high nuclear-to-cytoplasmic ratio and
hyperchromatic nuclei lining the vascular spaces.
Some of the cells appear to be floating free in
the vascular spaces.

34. •CD31 and Ulex lectin are usually positive
● CD34 and factor VIII are usually detected in better differentiated areas only
•CD163 is negative
•Expression of common endothelial cell antigens is variable
suggests a littoral cell derivation (littoral cell 8 and CD68 Positivity for CD ●
)angiosarcoma
, a marker of differentiation along the lymphatic endothelial 40-2Expression of D ●
lineage, has been reported in some cases; these cases could be classified a
ymphangiosarcomasL

35. •Malignant lymphoma is by far the most common malignant
tumor involving the spleen. Although usually affected as part
of a generalized process, in some cases the spleen represents
the only detectable site of disease

•Lymphoma can be nearly anechoic and mimic a cyst on
ultrasonography (US), however four gross patterns of
involvement were described: homogeneous, miliary, multiple
masses, and solitary masses which show some correspondence
to the various microscopic types.

37. GENERAL:Splenic metastasis is usually associated with extensive
metastases - isolated splenic metastasis is rare

EPIDEMIOLOGY: Usually from lung, breast,melanoma, colon, ovary
-Rarely from endometrium, brain, liver or salivary gland

RADIOLOGY: -In ultrasonographic examination, the metastatic foci
in the spleen may be hyperechoic, hypoechoic or nonechoic
-In CT, hypodense lesions are seen

38. •Splenic metastasis can be seen as solitary nodule, multiple nodules or
diffuse infiltration or cyst

•Rarely resembles follicular lymphoma grossly with multiple nodules

39. This specimen came to the ECDU, Pathology department, faculty
of medicine, Benha university on 1/10/2015.
The specimen was for a female patient 20 years old C/O
abdominal pain.
The patient was investigated by u/s and CT scan and diagnosed as
ovarian cyst reaching the spleen.
During surgery the cyst appeared to be of splenic origin.
Spleenectomy was done for pathological assesment.

41. Non capsulated benign neoplastic
growth formed of variable sized
and shaped intercommunicating
vascular spaces (H&E X 20)
Vascular spaces lined by plumpy
endothelial-like cells with
hobnailing nuclei (H&E X 40)