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1
Content available remote Epidermal Cyst of the Spleen - a Rare Case in Clinical Practice
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EN
Splenic cysts are rare disease that are diagnosed incidentally during imaging studies. In recent years, through the development of diagnostic methods the detection of their are increased, although documented and described in the literature of cases is still low. The disease can be asymptomatic - this concerns mainly small cysts, but greater changes cause unspecific symptoms resulting from oppression of enlarged spleen on adjacent organs. Due to the etiology of cysts, they are divided into primordial and false. Primordial cysts have an epithelial lining which distinguishes them from false and they are divided into parasitic and nonparasitic. Because of the possibility of complications cysts usually treated surgically, with the aim to preserve the splenic parenchyma. We present a case of a 28-year-old woman who has revealed the presence of epidermal cysts of the spleen
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Content available remote Giant Splenic Hematoma can be a Hidden Condition
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EN
An otherwise healthy 28-year old male presented to his general practitioner with dyspnoea in the morning and abdominal discomfort through months. Four months earlier, he had experienced a blunt trauma to the left side of his abdomen. Abdominal ultrasonography revealed a splenic hematoma and the patient was admitted to hospital. Vital signs were normal, and blood samples revealed a marginal anaemia and elevated C-reactive protein, but were otherwise normal. Computed tomography showed an 18 centimetre wide splenic hematoma. The patient was referred to another hospital for conservative treatment in the outpatient clinic.
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Content available Hidatidosis of the Spleen
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EN
Hydatidosis of the spleen (SH) is an extremally rare condition. The aim of the study was to present our experience and discuss diagnostic methods and therapeutical options in cases of spleen hydatidosis. Material and methods. Between 1993 and 2008, 8 patients were diagnosed with SH, 6 of whom were operated on (4 males and 2 females). Their average age was 44.5 years (the age range 30-59 years). Four patients presented isolated SH, one had a spleen and liver hydatidosis and there was also a case of one spleen, liver and peritoneal hydatidosis. Results. The main symptom of the condition was abdominal pain and hydatidosis serology was always positive. The average hydatidisis cyst size was 13.3 cm (range: 7-18 cm). Splenectomy was performed in 5 cases and a partial cystectomy in one case. A left lateral sectionectomy was required in 1 case, a segment III subsegmentectomy was delivered in 1 case and multiple cystectomies in the case of the patient with disseminated hydatisis. In the follow-up period of the above mentioned surgical procedures no mortality among the treated patients was reported. The majority of patients did not present any symptoms of morbidity (4 patients). We registered one wound infection and one cavity abscess solved with percutaneous drainage in the patient following partial cystectomy. The hospitalisation period avaraged to 5 days (within the range of 5 to 12 days). The patients’ follow-up was 98 months on average (range:19-190 months) without any traced relapse. Conclusions. Total splenectomy is the treatment of choice of SH. Other surgical techniques could be employed in special cases
EN
Introduction. Primary extrahepatic hydatid cysts are rare, and primary splenic hydatid cysts even rarer. Splenic hydatidosis constitutes 2% to 3.5% of all hydatid cysts. Aim. To present a case report of splenic hydatidosis with abdominal pain. Description of the case. We report here a case of isolated splenic hydatid cysts in a 23 year old female, who presented with dull dragging pain in the left hypochondrium. Diagnosis was made on computed tomography imaging of the abdomen and microscopic examination of the laminated hydatid cyst wall and supplemented with positive enzyme linked immunosorbent assay for hydatid antibodies. Conclusion. The incidence of splenic involvement by hydatid cysts is very low. Man is an accidental intermediate host, as entry of the larval forms into humans represents an end stage in its life cycle. Until recently the gold standard treatment for splenic hydatidosis was splenectomy, as medical therapy seems to be ineffective. However, the last two decades have shown a tendency towards splenic conservative surgery in suitable cases, to reduce opportunistic post splenectomy infection.
5
Content available remote Littoral cell angioma mimicking metastatic tumors
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EN
Littoral cell angioma is a rare primary, vascular tumor thought to originate from the endothelial cells lining the sinuses of the splenic red pulp (the “littoral cells”). It is a benign, usually asymptomatic lesion diagnosed incidentally. Ultrasound and tomography appearance is not characteristic and histopathological examination is required. This work provides a case-study of littoral cell angioma which was seen in a 55-year-old female who complained of non-specific upper abdominal pain. Computed tomography revealed multiple hypo-attenuated splenic lesions suggestive for metastasis. A splenectomy was performed and routine microscopic examination supported by immunohistochemistry reactions with CD68, CD34 and CD31 showed littoral cell angioma.
EN
Liver is a unique mammalian organ with a great capacity of regeneration related to its function. After surgical resection or injury, hepatic cells, especially hepatocytes, can proliferate rapidly to repair the damage and to regenerate the structure without affecting the function of the liver. Loss of catalase activity during regeneration indicates that oxidative stress is present in the liver not only in pathological conditions but also as a 'physiological' factor during regeneration. As we have shown in our previous work, liver stem cell-like cells treated with 4-hydroxynonenal (HNE), a cytotoxic and growth regulating lipid peroxidation product, recover in the presence of spleen cells. In the current study we characterized this novel cell line as liver-derived progenitor/oval-like cells, (LDP/OCs), i.e. functional liver stem-like cells. We showed that LDP/OC were OV6 positive, with abundant glycogen content in the cytoplasm and expressed α-fetoprotein, albumin, biliverdin reductase and γ-glutamyl transferase. Also, we compared their growth in vitro with the growth of cultured primary hepatocytes stressed with HNE and co-cultured with autologous spleen cells. The influence of spleen cells on HNE-treated primary hepatocytes and on LDP/OCs showed that spleen cells support in a similar manner the recovery of both types of liver cells indicating their important role in regeneration. Hence, LDP/OC cells may provide a valuable tool to study cell interactions and the role on HNE in liver regeneration.
7
Content available remote Hidatidosis of the Spleen
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EN
Hydatidosis of the spleen (SH) is an extremally rare condition.The aim of the study was to present our experience and discuss diagnostic methods and therapeutical options in cases of spleen hydatidosis.Material and methods. Between 1993 and 2008, 8 patients were diagnosed with SH, 6 of whom were operated on (4 males and 2 females). Their average age was 44.5 years (the age range 30-59 years). Four patients presented isolated SH, one had a spleen and liver hydatidosis and there was also a case of one spleen, liver and peritoneal hydatidosis.Results. The main symptom of the condition was abdominal pain and hydatidosis serology was always positive. The average hydatidisis cyst size was 13.3 cm (range: 7-18 cm). Splenectomy was performed in 5 cases and a partial cystectomy in one case. A left lateral sectionectomy was required in 1 case, a segment III subsegmentectomy was delivered in 1 case and multiple cystectomies in the case of the patient with disseminated hydatisis. In the follow-up period of the above mentioned surgical procedures no mortality among the treated patients was reported. The majority of patients did not present any symptoms of morbidity (4 patients). We registered one wound infection and one cavity abscess solved with percutaneous drainage in the patient following partial cystectomy. The hospitalisation period avaraged to 5 days (within the range of 5 to 12 days). The patients' follow-up was 98 months on average (range:19-190 months) without any traced relapse.Conclusions. Total splenectomy is the treatment of choice of SH. Other surgical techniques could be employed in special cases.
8
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EN
Tuberculosis(TB) is one of the most common infections affecting the population in the developing countries. With the rising human immunodeficiency(HIV) infection its incidence is on a rise even in the developed countries. Pulmonary TB is the commonest form of infection, However multiple extrapulmonary sites have also been reported. Spleen is thought to be a rare organ involved in this infection. Various presentations of the splenic TB have been reported in literature.The definitive diagnosis of this is essentially formulated on the post splenectomy specimen. A consensus statement based on the available case reports is lacking. The authors are providing an insight into this form of extrapulmonary TB after reviewing the available literature.
EN
The primary structure of porcine spleen RNase (RNase Psp1) was investigated as a mean of assessing the structure-function relationship of base non-specific ribonucleases of animal origin. N-terminal analysis of RNase Psp1 yielded three N-terminal sequences. These peptides were separated by gel-filtration on Superdex 75HR, after reduction and S-carboxymethylation of RNase Psp1. Determination of the amino-acid sequence of these peptides indicated that the RNase Psp1 preparation consisted of three peptides having 20 (RCM RNase Psp1 pep1), 15 (RCM RNase Psp1 pep2), and 164 (RCM RNase Psp1 pro) amino-acid residues, respectively. It possessed two unique segments containing most of the active site amino-acid residues of the RNases of the RNase T2 family. The alignment of these three peptides in RNase Psp1 was determined by comparison with the other enzymes in the RNase T2 family. The overall results showed that RCM RNase Psp1 pep1 and RCM RNase Psp1 pep2 are derived from the N-terminal and C-terminal regions of RNase Psp1, respectively, probably by processing by some protease. The molecular mass of the protein moiety of RNase Psp1 was 23235 Da.
EN
Purpose: The normal limits of spleen size must be known in order for pathological changes to be noticed. The aim of this retrospective study is to determine the normal limits of spleen size in healthy children and to reveal their relation to sex, age, body height and weight. Patients and methods: Three hundred and ten children (150 girls and 160 boys) between 0–16 years of age in Eastern Anatolia Region who had normal spleen ultrasound appearances were included in this study. The greatest longitudinal distance of the spleen from the dome to the tip (splenic length) measured at the hilum in the coronal plane was obtained by ultrasonography. Results: There was no significant difference between the sexes in children. Also, no statistically significant differences were found between the two sexes in any age group for splenic length (t-test, p > 0.05). Therefore, all data were rearranged without being separated according to sex. The correlation analysis has shown a positive and significant correlation between splenic length and age, body height, and weight, with high correlation coefficients (r > 0.80). Splenic length showed the strongest correlation with body height. Conclusion: In children clinically suspected of organomegaly, splenic length can be used to assess organ size. The presented data can be applied to routine ultrasonography examinations.
PL
Cel: Znajomość zakresu prawidłowych wymiarów śledziony jest konieczna by móc rozpoznać zmiany patologiczne. Celem niniejszego retrospektywnego badania było ustalenie prawidłowego przedziału wymiarów śledziony u dzieci zdrowych oraz poznanie ich zależności z płcią, wiekiem, wzrostem i wagą. Materiał i metody: Badaniem objęto trzysta dziesięcioro dzieci w wieku 0-16 lat ze Wschodniej Anatolii, u których badanie ultrasonograficzne wykazało prawidłowy obraz śledziony. W badaniu ultrasonograficznym rejestrowano maksymalną odległość pomiędzy biegunem dolnym a górnym śledziony, mierzoną we wnęce w płaszczyźnie czołowej Wyniki: Nie stwierdzono istotnych różnic w wielkości śledziony w zależności od płci. Nie stwierdzono również statystycznie istotnych różnic w długości śledziony pomiędzy płciami w którejkolwiek zbadanych grup wiekowych (test t-Studenta, p > 0,05). Z tego względu wszystkie dane zostały ostatecznie przedstawione bez podziału ze względu na płeć. Analiza korelacji wykazała dodatnią i istotną statystycznie zależność pomiędzy długością śledziony a wiekiem, wzrostem oraz wagą, przy wysokich współczynnikach korelacji (r > 0,80). Długość śledziony wykazała najsilniejszą korelację ze wzrostem/długością ciała. Wnioski: Długość śledziony jest parametrem pomocnym w ocenie wielkości śledziony u pacjentów z podejrzeniem organomegalii. Dane przedstawione w niniejszym artykule mogą być wykorzystywane jako wartości referencyjne w rutynowych badaniach ultrasonograficznych. Artykuł w wersji polskojęzycznej jest dostępny na stronie http://jultrason.pl/index.php/wydawnictwa/volume-18-no-72
EN
An important paper describing the Standards of the Polish Ultrasound Society regarding the assessment of portal and hepatic vasculature was published in the Journal of Ultrasonography. Due to the multiplicity of morphological and hemodynamic data required, the time needed to obtain these data and the legal responsibility of doctors for the results, there seems to be a need to determine a clear range of the assessed parameters depending on the reference level of a given healthcare facility. Therefore, the aim of the paper was to present the EFSUMB recommendations on the range of the evaluated ultrasonographic parameters in portal hypertension depending on the reference level. European healthcare institutions are characterized by a clear three-level reference network. Due to the lack of a similar division in Poland, we propose our own classification of the competence of medical entities. The first reference level: ultrasound assessments in a primary health care setting (performed by GPs, emergency physicians, non-specialist private practice physicians, non-specialist practice physicians); at least one mid-class ultrasound scanner with pulsed and color Doppler options, equipped with convex 3–5 MHz and linear 7–12 MHz transducers should be available at physician’s disposal. The second reference level: ultrasound assessments in the hospital setting and specialist outpatient clinics, performed by specialist private practice physicians, radiologists, gastroenterologists and hepatologists; top class (premium) digital ultrasound scanner should be available at physician’s disposal. Third reference level: ultrasound assessments performed in gastroenterology, hepatology and liver surgery departments as well as their specialist outpatient clinics; physicians should use top class digital ultrasound equipment. At every reference level, physicians performing abdominal ultrasound should have the appropriate certification to perform such an assessment or specialize in gastrointestinal diagnosis.
PL
W „Journal of Ultrasonography” została opublikowana ważna praca opisująca standardy badań ultrasonograficznych Polskiego Towarzystwa Ultrasonograficznego dotyczące oceny układu wrotnego i naczyń wątroby. Z uwagi na mnogość koniecznych do określenia danych morfologicznych i hemodynamicznych, czas potrzebny do ich uzyskania oraz odpowiedzialność prawną lekarzy za ich wynik wydaje się, że konieczne jest sporządzenie dokładnego zakresu ocenianych parametrów w zależności od referencyjności ośrodka. Celem pracy jest więc zaprezentowanie rekomendacji Europejskiej Federacji Towarzystw Ultrasonografii w Medycynie i Biologii określających zakres badanych parametrów ultrasonograficznych dotyczących nadciśnienia wrotnego w odniesieniu do referencyjności ośrodka. W wielu krajach europejskich istnieje wyraźna trójstopniowa referencyjność ośrodków medycznych. W związku z tym, że w Polsce taki podział nie obowiązuje, autorzy tej pracy proponują własną klasyfikację kompetencyjności podmiotów medycznych. I stopień referencyjności: badania USG wykonywane w ramach podstawowej opieki medycznej (przez lekarza rodzinnego, lekarza SOR, lekarza zajmującego się niespecjalistyczną praktyką prywatną, lekarza pracującego w przychodni niespecjalistycznej); do dyspozycji lekarza powinien być co najmniej aparat cyfrowy klasy średniej z opcją impulsowego i kolorowego dopplera oraz dopplera mocy, wyposażony w głowicę konweksową 3–5 MHz i liniową 7–12 MHz. II stopień referencyjności: badania wykonywane w warunkach szpitalnych, w przychodniach specjalistycznych, przez lekarzy wykonujących specjalistyczną praktykę prywatną oraz przez radiologów, gastrologów i hepatologów; do dyspozycji lekarza powinien być aparat cyfrowy najwyższej klasy (premium). III stopień referencyjności: badania ultrasonograficzne wykonywane w klinikach o profilu gastrologicznym, hepatologicznym i chirurgii wątroby oraz w przychodniach specjalistycznych tych placówek; lekarz powinien badać na aparacie cyfrowym najwyższej klasy. Na każdym etapie ośrodka referencyjnego lekarz wykonujący badania USG jamy brzusznej powinien legitymować się odpowiednim certyfikatem uprawniającym do wykonywania takich badań lub specjalizacją z zakresu diagnostyki przewodu pokarmowego. Artykuł w wersji polskojęzycznej jest dostępny na stronie http://jultrason.pl/index.php/wydawnictwa/volume-17-no-69
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Deltamethrin, a well-known type 2 synthetic pyrethroid insecticide, is a widespread environmental toxicant. It has potential to accumulate in body fluids and tissues due to its lipophilic characteristics. The immune system is among the most sensitive targets regarding toxicity of environmental pollutants. Various methods are available in the literature to analyze deltamethrin (DLM) concentration in plasma and tissues, but regarding the immune organs, only one gas chromatography–tandem mass spectrometry (GC–MS/MS) method (on spleen tissues) has been reported. In the present investigation, a rapid and sensitive high-performance liquid chromatography (HPLC) method has been developed and validated to determine DLM concentration in plasma, thymus, and spleen using zaleplone as an internal standard. Liquid chromatography (LC) separation is performed on an Agilent Zorbax® C8 column (250 mm × 4.6 mm, i.d., 5 μm) with isocratic elution using a mobile phase consisting of acetonitrile–5 mM KH2PO4 (70:30, v/v) at a flow rate of 1 mL min−1. The lower limit of quantification (LLOQ) for DLM is 10 ng mL−1 (plasma, thymus, and spleen). The method has been validated in terms of establishing linearity, specificity, sensitivity, recovery, accuracy, and precision (intra- and inter-day) and stabilities study. This validated method was successfully applied to a pharmacokinetic and tissue distribution study of DLM in mice.
13
Content available remote Splenic Absces - Diagnostics and Treatment
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EN
Splenic abscess is a rare condition often difficult to diagnose and always fatal, if untreated. It is frequently concomitant with immunodeficiency, especially in hematological disorders.The aim of the study was to share our own experience in the treatment of splenic abscess and to present the review of current literature on the subject.Material and methods. In the period January-June 1997, 8 patients were treated for splenic abscess at the Department of General and Hematological Surgery of the Institute of Hematology and Transfusion Medicine in Warsaw; (6 men and 2 women; mean age 51.3 years). Six patients reported immunodeficiency disorders in medical interview (immunoglobulin deficiency, alcoholism, leukopenia, agranulocytosis, lymphoproliferative disorders).Prior to operation, chest X-rays as well as US and CT imaging were performed for all patients; all were qualified for splenectomy.Results. In all cases, imaging studies revealed splenomegaly and characteristics suggestive of splenic abscess, in chest X-ray of 6 patients typical abscess changes were also found. Classic splenectomy was performed in all 6 cases. The total mass of spleen removed was 365 g-1560 g, mean of 962 g. Procedure duration was 72 to 135 min, mean of 88,3 min. Patients were transfused 1 to 4 units of red blood cell concentrate, mean of 2.1 units. In patients with perisplenitis, priooperative blood loss was greater and the procedure was extended. In the postoperative period, such complications as deep vein thrombosis of lower extremities, portal vein thrombosis, aggrevation of chronic renal insufficiency and circulatory insufficiency evoked by paroxysmal atrial fibrillation were observed in 4 patients. No deaths were reported. Six patients were discharged in a satisfactory state; 2 were transferred to the hematological department for further treatment due to persisting septic state.Conclusion. Despite a high incidence rate of periooperative complications, classic splenectomy still remains the procedure of choice for splenic abscess treatment.
14
Content available Splenic melanosis in agouti and black mice
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EN
An interesting example of extradermal deposition of melanin in vertebrates, notably in mammals, is splenic melanosis. In particular, if the phenomenon of splenic melanosis is correlated with hair or skin pigmentation, it must reflect the amount and perhaps the quality of pigment produced in hair follicle melanocytes. The present paper is our first study on splenic pigmentation in mice of phenotype agouti. We used untreated mixed background mice C57BL/6;129/SvJ (black - a/a, agouti - A/a, A/A), and as a control - black C57BL/6 and agouti fur from 129/SvJ mice, Mongolian gerbils (Meriones unguiculatus) and golden hamsters (Mesocricetus auratus). After euthanasia skin and spleen was evaluated macroscopically, photographed and collected for further analysis using Fontana-Masson and hematoxylin-eosin staining and electron paramagnetic resonance (EPR) at X-band. Spleens of the agouti mice revealed splenic melanosis but were slightly weaker pigmented than their black counterparts, while the presence of pheomelanin was difficult to determine. The fur of both phenotypes was of similar melanin content, with the same tendency as in the spleens. The contribution of pheomelanin in the agouti fur was on the border of detectability by EPR. Histological and EPR analysis confirmed the presence of melanin in the melanotic spleens. The shape of the EPR signal showed a dominance of eumelanin in fur and in melanized spleens in both phenotypes of mice. Therefore, splenic melanosis does reflect the hair follicle pigmentation not only in black, but also in agouti mice.
EN
Objectives The objective of the present study was to observe the effects of 50 Hz magnetic fields (MFs) on the immune function of splenic lymphocytes in mice. Material and Methods Twenty male Kunming mice (6 weeks old), weighing 18– 25 g, were randomly divided into sham exposure (N = 10) and 500 μT MFs (N = 10) groups. The mice in the MFs group were exposed to 500 μT MFs for 8 h daily (5 days/week) for up to 60 days. In vitro study was carried out to examine the effects of 50 Hz MFs on the expression of inflammatory factor genes and a cluster of differentiation 69 (CD69) in mouse prime splenic lymphocytes activated by para-Methoxyamphetamine (PMA) and ionomycin. In the in vitro experiments, lymphocytes were isolated from the spleen of 10 healthy Kunming mice, the cells were cultured in the Roswell Park Memorial Institute 1640 medium (RPMI-1640) and exposed to 0 μT, 250 μT, 500 μT, or 1 mT MFs in an incubator under 5% carbon dioxide (CO₂) at 37°C for 6 h. The levels of interleukin-2 (IL-2), IL-4, interferon-gamma (IFN-γ), GATA binding protein 3 (GATA-3) and T cell-specific T-box transcription factor (T-bet) were assessed by the real-time quantitative reverse transcription polymerase chain reaction (RT-qPCR), respectively. The expression of CD69 was checked using the flow cytometry. Results Under our experimental conditions, body weight of the mice exposed to occupational, extremely low frequency- electromagnetic fields (ELF-EMFs) significantly decreased on day 20 and day 30. There were no significant changes observed in vivo in spleen weight, splenic coefficient, splenic histology profile and cytokine production in spleen tissues. Our in vitro experiments showed that 50 Hz MFs had no effect on the expression of these genes and CD69 to primary splenic cells. Conclusions In conclusion, under the applied experimental conditions, occupational exposure to 50 Hz magnetic field did not alter responses of inflammatory genes and activation of splenic lymphocytes in mice, except for body weight.
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Content available remote Splenic melanosis during normal murine C57BL/6 hair cycle and after chemotherapy
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EN
Cancer chemotherapy is associated with serious side effects, including temporary hair loss and impairment of pigmentation. We suspect that ectopic melanin deposition occurring due to chemotherapy may add to these effects worsening the already unpleasant symptoms. We associated the ectopic occurrence of follicular melanin after chemotherapy with splenic melanosis - an interesting example of extradermal melanin localization - and we expected an increase in splenic melanin deposition after chemotherapy. Using the C57BL/6 murine model of synchronized hair cycle induced by depilation, we visualized splenic melanin by means of several histological and histochemical protocols of staining: hematoxylin and eosin, May-Grünwald-Giemsa and Fontana-Masson. Unexpectedly, the splenic deposition of melanin decreased due to application of cyclophosphamide (i.p. 120 mg/ kg body weight on day 9 post depilation). The drop was abrupt and lasted for at least 5 days (day 13-18 post depilation), as compared with normal hair cycle. Moreover, in mice with normal, depilation-induced hair cycle we observed a similar drop shortly before entering catagen (day 15 post depilation), followed by a slow and partial increase in splenic melanization up to day 27 post depilation in both groups. We conclude that cyclophosphamide negatively affects splenic melanization and/or extradermal transfer of ectopic melanin from the dystrophic hair follicles, but the most powerful down-regulator of splenic melanosis is normal and dystrophic catagen - the phase of hair follicle involution and re-modelling.
EN
The study aimed at the analysis of splenic pathologic lesions in mix-breed dogs of varied age and sex in the Lublin Province in 2005-2008. The research material comprised 33 spleen specimens collected both during surgery and post mortem. The material was fixed in 4% buffered formalin, dehydrated, and paraffin-embedded. The 4-µm-thick sections were stained with haematoxylin and eosin. The non-cancerous lesions were detected in young dogs under 2 years of age. Angiosarcoma proved to be the most common lesion and accounted for over 36% of total cases, followed by haemangioma recognised in above 27% of all cases. Nodular hyperplasia, hyperaemia, histiocytic sarcomas, haemangiopericytomas, lymphomas, and necrotic lesions were observed in notable minority of cases.
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