• Differential diagnoses / indications: traumatic laceration, incidental to other procedures (e.g., distal pancreatectomy) hypersplenism, and rarely staging of lymphoreticular neoplasms.
• Measure (three dimensions) and weigh the specimen, including accessory spleens and lymph nodes, if present.
• Examine the external surface for capsular defects or lacerations, especially at the hilum, and measure their length and depth.
• Determine the need for special studies or procedures:
• Microbiologic culture: If infection suspected clinically, using sterile technique, take tissue from the interior (previously-unsectioned part) of a suspicious area, if possible, and submitted for bacterial culture.
• Lymphoma work-up:  to be performed if leukemia or lymphoma is suspected clinically, following frozen section, or on gross examination.  See Lymphoma Work-Up.
• Sickle cell disease:  as soon as the specimen is received, cut a block of tissue and place it in formalin.
• Serially section the spleen across the short axis in the unfixed (or minimally fixed) state, at 1.0 cm intervals if removed incidentally or for trauma and at 0.5 cm intervals if removed for disease.  Examine the cut surface for nodules, fibrosis, infarcts, and other lesions and measure these, where appropriate.  Describe the overall cut surface (color, consistency).  Palpate each slice individually for nodules if lymphoma is suspected clinically.
• Take photographs, if indicated.

• Non-diseased spleen (i.e. incidental or traumatic):  two (if incidental) to three (if traumatic) sections.  Including capsule in all sections.  Include capsular lacerations in two blocks, if present.
• Spleen for lymphoma work-up:  sample all nodules, up to ten sections, regardless of small size.  Include hilum in one section and capsule in two sections.  Request thin H&E sections (3 µm-thick).
• Spleen with other disease:  at least five sections.  Include lesions in multiple sections, hilum in one section, and capsule in at least two sections.
• Accessory spleens:  one to two sections per accessory spleen, depending on size, if present.
• Lymph nodes:  entirely submit.  There is no need to submit hilar adipose tissue or vessels if lymph nodes are not identified.

Internal use only

Received without fixative/in formalin, labeled _____ and “_____”, is a __ g, __ x __ x __ cm spleen.  The capsule is _____ (color, texture, thickened, adhesion-covered) and has a __ cm laceration with surrounding hemorrhage not/extending to the hilum which continues into the splenic parenchyma for a depth of __ cm.  There is a __ g, __ x __ x __ cm accessory spleen in the hilum.  It has a _____ capsule and a _____ cut surface.  A __ x __ x __ cm lymph node with a _____ cut surface is also in the hilum.  The splenic cut surface is _____ (color, consistency, fibrosis), with __ (number)/multiple _____ (color, consistency, necrosis) nodules/peripheral infarcts, ranging from __ to __ cm in diameter.  Touch preps are prepared.  Photographs are taken.  Tissue is submitted for microbiologic culture/flow cytometry/gene rearrangement studies.  Representatively submitted as follows:

#__ - #__  = capsular laceration

#__ - #__  = nodules

#__ = accessory spleen

#__ = one lymph node, bisected

__ blocks, __ H&E, __ touch preps (__ Diff-Quik, __ H&E)