A 44-year-old woman with a long history of chronic urticaria and chronic hepatitis B virus infection presented with vague epigastric pain of 1 month’s duration. She had been diagnosed as having asymptomatic splenomegaly during annual ultrasonographic follow-up 2 years earlier. Five years before presentation, she had undergone a hysterectomy for uterine leiomyomata. She had not experienced weight loss, fever, or night sweats. The physical examination and laboratory investigation results were unremarkable. Computed tomography of the abdomen disclosed multiple hypodense lesions in the spleen (Figure 1). A splenectomy was performed. Grossly, the spleen weighed 160 g, measured 12 × 8 × 3 cm, and had a nodular surface. Cut sections showed a spongy appearance and multiple tan, cystic lesions throughout the splenic parenchyma that ranged in size from 0.5 to 1.5 cm. The intervening splenic parenchyma was unremarkable. A photomicrograph of the splenic lesions is shown in Figure 2.
Computed tomographic scan of the abdomen with 2-dimensional reconstruction demonstrating multiple hypoattenuating masses of various sizes throughout an enlarged spleen.
Photomicrograph showing anastomosing vascular channels with irregular lumina and papillary projections. The vascular spaces are lined with plump endothelial cells that have vesicular nuclei and clear to eosinophilic cytoplasm, some of which have sloughed into the lumen (hematoxylin-eosin, original magnification ×200).
B. Littoral cell angioma
C. Splenic metastases
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
Thank you for submitting a comment on this article. It will be reviewed by JAMA Surgery editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 3
Customize your page view by dragging & repositioning the boxes below.
The Rational Clinical Examination
1. Weight Loss in the 6 Months Before the Examination, Expressed as a Proportionate Loss From Previous Weight
All results at
and access these and other features:
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.