Feature punctates spleen in some diseases and tumors

Under certain pathological processes the number of red cells number of degrees of maturity in punctate can reach 8-10 %. A significant number of myelocytes typical for splenogrammy in chronic myeloid leukemia. Myeloblasts appear punctate with acute myeloid leukemia, and exacerbation of chronic myeloid leukemia (vlastnыy crisis), and megakaryocytes - in chronic myeloid leukemia, subacute bacterial endocarditis, eritremii, some forms of liver cirrhosis.

For diagnostic purposes spleen puncture advantageously carried out at aleukemic form of chronic myeloid leukemia. In this case the suspected disease allows myeloid metaplasia spleen expressed in the absence of changes in the peripheral blood. The detected punctate neutrophil, eosinophil and basophil granulocyte all degrees of maturity of up to mature, erythroblasts and all kinds normotsntov (with a predominance of- lihromatofilnyh), as well as a small number of megakaryocytes.

The emergence of foci of hematopoiesis in the spleen may also occur in many diseases neleykemicheskoy nature (cirrhosis, trombotsitopenicheskaya purpura, subacute bacterial endocarditis, malaria and others.), However, in a punctate dominated by mature granulocytes and marked a low content eritronormoblastov. Magakariotsity unit or there are no. The puncture of the spleen is of particular diagnostic value with chlamydia, Gaucher sorrows, Niemann-Pick disease, etc.. If chlamydia cytologic diagnosis is based on the presence of specific spleen punctate smear giant cells Berezovsky-Sternberg.

Gaucher Bolezny

Gaucher disease - a hereditary disease, caused by deficiency of an enzyme glikoperebrozidazy. Suffer the children, and adults, mostly women. Clinically, enlargement of the spleen, often substantial. Specific elements of punctate - Gaucher cells of large sizes, diameter up to 20-80 mm. The cytoplasm of cells predominates over the size of the nucleus, has vacuolated, foamy, glassy, ​​viscous or striated fibrillar character as a result of accumulation in her glikotserebrozidov.

The hinges between the cells or fibrillar bundles are highlights from the gleam of metal. Sometimes, in the cytoplasm of Gaucher cells visible clumps hemosiderin. The presence of these inclusions indicates phagocytic activity of Gaucher cells. The nuclei of the extended, round or oval, grubosetchatoy structure, compact, located in the center and, and on the periphery of the cell. There may be a cell before 20 cores and more. Sometimes there syncytial formation. Gaucher cells Molodыe different homogeneous basophilic cytoplasm without inclusions. In punctates spleen may show various degenerative forms of Gaucher cells. Acute forms of the disease occur in children, chronic - in adults.


NPD, as Gaucher's disease - familial constitutional pathology. It manifests itself in early childhood (even in breast), It occurs most often in girls. Proceeds in two clinical variants - visceral and bone. The disease is caused by deficiency of the enzyme sphingomyelinase. Because disturbances of lipid metabolism in the body are accumulated in a large amount sphingolipids, are deposited in the form of droplets in macrophages. They are called Niemann-Pick cells. These cells are found in the spleen, liver and bone marrow. Niemann-Pick cells were large, 30-40 microns in diameter, polygonal or rounded shape. Their bright wide cellular cytoplasm has character, because it is filled with many brilliant lipid grains (in native preparations), part of which gives the double refraction. Some cells have a homogeneous cytoplasm. The cell nuclei are small.

Many researchers called the cells Niemann-Pick foamy, since fixation and staining cytoplasm becomes perforated, tracery (preparations treated with alcohol, dissolving lipids). In distinction from Gaucher kletok, Niemann-Pick cells are stained with Sudan III and osmium (specific dyes for detection of lipid).

Tumors of the spleen

Tumors of the spleen (primary and metastatic) rare. Primary tumors are divided into vascular and dense (sarkoma). For vascular tumors include angioma and cavernoma, forming units in the spleen of the larger or smaller. The puncture of the spleen vascular tumors has no special diagnostic value, Although aspiration of large amounts of blood during puncture should attract attention.

The cells in the small punctate (He diluted blood), characteristic morphological features of the tumor is not found.

Sarcoma spleen It occurs only rarely. It grows in the form of nodular formations (single or multiple), sometimes affecting the whole body. When the spleen sarcoma increases, It becomes painful. Histologically distinguish hemangioendothelioma, limfangioendoteliomu, fibrosarcoma tumors and other. Puncture spleen sarcoma is of great diagnostic value.

Metastatic tumors in the spleen are rare, generally at sarcomas, melanoma and carcinoma. Cytological diagnosis of tumors at an appropriate microscopic picture of the difficulties is not punctate.

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