X4167: Spleen

Body system: Lymphatic System

Patient information: Male, aged late 20s.

Overview

Spleen weighing 9.5 kg from a patient who suffered from chronic myelocytic leukaemia for 5.5 years. Death was 4 months after the leukaemia underwent blastic transformation. Note the extensive acute infarction. Microscopy shows the pulp to be heavily infiltrated by leukemic cells.

Clinical history

Patient presented with chronic myeloid leukaemia. Initial therapy consisted of Busulphan followed by Melphalan. Cytotoxic therapy stopped five years later. Patient responded well and was allowed to return home. After numerous re-admissions for cytotoxic therapy, patient had recurrent complications of anaemia, neutropenia and thrombocytopaenia. Other therapies were administered including blood and platelet transfusions and antibiotics. On final admission to hospital, patient had a temperature of 38.7 degrees and weakness/lethargy. The left side of the abdomen was tense. Patient had antibiotics and blood transfusion as well as medication for pain relief. Over the following days they only responded to painful stimuli and eventually died. Final cause of death at autopsy was recorded as pulmonary congestion and collapse, myeloid leukaemia in blastic phase, infiltration of leukaemia into other organs (liver, spleen, marrow and retroperitoneal fat), multiple splenic infarcts and haemorrhage into retroperitoneal fat.

Definitions

Busulphan and Melphalan – drugs used in chemotherapy.

Cytotoxic – drugs used that are toxic to cells and prevent them from replicating. Used to treat cancer.

Neutopenia – occurs when there are too few neutrophils, types of white blood cells.

Thrombocytopaenia – a condition arising from low blood platelet count. Platelets are colourless blood
cells that help blood clot.

Retroperitoneal – tissue that lines the abdominal wall and covers most of the organs in the abdomen.

Infarcts – small, localised areas of dead tissue resulting from a failure of blood supply.