Splenic pathology after traumatic injury.

Little is known concerning the pathology of spleens removed for traumatic injury. The authors studied the gross and microscopic features of 44 spleens removed for trauma and received at the Surgical Pathology Division of Parkland Memorial Hospital and 10 normal control spleens from the Medical Examiner's Office, Dallas County, Texas. The mean age of patients undergoing post-traumatic splenectomy was 29.6 years with a male:female ratio of 6:1. The most common procedure done for traumatic splenic rupture was splenectomy (39 of 44 cases); wedge resection or partial splenectomy was done in 5 cases. The mean weight of the spleens was 167 g (181 g in males, 93 g in females, P = .056). Capsular laceration or rupture were noted in 86% of post-trauma spleens, usually involving the superior pole and/or hilum. Subcapsular neutrophilic infiltrates were seen in 7%. Gross evidence of parenchymal hemorrhage was seen in 25%, and microscopic evidence in 68%. Control spleens showed none of these findings. Germinal centers were present in 77% of spleens with germinal center hyperplasia in 55% (including patients 16-59 years 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 infection, granulomas (other than lipogranulomas), or infarct. The findings suggest that splenic rupture after trauma may be related to prior immunologic stimulation of the spleen, and that spleens removed for trauma are not equivalent to normal controls.