Normal constituents

Normal constituents The constituents of the red pulp are generally poorly represented on sFNC, while platelets, macrophages and scattered fibrous or endothelial cells may be observed. The white pulp is represented by dense fragments of tightly packed lymphoid cells, with nuclear details observable only at the edges of the fragments. Invariably one or two vascular […]

White pulp hypeplasia: PALS (T-cells) and follicles (B-cells)

White pulp hypeplasia: PALS (T-cells) and follicles (B-cells) In white pulp hyperplasia smears are highly cellular with numerous and large PALS and dispersed lymphoid cells. White pulp hyperplasia may be observed in infective diseases or immunologic disorders, in children is mainly related to a heightened immunologic state.  

Acute, suppurative necrotizing processes

Acute, suppurative necrotizing processes Abscesses, may occur in blood-borne infections; sometimes along leukaemia or immunodeficiency syndromes. Sometimes these processes cause sub acute inflammatory processes with histiocytes and multinucleated giant cells. Infarcts are more common mainly caused by systemic or infective emboli determining coagulative or suppurative necrosis.  

Myeloid metaplasia

Myeloid metaplasia Myeloid metaplasia may occur mainly in cases of myelofibrosis and myeloproliferative syndromes but may be observed in different pathological condictions such as lymphomas, previous infective diseases or after chemotherapies. The hallmark of this condition is the presence of megakaryocytes, which may be isolated or attached to PALS.   Myeloid metaplasia causing diffuse splenomegaly […]

Granulomatous processes

Granulomatous processes Sarcoidosis and tuberculosis and other infective diseases may cause granulomatous lesions to the spleen. Hodgkin and non Hodgkin lymphoma and chemotherapy may be followed by granulomatous lesions which may cause equivocal clinical features. Epithelioid cells (left) and granulomatous structure in a hematic background in a splenomegaly developed in a NHL patient in remission. […]

Storage diseases

Storage diseases Splenic FNA of storage diseases showing numerous histiocytes with large, pale, bubbly cytoplasm, dispersed or attached to PALS edges. Cytoplasm is typically pinkish or with many small lipidic droplets.  


Lymphomas Hodgkin (HL) and non Hodgkin lymphomas (NHL) may involve the spleen; HL and large cell NHL may determine nodular lesions as well as primary splenic NHL, which is generally a B- large cell NHL and presents with nodular lesions. Small cell NHL may present as diffuse or “miliaric”. Non invasive diagnostic procedures have drastically […]

Hodgkin lymphoma

Hodgkin lymphoma Spleen if frequently involved in advanced stages of HL giving a nodular presentation. Cytological criteria are almost the same of lymph nodes, whereas, in case of relapse, atypical mono and binucleated cells may be sufficient for the diagnosis.  

Classification of splenomegalies

Disordes associated with splenomegaly INFECTIONS Non specific splenitis Mononucleosis Tuberculosis Brucellosis Malaria Histoplasmosis Leishmaniosi Echinococcosis CONGESTIVE STATES Cirrhosis Portal or splenic thrombosis Cardiac failure AUTOIMMUNE DISEASES Rheumatoid arthritis Systemic lupus erythematosus STORAGE DISEASES Gaucher disease Niemann-Pick disease Mucopolysaccaridoses LYMPHOHEMATOGENOUS DISORDERS Hodgkin’s lymphoma Non-Hodgkin lymphomas Histiocytoses Multiple myeloma Myeloproliferative syndromes (CML, polycytemia vera, myelofibrosis, myeloid metaplasia) […]

Malignant hystiocytosis

Malignant hystiocytosis A monotonous proliferation of histiocytes with large, dense cytoplasm and occasional emperipolesis (arrow). Normal constiuent are completely absent. Despite the bland cytological features the disease may be subtle and aggressive.