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 reduced the need for direct investigations. Moreover, although primary splenic NHL are generally diagnosed and treated by splenectomy, FNC may be requested in peculiar clinical contexts.
Cytological criteria and a diagnostic algorithm are almost the same as those described for lymph nodes, whereas the diagnostic criteria for HL relapse are less stringent than for the primary diagnosis.
Small cell non Hodgkin lymphoma
Small lymphocytic lymphoma involving the spleen: a monomorphous cell population of small lymphocytes are interspersed in the background. PALS may be preserved as observed on the top and corresponding histological sample.
Small cell follicular lymphoma involving the spleen: a monomorphous cell population of small lymphocytes are interspersed in the background. PALS are preserved.
Differential diagnosis between florid white pulp hyperplasia and small cell non Hodgkin lymphoma. FC and ICC evidence of light chain restriction on cytospins (upper right and left) may determine the diagnosis.
Primary lymphoma of the spleen and large cells NHL
Primary NHL of the spleen and large B-cell lymphoma (DLBCL) may generally arise or involve the spleen with single or multiple nodules. Smears show dispersed, atypical, large lymphoid cells. PALS are scantly or not present.
Primary lymphoma of the spleen and large cells NHL showing large atypical, lobulated cells. PALS are scanty or absent.
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