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An autopsy case of severe thrombocytosis associated with cancer of gallbladder is described as the first case in the literature. A 78-year-old male patient was admitted to the hospital with abnormal hepatic functions on August 6, 1975. Laboratory examination revealed platelet count of 5,664,000/cu mm, anemia, leukocytosis and bilirubinemia. Jaundice was progressive and the patient died after a month. Severe thrombocytosis persisted throughout the course. Main autopsy findings were cancer of gallbladder with metastasis to the liver, fibrosis of spleen and purulent bronchopneumonia. A possible mechanism of unusually severe degree of thrombocytosis associated with the present case is discussed in light of the literature.

On the occasion of 34 spleen scintigrams performed in children with sickle cell anemia, the frequency and precocity of the "functional asplenia" is emphasized and its relationship with the infectious history of such children is discussed. The anti-bacterial role of the spleen and the responsibility, at least partial, or asplenia in the susceptibility of patients with sickle cell anemia to infections, especially pneumococcal ones, are reviewed. The pathophysiologic mechanism of functional asplenia is then discussed. The author concludes that asplenia has no predictive value in selecting children "at risk" for infection and stresses the necessity of a systematic prevention by penicillin therapy and antipneumococcal vaccination in such patients before 4 years of age.

A 47-yr-old man with malignant mastocytosis, a malignant neoplasia of mast cells, presented with anemia. Ultrasonography revealed an enlarged spleen. A liver-spleen scan using [99mTc]sulfur colloid failed to show any splenic uptake consistent with the diagnosis of functional asplenia. Functional asplenia related to this condition has not been reported previously. Since the spleen was heavily infiltrated with space occupying mast cells, a mass displacing effect along with impaired perfusion are discussed as underlying mechanism.

Infective endocarditis is the most common condition predisposing a patient to splenic abscess, and the conditions of 37 such patients are reviewed herein. Streptococci accounted for 18 abscesses, with six containing enterococci; 12 other contained staphylococci. Symptoms suggesting splenic abscess include abdominal distention, hiccups, and pain in the left flank, abdomen, and shoulder. Physical signs include recurrent or persistent fever and abdominal tenderness, with splenomegaly often inapparent. The most frequent finding on x-ray film is pleural effusion on the left side. Seventeen patients not undergoing splenectomy died; in these, the diagnosis of splenic abscess was established postmortem. Twenty patients underwent splenectomy, 19 of whom received antibiotics and survived; one patient who was not treated with antibiotics died. Physicians should suspect splenic abscess in patients with endocarditis, particularly those with staphylococcal or enterococcal endocarditis. Those patients with clinical evidence suggestive of splenic abscess should undergo specific diagnostic studies, and exploratory laparotomy may be necessary.