SPLENIC PATHOLOGY AFTER TRAUMATIC INJURY

Little is known concerning the pathology of spleens removed for trauma tic injury. The authors studied the gross and microscopic features of 44 spleens removed for trauma and received at the Surgical Pathology D ivision of Parkland Memorial Hospital and 10 normal control spleens fr om the Medical Examiner's Office, Dallas County, Texas. The mean age o f patients undergoing post-traumatic splenectomy was 29.6 years with a male:female ratio of 6:1. The most common procedure done for traumati c splenic rupture was splenectomy (39 of 44 cases); wedge resection or partial splenectomy was done in 5 cases. The mean weight of the splee ns was 167 g (181 g in males, 93 g in females, P = .056). Capsular lac eration or rupture were noted in 86% of post-trauma spleens, usually i nvolving the superior pole and/or hilum. Subcapsular neutrophilic infi ltrates were seen in 7%. Gross evidence of parenchymal hemorrhage was seen in 25%, and microscopic evidence in 68%. Control spleens showed n one of these findings. Germinal centers were present in 77% of spleens with germinal center hyperplasia in 55% (including patients 16-59 yea rs old), numerous primary follicles in 45%, mantle zone hyperplasia in 10%, and marginal zone hyperplasia in 41% of patient spleens. Control spleens showed few or none of these findings. No patient spleens had histologic features suggestive of Epstein-Barr virus (EBV) or other in fection, granulomas (other than lipogranulomas), or infarct. The findi ngs suggest that splenic rupture after trauma may be related to prior immunologic stimulation of the spleen, and that spleens removed for tr auma are not equivalent to normal controls.