Skip to main content

Infectious and Inflammatory Mimickers of Hematopoietic Disorders in the Liver and Spleen

  • Chapter
  • First Online:
Diagnostic Pathology of Hematopoietic Disorders of Spleen and Liver
  • 886 Accesses

Abstract

Benign or malignant diseases confined to the liver can be associated with inflammation, including lymphoid or plasmacytic infiltrate, and can rarely mimic neoplastic hematopoietic disorders. These differential diagnoses have received limited attention in the literature. Understanding the patterns of liver histology caused by lymphoma and various non-neoplastic inflammatory pathologies is essential, as the differential diagnosis varies depending on whether an inflammatory infiltrate primarily involves portal tracts, primarily involves sinusoids, or forms a discrete mass lesion.

The differential diagnosis for pathologic enlargement of the spleen is broad. As a hematopoietic organ, the spleen is a site of primary lymphoma, but also manifests pathologic abnormalities in a variety of infectious diseases, hematologic disorders, and systemic inflammatory disorders that may mimic primary or secondary involvement by a hematopoietic malignancy.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Baumhoer D, Tzankov A, Dirnhofer S, Tornillo L, Terracciano LM. Patterns of liver infiltration in lymphoproliferative disease. Histopathology. 2008;53(1):81–90.

    Article  CAS  PubMed  Google Scholar 

  2. Cohen JI. Epstein-Barr virus infection. N Engl J Med. 2000;343(7):481–92.

    Article  CAS  PubMed  Google Scholar 

  3. Petrova M, Kamburov V. Epstein-Barr virus: silent companion or causative agent of chronic liver disease? World J Gastroenterol. 2010;16(33):4130–4.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Maurmann S, Fricke L, Wagner HJ, et al. Molecular parameters for precise diagnosis of asymptomatic Epstein-Barr virus reactivation in healthy carriers. J Clin Microbiol. 2003;41(12):5419–28.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Richinson A, Kieff E. Epstein-Barr virus. In: Knipe D, Howley P, editors. Tields virology. Vol 1 and 2. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 2575–627.

    Google Scholar 

  6. CDC. Epstein-barr virus and infectious mononucleosis: laboratory testing. https://www.cdc.gov/epstein-barr/laboratory-testing.html. Updated 2018.

  7. Handin R. Blood: pricinples and practice of hematology. Philadelphia: Lippincott Williams & Wilkins; 2003.

    Google Scholar 

  8. Mononucleosis. https://www.mayoclinic.org/diseases-conditions/mononucleosis/diagnosis-treatment/drc-20350333. Accessed 6 Aug 2017.

  9. Elgh F, Linderholm M. Evaluation of six commercially available kits using purified heterophile antigen for the rapid diagnosis of infectious mononucleosis compared with Epstein-Barr virus-specific serology. Clin Diagn Virol. 1996;7(1):17–21.

    Article  CAS  PubMed  Google Scholar 

  10. Straus SE. The chronic mononucleosis syndrome. J Infect Dis. 1988;157(3):405–12.

    Article  CAS  PubMed  Google Scholar 

  11. Vento S, Cainelli F. Is there a role for viruses in triggering autoimmune hepatitis? Autoimmun Rev. 2004;3(1):61–9.

    Article  PubMed  Google Scholar 

  12. Drebber U, Kasper HU, Krupacz J, et al. The role of Epstein-Barr virus in acute and chronic hepatitis. J Hepatol. 2006;44(5):879–85.

    Article  CAS  PubMed  Google Scholar 

  13. Jabs WJ, Wagner HJ, Schlenke P, Kirchner H. The primary and memory immune response to Epstein-Barr virus infection in vitro is characterized by a divergent production of IL-1beta/IL-6 and IL-10. Scand J Immunol. 2000;52(3):304–8.

    Article  CAS  PubMed  Google Scholar 

  14. Suh N, Liapis H, Misdraji J, Brunt EM, Wang HL. Epstein-Barr virus hepatitis: diagnostic value of in situ hybridization, polymerase chain reaction, and immunohistochemistry on liver biopsy from immunocompetent patients. Am J Surg Pathol. 2007;31(9):1403–9.

    Article  PubMed  Google Scholar 

  15. Niedobitek G, Agathanggelou A, Steven N, Young LS. Epstein-Barr virus (EBV) in infectious mononucleosis: detection of the virus in tonsillar B lymphocytes but not in desquamated oropharyngeal epithelial cells. Mol Pathol. 2000;53(1):37–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Loddenkemper C, Longerich T, Hummel M, et al. Frequency and diagnostic patterns of lymphomas in liver biopsies with respect to the WHO classification. Virchows Arch. 2007;450(5):493–502.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Shi Y, Wang E. Hepatosplenic T-cell lymphoma: a clinicopathologic review with an emphasis on diagnostic differentiation from other T-cell/natural killer-cell neoplasms. Arch Pathol Lab Med. 2015;139(9):1173–80.

    Article  CAS  PubMed  Google Scholar 

  18. Kaplan D, Smith D, Meyerson H, Pecora N, Lewandowska K. CD5 expression by B lymphocytes and its regulation upon Epstein-Barr virus transformation. Proc Natl Acad Sci U S A. 2001;98(24):13850–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Castillo JJ, Beltran BE, Miranda RN, Paydas S, Winer ES, Butera JN. Epstein-barr virus-positive diffuse large B-cell lymphoma of the elderly: what we know so far. Oncologist. 2011;16(1):87–96.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Fugl A, Andersen CL. Epstein-Barr virus and its association with disease – a review of relevance to general practice. BMC Fam Pract. 2019;20(1):62.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Biemer JJ. Hepatic manifestations of lymphomas. Ann Clin Lab Sci. 1984;14(4):252–60.

    CAS  PubMed  Google Scholar 

  22. Yam LT, Janckila AJ, Chan CH, Li CY. Hepatic involvement in hairy cell leukemia. Cancer. 1983;51(8):1497–504.

    Article  CAS  PubMed  Google Scholar 

  23. Choi WT, Gill RM. Hepatic lymphoma diagnosis. Surg Pathol Clin. 2018;11(2):389–402.

    Article  PubMed  Google Scholar 

  24. Wotherspoon A, Attygalle A, Mendes LS. Bone marrow and splenic histology in hairy cell leukaemia. Best Pract Res Clin Haematol. 2015;28(4):200–7.

    Article  PubMed  Google Scholar 

  25. Kreitman RJ, Arons E. Update on hairy cell leukemia. Clin Adv Hematol Oncol. 2018;16(3):205–15.

    PubMed  PubMed Central  Google Scholar 

  26. Kaye K. Cytomegalovirus (CMV) infection. https://www.merckmanuals.com/home/infections/herpesvirus-infections/cytomegalovirus-cmv-infection. Accessed 27 May 2019.

  27. Eguchi H, Horita N, Ushio R, et al. Diagnostic test accuracy of antigenaemia assay for PCR-proven cytomegalovirus infection-systematic review and meta-analysis. Clin Microbiol Infect. 2017;23(12):907–15.

    Article  CAS  PubMed  Google Scholar 

  28. Weinberg A, Hodges TN, Li S, Cai G, Zamora MR. Comparison of PCR, antigenemia assay, and rapid blood culture for detection and prevention of cytomegalovirus disease after lung transplantation. J Clin Microbiol. 2000;38(2):768–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Kunno A, Abe M, Yamada M, Murakami K. Clinical and histological features of cytomegalovirus hepatitis in previously healthy adults. Liver. 1997;17(3):129–32.

    Article  CAS  PubMed  Google Scholar 

  30. Colina F, Juca NT, Moreno E, et al. Histological diagnosis of cytomegalovirus hepatitis in liver allografts. J Clin Pathol. 1995;48(4):351–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Weinberg JL, Kovarik CL. The WHO clinical staging system for HIV/AIDS. Virtual Mentor. 2010;12(3):202–6.

    PubMed  Google Scholar 

  32. Wilkins MJ, Lindley R, Dourakis SP, Goldin RD. Surgical pathology of the liver in HIV infection. Histopathology. 1991;18(5):459–64.

    Article  CAS  PubMed  Google Scholar 

  33. Garcia-Samaniego J, Soriano V, Castilla J, et al. Influence of hepatitis C virus genotypes and HIV infection on histological severity of chronic hepatitis C. The Hepatitis/HIV Spanish Study Group. Am J Gastroenterol. 1997;92(7):1130–4.

    CAS  PubMed  Google Scholar 

  34. Mohsen AH, Easterbrook PJ, Taylor C, et al. Impact of human immunodeficiency virus (HIV) infection on the progression of liver fibrosis in hepatitis C virus infected patients. Gut. 2003;52(7):1035–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Diaz LK, Murphy RL, Phair JP, Variakojis D. The AIDS autopsy spleen: a comparison of the pre-anti-retroviral and highly active anti-retroviral therapy eras. Mod Pathol. 2002;15(4):406–12.

    Article  PubMed  Google Scholar 

  36. Falk S, Muller H, Stutte HJ. The spleen in acquired immunodeficiency syndrome (AIDS). Pathol Res Pract. 1988;183(4):425–33.

    Article  CAS  PubMed  Google Scholar 

  37. Tangpukdee N, Duangdee C, Wilairatana P, Krudsood S. Malaria diagnosis: a brief review. Korean J Parasitol. 2009;47(2):93–102.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Viriyavejakul P, Khachonsaksumet V, Punsawad C. Liver changes in severe Plasmodium falciparum malaria: histopathology, apoptosis and nuclear factor kappa B expression. Malar J. 2014;13:106.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  39. Leoni S, Buonfrate D, Angheben A, Gobbi F, Bisoffi Z. The hyper-reactive malarial splenomegaly: a systematic review of the literature. Malar J. 2015;14:185.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Mothe B, Lopez-Contreras J, Torres OH, Munoz C, Domingo P, Gurgui M. A case of hyper-reactive malarial splenomegaly. The role of rapid antigen-detecting and PCR-based tests. Infection. 2008;36(2):167–9.

    Article  CAS  PubMed  Google Scholar 

  41. SM AE, El-Rayah el A, Giha HA. Validation of PCR for detection and characterization of parasitaemia in massive splenomegaly attributed clinically to malaria infection. Diagn Microbiol Infect Dis. 2011;70(2):207–12.

    Article  CAS  Google Scholar 

  42. George MR. Hemophagocytic lymphohistiocytosis: review of etiologies and management. J Blood Med. 2014;5:69–86.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Chen JH, Fleming MD, Pinkus GS, et al. Pathology of the liver in familial hemophagocytic lymphohistiocytosis. Am J Surg Pathol. 2010;34(6):852–67.

    Article  PubMed  Google Scholar 

  44. Kauffman CA. Histoplasmosis: a clinical and laboratory update. Clin Microbiol Rev. 2007;20(1):115–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Lee DG, Choi JH, Kim YJ, et al. Hepatosplenic tuberculosis mimicking disseminated candidiasis in patients with acute leukemia. Int J Hematol. 2001;73(1):119–21.

    Article  CAS  PubMed  Google Scholar 

  46. Gupta PP, Fotedar S, Agarwal D, Sansanwal P. Tuberculosis of spleen presenting with pyrexia of unknown origin in a non-immunocompromised woman. Lung India. 2008;25(1):22–4.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Everett J, Srivastava A, Misdraji J. Fibrin ring granulomas in checkpoint inhibitor-induced hepatitis. Am J Surg Pathol. 2017;41(1):134–7.

    Article  PubMed  Google Scholar 

  48. Marazuela M, Moreno A, Yebra M, Cerezo E, Gomez-Gesto C, Vargas JA. Hepatic fibrin-ring granulomas: a clinicopathologic study of 23 patients. Hum Pathol. 1991;22(6):607–13.

    Article  CAS  PubMed  Google Scholar 

  49. Pedrosa I, Saiz A, Arrazola J, Ferreiros J, Pedrosa CS. Hydatid disease: radiologic and pathologic features and complications. Radiographics. 2000;20(3):795–817.

    Article  CAS  PubMed  Google Scholar 

  50. Goodman ZD, Ishak KG. Histopathology of hepatitis C virus infection. Semin Liver Dis. 1995;15(1):70–81.

    Article  CAS  PubMed  Google Scholar 

  51. Tucci FA, Broering R, Lutterbeck M, Schlaak JF, Kuppers R. Intrahepatic B-cell follicles of chronically hepatitis C virus-infected individuals lack signs of an ectopic germinal center reaction. Eur J Immunol. 2014;44(6):1842–50.

    Article  CAS  PubMed  Google Scholar 

  52. Vardhanabhuti V, Venkatanarasimha N, Bhatnagar G, et al. Extra-pulmonary manifestations of sarcoidosis. Clin Radiol. 2012;67(3):263–76.

    Article  CAS  PubMed  Google Scholar 

  53. Lv A, Liu W, Qian HG, Leng JH, Hao CY. Reactive lymphoid hyperplasia of the liver mimicking hepatocellular carcinoma: incidental finding of two cases. Int J Clin Exp Pathol. 2015;8(5):5863–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  54. Fan N, Lavu S, Hanson CA, Tefferi A. Extramedullary hematopoiesis in the absence of myeloproliferative neoplasm: Mayo Clinic case series of 309 patients. Blood Cancer J. 2018;8(12):119.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Tefferi A. Primary myelofibrosis: 2019 update on diagnosis, risk-stratification and management. Am J Hematol. 2018;93(12):1551–60.

    Article  PubMed  Google Scholar 

  56. Kim CH. Homeostatic and pathogenic extramedullary hematopoiesis. J Blood Med. 2010;1:13–9.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Chopra R, Al-Mulhim AR, Al-Baharani AT. Fibrocongestive splenomegaly in sickle cell disease: a distinct clinicopathological entity in the Eastern province of Saudi Arabia. Am J Hematol. 2005;79(3):180–6.

    Article  PubMed  Google Scholar 

  58. Selcuk D, Demirel K, Kantarci F, Mihmanli I, Ogut G. Gamna-Gandy bodies: a sign of portal hypertension. Turk J Gastroenterol. 2005;16(3):150–2.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Andrew G. Evans .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Gonzalez, R.S., Evans, A.G. (2020). Infectious and Inflammatory Mimickers of Hematopoietic Disorders in the Liver and Spleen. In: Zhang, L., Shao, H., Alkan, S. (eds) Diagnostic Pathology of Hematopoietic Disorders of Spleen and Liver. Springer, Cham. https://doi.org/10.1007/978-3-030-37708-3_21

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-37708-3_21

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-37707-6

  • Online ISBN: 978-3-030-37708-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics