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    Spleen

    Background

    Spleen may be removed in cases of suspected malignancy such as lymphoma, haematological disorders or as part of a wider resection for tumours in other organs.1-3 However, spleen is commonly removed for trauma pre-operatively or laceration during surgical procedures.


    Record the patient identifying information and any clinical information supplied together with the specimen description as designated on the container. See overview page for more detail on identification principles.

    • No
      • Non-routine fixation (not formalin), describe.
    • Yes
      • Special studies required, describe.
      • Ensure samples are taken prior to fixation.
      • Flow cytometry
      • Microbiology
      • Cytogenetics

    Fresh unfixed tissue should be handled in appropriate extraction cabinets and with suitable personal protection equipment for infection control.

    Sample(s) for special studies may be taken prior to fixation from the splenic parenchyma or any attached hilar lymph nodes. Note that it may be possible to retrieve some unfixed tissue for flow cytometry from deeper areas of a formalin-treated intact spleen within the first 12-24 hours, due to the slow penetration of formalin through the splenic parenchyma.

    • Not performed
    • Performed, describe type and result
      • Frozen section
      • Imprints
      • Other, describe

    See general information for more detail on specimen handling procedures.

    Inspect the specimen and dictate a macroscopic description.


    External Inspection

    Orientate and identify the anatomical features of the specimen.

    Record additional orientation or designation provided by operating clinician:

    • Absent
    • Present
      • Method of designation (e.g. suture, incision)
      • Featured denoted

    Photograph the intact specimen if required.

    Describe the following features of the specimen:

    Procedure

    Record as stated by the clinician.

    • Splenectomy
      • For suspected malignancy
      • For trauma, describe
      • Other, describe

    Anatomical components (more than one may apply) and specimen dimensions (mm)

    • Spleen, in three dimensions
    • Other, describe

    Weight (g)2,3

    • Total specimen (including blood clot)
    • Spleen

    Specimen integrity

    • Intact
    • Disrupted/morcellated, describe

    Outer surface

    • Normal
    • Abnormal
      • Irregular
      • Nodules
      • Plaques
      • Laceration(s)

    Dissection

    Identify any hilar lymph nodes and submit them separately. A section from the vascular margin may be appropriate. If received fresh special studies may be required.

    On arrival in the laboratory, section the spleen transversely at 10-20 mm intervals and lay out sequentially to inspect the internal appearance. 2 Due to the dense nature of spleen and its propensity to distort, the specimen should be allowed to fix overnight in a larger quantity of formalin after initial dissection before sections are taken.2 Swirling the sectioned spleen gently around in the formalin will rinse blood from the specimen and may improve fixation particularly if refilled with fresh formalin.

    Dilution and contamination of the formalin by blood will reduce its effectiveness. After describing the cut surface, it may be necessary to rinse the slices of spleen and replenish with fresh formalin to assist fixation. It has also been suggested that the tissue be re-weighed at this stage to obtain a more accurate record in cases of acute congestion.2


    Internal Inspection

    Describe the internal or cut surface appearance including the following items:

    Parenchymal lesion(s)

    • Absent
    • Present
    • Number; if more than one lesion, describe number and appearance

    Small white lesions may be prominent white pulp but if representative of Hodgkin lymphoma the number, sizes and locations are important clinically.1

    Lesion size (mm)

    • In two dimensions
    • If more than two, record the range of sizes

    Lesion site (more than one may apply)

    • Subcapsular
    • Parenchymal

    Lesion description

    • Solid nodule
    • Multinodular
    • Cystic
    • Miliary nodules, describe variation in sizes

    Hilar lymph node(s)

    • Absent
    • Present
      • Measure the maximum dimension (mm) of each

    Photograph the dissected specimen, if required.

    Note any photographs taken, diagrams recorded and markings used for identification.


    Processing

    Submit sections for processing according to the illustrations provided.

    It is suggested that sections of tissue in cassettes may be left to fix for another 24 hours before processing for best results.2

    Submit representative sections, two to four blocks, of:

    • Centre of convex aspect
    • Superior and inferior poles, if relevant
    • Hilum including any lymph nodes

    Submit representative sections of:

    • Vascular margins, if required
    • Representative sections of any focal lesion demonstrating relationship with capsule and adjacent tissue
    • Non-lesional spleen
    • Hilum including any lymph nodes

    Record details of each cassette.

    An illustrated block key similar to the one provided may be useful.

    Block allocation key

    Cassette id Site No. of pieces
    A Spleen, centre of convex aspect  
    B Spleen, superior pole  
    C Spleen, inferior pole  
    D Hilum, representative sections  
    E+ Lymph nodes  
    Cassette id Site No. of pieces
    A-B Vascular margins if present  
    C-E Lesion, representative sections demonstrating relationship with capsule and adjacent tissue  
    F Spleen, non-lesional tissue  
    G Hilum, representative sections  
    H+ Lymph nodes  

    Acknowledgements

    Associate Professors David Ellis and John Miliauskas for their contribution in reviewing and editing this protocol.


    References

    1. Lester SC. Manual of Surgical Pathology, Saunders Elsevier, Philadelphia, 2010.
    2. Ramsay A, Attygale A, Menon G, Naresh K and Wilkins B. Tissue pathways for lymph node, spleen and bone marrow trephine biopsy specimens, The Royal College of Pathologists, London, 2008.
    3. Norris D, Ellis D, Green M, Joske D, Macardle P, Miliauskas J, Spagnolo D and Turner J. Tumours of haematopoietic and lymphoid tissue structured reporting protocol, The Royal College of Pathologists of Australasia, Surry Hills, NSW, 2010.

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      Spleen 1

      Spleen with attached soft tissue

      Spleen 2

      Spleen hilum

      Spleen 3

      Spleen concave surface

      Spleen 4

      Spleen anterior aspect

      Spleen 5

      Spleen dissected

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      26-Mar-2019
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