Spontaneously Ruptured Spleen Samples in Patients With Infectious Mononucleosis

Analysis of Histology and Lymphoid Subpopulations

Marcos M Siliézar, MD; Catuxa Celerio Muñoz, MD; Jon Danel Solano-Iturri, MD; Laura Ortega-Comunian, MD; Manuela Mollejo, MD; Santiago Montes-Moreno, MD; Miguel A Piris, MD

Disclosures

Am J Clin Pathol. 2018;150(4):310-317. 

In This Article

Abstract and Introduction

Abstract

Objectives: Spontaneous rupture of the spleen is occasionally seen as the presenting event in infectious mononucleosis (IM). Diagnosis of these cases can be very challenging.

Methods: We describe the morphologic and immunohistochemical findings in a series of seven splenectomy specimens removed after spontaneous rupture in patients with IM. Most cases were submitted for a second opinion since the histology of the cases suggested malignant lymphoma.

Results: All the cases showed similar findings, with red pulp expansion occupied by activated T and B cells, including scattered large lymphocytes with both T- and B-cell markers, together with a polymorphic background rich in cytotoxic T cells. Clonality analysis revealed T-cell receptor clonal patterns in four of the six cases evaluated.

Conclusions: IM should be considered a possible diagnosis in any case of splenic rupture whose histology suggests possible aggressive lymphoma.

Introduction

Spontaneous rupture of the spleen has occasionally been reported as the presenting event in infectious mononucleosis (IM).[1,2] Up to 15% of splenic ruptures without risk factors or previously diagnosed disease have been attributed to IM.[2–4] Diagnosis of these cases can be challenging, since some of the histologic features of splenic involvement by IM may strongly suggest a malignant lymphoproliferative process.[5,6] The histologic features of IM tissue involvement have most often been described in lymph nodes and the Waldeyer ring[5] but only in isolated cases in the spleen.[7] We report morphologic and immunohistochemical findings in a series of seven cases in which the spleen was removed after spontaneous rupture in patients with IM; most cases were referred for a second opinion because of histologic findings that suggested a malignant lymphoproliferative process.

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