An indolent variant of splenic marginal zone lymphoma (SMZL) lacking m
assive splenomegaly has been described as an incidental finding in spl
eens removed for rupture or hypersplenism, We studied traumatically ru
ptured spleens with expanded margind zones (MZs) to assess the inciden
ce of occult monoclonal B-cell populations in this setting, Ninety-one
ruptured or lacerated spleens removed from 1984 to 1995 were classifi
ed as to whether they had expanded MZs (> 12 cell layers thick), When
available, paraffin-embedded, formalin-fixed tissue from cases with ex
panded MZs was examined for immunoglobulin heavy chain gene rearrangem
ent by polymerase chain reaction (PCR) and stained for CD20, CD43, and
kappa and lambda Light chains, Splenectomies were performed for blunt
(70 patients) and penetrating (7 patients) trauma, surgical misadvent
ure (13 patients), or spontaneous rupture (1 patient). There were 58 m
en and 33 women in our study, ranging in age from 17 to 87 years (mean
, 40 yr), Average spleen weight was 183 g (range, 44-505 g). Twenty-se
ven (30%) of 91 patients had expanded MZs, There were no significant d
ifferences in age, sex, spleen weight, or reason for excision between
those cases with and without MZ expansion, Germinal centers varied fro
m absent to inactive to floridly reactive, Paraffin blocks were availa
ble in 24 cases; the 20 with amplifiable DNA were polyclonal by PCR, F
ollow-up was available for 25 of the 27 patients with expanded MZs (ra
nge, 1-85 mo; medial, 6 mo); lymphoma did not develop in anyone, altho
ugh one patient's spleen was morphologically suspicious for lymphoma,
showing involvement of red pulp by MZ-type B-cells; PCR revealed a pol
yclonal pattern, This patient's 3-year follow-up revealed no evidence
of lymphoma Traumatically ruptured spleens with expanded MZs do not se
em to harbor occult B-cell clones, as detected by PCR, Although a few
cases of incidentally removed spleens have been reported to contain lo
w-stage SMZL, this seems to be an infrequent event.