Clinical History
A 73 year-old man presented to the emergency room with severe, spontaneous abdominal pain. At laparotomy, he was found to have a hemoperitoneum and splenic rupture. A splenectomy was performed and the specimen was sent for pathological examination.
Three and a half years earlier, the patient had been diagnosed with chronic lymphocytic leukemia (CLL). An abdominal CT scan at that time revealed a 5 cm splenic mass with heterogeneous attenuation as well as periaortic and portocaval lymphadenopathy.
Abdominal CT Scan
The splenic mass was attributed to involvement by the patient’s CLL. The splenic mass had continued to enlarge to a maximal diameter of 11 cm, despite treatment of his CLL with multiple chemotherapeutic agents including fludarabine, rituximab, and mitoxantrone.
Gross Pathology
Gross Image of Spleen
The splenic capsule was focally disrupted, and was markedly distended by a 9 cm, well-circumscribed mass with a heterogeneous cut surface, including solid, tan rubbery areas as well as regions of necrotic-appearing tissue and pools of hemorrhagic fluid.
View Whole Slide Image (preferred) [username: resident; password: resident]