splenectomy

Technical Problems of Splenectomy in Hematological Diseases

SURGERY IN ONCOHEMATOLOGY , , ,

SR Karagyulyan, KI Danishyan, SA Shutov, MA Silaev

Hematology Research Center under the Ministry of Health of the Russian Federation, 4а Novyi Zykovskii pr-d, Moscow, Russian Federation, 125167

For correspondence: Karen Ismailovich Danishyan, PhD, 4а Novyi Zykovskii pr-d, Moscow, Russian Federation, 125167; e-mail: ntanisian@gmail.ru

For citation: Karagyulyan SR, Danishyan KI, Shutov SA, Silaev MA. Technical Problems of Splenectomy in Hematological Diseases. Clinical oncohematology. 2017;10(1):101–7 (In Russ).

DOI: 10.21320/2500-2139-2017-10-1-101-107

ABSTRACT

The article focuses on the technical aspects of splenectomy (SE) in 1628 patients using two main techniques: laparoscopy (885 SEs) and laparotomy (743 SEs), with a description of various factors that influence the invasiveness and the success of the surgery. The fact is that in addition to the shape and size of an enlarged spleen, the technical complexity of the SE, especially in laparoscopic access depends on the following factors: perisplenitis, close presentation and fusion of the tail of the pancreas to the spleen, tumor infiltration of splenic vascular pedicle, branchy type of its structure, visceral obesity, compression of the splenic pedicle with enlarged and united lymph nodes. In most cases (60 %), there is a combination of several risk factors, thus making the surgery even more difficult. The indications for splenectomy, as well as its influence on the course of the main hematological disease are not considered in this paper.

Keywords: hematological disorders, splenectomy, laparoscopy, laparotomy.

Received: August 11, 2016

Accepted: November 14, 2016

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REFERENCES

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Pathomorphological Diagnosis of Splenic Diffuse Red Pulp Small B-Cell Lymphoma

LYMPHOID TUMORS , , ,

AM Kovrigina, SM Korzhova, LS Al’-Radi, UL Dzhulakyan, BV Biderman, IA Yakutik, AB Sudarikov

Hematology Research Center, 4а Novyi Zykovskii pr-d, Moscow, Russian Federation, 125167

For correspondence: Alla Mikhailovna Kovrigina, DSci, Professor, 4а Novyi Zykovskii pr-d, Moscow, Russian Federation, 125167; Tel.: 7(495)612-61-12; e-mail: kovrigina.alla@gmail.com

For citation: Kovrigina AM, Korzhova SM, Al’-Radi LS, et al. Pathomorphological Diagnosis of Splenic Diffuse Red Pulp Small B-Cell Lymphoma. Clinical oncohematology. 2016;9(3):287-95 (In Russ).

DOI: 10.21320/2500-2139-2016-9-3-287-295

ABSTRACT

Background. Unclassifiable splenic B-cell lymphoma/leukemia is a rare and poorly studied disorder introduced in the WHO classification of hematopoietic and lymphoid tissue malignancies for the first time in 2008. This type of lymphoma requires differential diagnosing between hairy cell leukemia-variant (HCL-V) and splenic diffuse red pulp small B-cell lymphoma (SDRPL).

Aim. To develop criteria for diagnosis of SDRPL by comparison of bone marrow biopsies (BMB) and surgical specimens of the spleen.

Methods. In the Department of Morbid Anatomy of the Hematology Research Center, preoperative BMBs and surgical specimens of the spleen (2013–2015) were compared in 71 patients (men/women ratio 1:2.6, age range 44–81, median age 58 years) using morphological and extended immunohistochemical studies. Sanger sequencing and PCR assay were carried out to analyze the mutational status of IgHV and to identify mutations in MAP2K1, NOTCH, BRAF.

Results. SDRPL was diagnosed in 5 (7 %) of 71 patients. In 2 groups of patients (with normal and high WBC count), the morphological features of spleen tissue were similar to those of a neoplastic substrate of HCL-V. The immunohistochemical assay demonstrates monomorphic expression of CD20 and DBA.44 and heterogeneous expression of CD11c, TRAP, CD103, CD123 in all cases. In none of the 5 cases, expression of CD25, CD27, Cyclin D1, Annexin-1 was found. In bone marrow (unlike HCL and HCL-V), predominantly interstitial and intravascular scant CD20+ lymphoid infiltration (4 of 5 cases) was found without detectable nucleoli in nuclei of small lymphoid cells. In 1 case, there was a combined lymphoid infiltration: CD20+ microfocal-interstitial infiltration with an intravascular component. No persistent molecular mutations in the spleen tissue specimens were found.

Conclusion. SDRPL is diagnosed in 7 % of splenic B-cell lymphomas. It is a rare disorder, whose verification requires an integrated approach taking into account clinical and laboratory data, results of flow cytometry, cytological, morphological, extended IHC and molecular biological studies.

Keywords: immunohistochemistry, splenic diffuse red pulp small B-cell lymphoma, splenectomy, bone marrow biopsy.

Received: April 28, 2016

Accepted: April 29, 2016

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