https://doi.org/10.53453/ms.2024.9.8
Spleen weight variation in population of Lithuania – a
retrospective study and literature review
Goda Klapatauskaitė
1
, Gabrielė Lisauskaitė
1
, Sigitas Chmieliauskas
2
, Sigitas Laima
2
, Diana Vasiljevaitė
2
,
Jurgita Stasiūnienė
2
1
Faculty of Medicine, Vilnius University, Vilnius, Lithuania
2
Department of Pathology, Forensic Medicine, Institute of Biomedical Sciences of the Faculty of Medicine of
Vilnius University, Vilnius, Lithuania
Abstract
Background. The weight of organs is often used to determine whether a pathological condition is present. Spleen
weight can vary and correlate with anthropometric indicators and an individual's gender, with the spleen being
larger in men compared to women and in heavier individuals. The correlation between age and spleen weight is
significant as it aids in understanding age-related changes in spleen function and pathology.
The aim of this article is to analyze statistical data and literature on splenic hypertrophy and to find out if there is
a correlation between age and spleen weight based on an autopsy study and to discuss three cases of splenic
hypertrophy.
Materials and methods: This research was designed as a retrospective study. The study sample consisted of 371
autopsy cases from 2016 to 2023.
Results. In the entire sample, the average weight of the spleen was 149.7 g. The average spleen weight of men
was not significantly different from the average spleen weight of women. There was a statistically significant but
weak correlation between the spleen weight and height of the deceased. A weak negative correlation was found
between spleen weight and the age of the deceased.
Conclusions. As the weight of the spleen can vary between age groups, it is important to know the normal
parameters of this to suspect and correctly diagnose pathology. If a larger than normal spleen is detected, it is
worth assessing whether the patient has any comorbidities and accompanying significant pathology.
Keywords: spleen, splenomegaly, autopsy, pathology, forensic medicine.
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Medical Sciences 2024 Vol. 12 (4), p. 62-70, https://doi.org/10.53453/ms.2024.9.8
62
1. Introduction
Organ weights are commonly used to assess the
presence of pathological conditions. Nonetheless,
there is a dearth of precise definitions of aberrant
organ weights in the medical literature. A large brain
could be a sign of cerebral edema, while a large
spleen might be a sign of a possible hematologic
cancer. It has been suggested that normal organ
weights should only be evaluated in a population of
healthy individuals who passed away unexpectedly
from traumatic causes to be sufficiently and properly
determined (1). With these limitations in mind, we
conducted a study analyzing cases of sudden death,
excluding those with medical pathology. The
correlation between age and spleen weight is
significant as it aids in understanding age-related
changes in spleen function and pathology. The aim
of this article is to analyze statistical data and the
literature on splenic hypertrophy in different age
groups and find out if there is a correlation between
age and spleen weight via autopsy study. This article
will also examine the differences and discuss three
spleen hypertrophy cases.
The spleen is a coffee-bean-shaped, dark-purplish,
highly vascular organ of mesodermal origin that is
located between the left kidney, the diaphragm, the
fundus of the stomach, and the splenic flexure of the
colon at the level of the eighth to eleventh ribs in the
left upper quadrant of the abdomen (2). The typical
weight range of the spleen for an adult is from 70
grams to 200 grams. Enlargement is defined as a
spleen greater than 12 cm in length or over 400
grams in weight. Massive splenomegaly refers to
even greater enlargement, with a spleen size larger
than 20 cm in length or over 1 kg in weight (3). The
size and weight of the spleen may vary and correlate
with anthropometric indicators and sex of an
individual, with larger spleen sizes seen in men
compared to women and in heavier or taller
individuals. Also, spleen parameters can vary
depending on race, genetic factors, and disease
(4,5,6).
2. Materials and methods
This research was designed as a retrospective
study. The study sample consisted of 371 autopsy
cases from 2016 to 2023. The State Forensic
Medicine Service (Lithuania) provided the autopsy
data for 371 cases. In every case, information was
provided by the law enforcement agencies,
including the possible crime location, time of death,
and presumed death mechanism. The study data
were analyzed by dividing all subjects into nine age
groups at ten-year intervals. Spleen weights were
assessed for all sudden deaths in all age groups
during the specified period. The spleen was
separated from the organ complex at autopsy and
weighed and measured for each of the deceased. The
exclusion criterion was the presence of advanced
putrefaction - autolysis. Such cases were excluded
from the sample.
The collected data was processed using R software.
The Shapiro-Wilk test was used to determine
whether the data was normally distributed. The
Student’s t-test was used to assess the statistical
significance of differences in continuous variables
between the study groups. Spearman’s correlation
coefficients were assessed. A weak correlation was
defined as R-values < 0.39; a moderate correlation
with R-values from 0.40 to 0.69; and a strong
correlation with R-values > 0.70. Additionally, 95%
confidence intervals were calculated. Differences
with p values less than 0.05 were considered
significant.
In all cases, the deceased were subjected to full
autopsies with tests for ethyl alcohol and its
surrogates, as well as toxicological tests for the
detection of drugs and other potent substances in the
blood and urine.
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Histological sections were cut and prepared for
routine light microscopy. Histomorphological
features of the sample were examined using
hematoxylin and eosin (H&E) staining. Perls’
Prussian blue reaction was used to detect ferric iron,
and Masson's trichrome staining was used for
collagen fibers. The H&E staining process consists
of several stages: the removal of paraffin, staining,
and dehydration. Sections are deparaffinated by
keeping them sequentially in absolute alcohol, 96%
and 70% ethanol, and distilled water for a certain
time. After that, specimens are stained with a
hematoxylin solution and then continuously
irrigated with flowing water. Afterward, an eosin-
floxin solution is applied. Finally, specimens are
quickly sequentially dehydrated in 70%, 90%, and
absolute alcohol and enclosed with covering
material. The nucleus and other DNA/RNA-
containing structures are dyed blue-violet, whereas
the cytoplasm and matrix have different pink tints.
3. Results
Of the 371 individuals in the sample (278 male and
93 female), the mean age with standard deviation
was 57±17.01 years. The mean age of male in the
whole sample was 55.31±15.02 years, and that was
statistically significantly different from the mean
age of female 62.09±21.19 years (two-sample t-
test), p = 0.005. The youngest was 1 year old, and
the oldest was 97 years old.
In the entire sample (n = 371), the mean weight of
the spleen was 149.7 g, the median was 125.0 g, the
lowest weight was 2.5 g (1-year-old child) and the
highest weight was 545 g (Fig. 1). The mean spleen
weight of male (151.45±83.94 g) was not
statistically significantly different from the mean
spleen weight of female (144.52±85.26 g) (Two
Sample t-test, p = 0.49).
Fig. 1. The mean spleen weight of the different age groups
Based on the literature, liver and spleen weights
correlate with height. Thus, we assessed the height
of the deceased in the sample, which differed
significantly. Of the entire male sample, the mean
height of 175±12 cm was statistically significantly
different from the female mean height of 160±17 cm
(Two Sample t-test, p < 0.05). Meanwhile, the mean
height of the entire sample was 171 cm, the median
was 173 cm, the lowest height was 48 cm, and the
highest height was 198 cm. Spearman’s correlation
coefficient was calculated to see how spleen weight
correlates with the height of the deceased. There was
a statistically significant but weak correlation
between the spleen weight and height of the
deceased (r = 0.2; p < 0.05).
Also, Spearman’s correlation coefficient was
calculated to see how spleen weight correlates with
the age of the deceased. A weak negative correlation
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64
was found between spleen weight and the age of the
deceased (r = -0.14; p = 0.007). This indicates a
trend towards lower spleen weight with increasing
age (Table 1).
Male (n=278)
Female (n=93)
p
Mean age
55.31±15.02
62.09±21.19
p < 0.05
Mean height of individuals (cm)
175±12
160±17
p < 0.05
Mean weight of spleen (g)
151.45±83.94
144.52±85.26
p > 0.05
Table. 1 The spleen weight of male and female
The spleen weight of the age group 1–10 years was
statistically significantly different from the spleen
weight of all other age groups (Paired t-test, p
< 0.05).
The spleen weight of the group’s 11–20 years old,
21–30 years old, and 31–40 years old differed
significantly from the spleen weight of the 71–80
years old and >81 years old age groups (p < 0.05).
There was a significant difference in the spleen
weight in the groups of 41–50 years old and 51–60
years old deceased comparing with a group of >81
years old (p = 0.02).
The spleen weight of the age group 71–80 years
differed insignificantly from the age group >81
years (p = 0.08) (Table 2).
Age
groups
Mean weight of spleen (g)
n
1–10
36.58 ± 28.75
6
11–20
182.50 ± 27.23
4
21–30
187.69 ± 83.56
13
31–40
202.23 ± 113.68
31
41–50
158.45 ± 99.29
66
51–60
152.99 ± 74.11
85
61–70
132.91 ± 68.04
91
71–80
148.44 ± 82.99
50
>81
116.20 ± 43.26
25
Table 2. The mean spleen weight of the age group
During the toxicological testing in 166 cases out of
371, ethyl alcohol was detected in the blood. The
mean age of the alcohol users was 54.3±13.4 years,
while the mean age of the control group (no alcohol
detected) was 59.56±20.11 years. The mean age was
statistically significantly different in these groups (p
= 0.005). A mean concentration with a standard
deviation of 1.86±1.21 promille (‰). The mean
concentration of ethyl alcohol in the blood of male
(1.89±1.23 promille) was not statistically
significantly different from the mean concentration
in the blood of female (1.70±1.12 promille), (p =
0.43). The groups of alcohol users were compared
with the corresponding groups of non-drinkers. Each
age group was compared separately. No statistically
significant difference in spleen weight was observed
in all groups (p > 0.05). The weight of the spleen in
the group where ethyl alcohol was found did not
show a statistically significant difference between
the group in which ethyl alcohol was not found (p =
0.34).
3.1 Clinical Cases
3.1.1 Case 1
A forensic autopsy of a 69-year-old male of medium
build, 174 cm tall was conducted. He was found
suddenly dead at home. An external examination
revealed no mechanical injuries of the body. The
autopsy revealed marked atherosclerotic lesions to
the cardiovascular system with arterial stenosis of
more than 75% and ischemic changes in myocardial.
Fatty liver, esophageal mucosal erosions and
pancreatic fibrosis have been observed. Hypertrophy
of the spleen was documented. The measures of the
spleen were 29x19x8 cm and the weight was 2410 g
(Fig. 2). In the incision the spleen was dark red-
purple and histologically showed perivascular
fibrosis, sclerotic foci and focal fibrosis in the
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capsule of the spleen. Toxicological tests did not
reveal the presence of toxic substances or ethyl
alcohol.
The cause of death was ischemic heart disease.
Splenic hypertrophy was found incidentally as a
concomitant pathology. The cause of splenomegaly
while the person was alive has not been identified.
Fig. 2. Macroscopic view of the spleen hypertrophy
3.1.2 Case 2
A corpse of a 76 year-old female, 167 cm tall, with
a medium build, was examined. She died as a result
of multiple pelvic fractures during a fall, leading to
complications such as pulmonary embolism,
pneumonia and sepsis. An external examination
showed injuries on the pelvic area. During the
autopsy, multiple pelvic fractures, atherosclerotic
lesions of the cardiovascular system with arterial
stenosis of more than 75%, and a scar from
myocardial infarction was established. Bilateral
pneumonia, fatty liver, esophageal erosions,
pancreatic fibrosis and severe renal sclerosis were
also observed. Splenic hypertrophy was found (Fig.
3). The measures of the spleen were 32x19x8 cm and
the weight was 2660 g (Fig. 4). The spleen was dark
red-purple in the incision. Histologically, the spleen
was full-blooded and hyperplastic. Clinically
determined polycythemia and thrombocytosis.
Toxicological tests did not reveal the presence of
toxic substances or ethyl alcohol.
The cause of death was trauma and splenic
hypertrophy was found as an incidental finding. The
cause of splenomegaly remains unknown.
Fig. 3. Macroscopic view of the spleen hypertrophy
- visceral surface
Fig. 4. Macroscopic view of the spleen hypertrophy
- diaphragm surface.
3.1.3 Case 3
An autopsy of a 57 year-old male, 171 cm tall, with
a hypersthenic build was performed. He was found
suddenly dead at home. An external examination
revealed no mechanical injuries on the body. The
autopsy revealed a heart weighing 915 g,
hypertrophy of the heart muscle, marked
atherosclerotic lesions of the cardiovascular system
with arterial stenosis of more than 95%, up to a
punctate radius, ischemic changes in the
myocardium and a wide myocardial infarction scar
of 12x10x1.8 cm in the anterior wall of the left
ventricle extending into the septum. It also revealed
fatty liver, esophageal erosions, pancreatic fibrosis,
renal sclerosis and splenic hypertrophy. The
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measure of the spleen was 20x12x7 cm and the
weight was 875 g. Histologically, the spleen was
full-blooded and capsule fibrosis was found.
Clinical findings included primary arterial
hypertension, arterial hypertension, left ventricular
hypertrophy, hypertrophic cardiomyopathy, heart
failure and type 2 diabetes mellitus.
Toxicological tests did not reveal the presence of
toxic substances or ethyl alcohol.
The cause of death was ischemic heart disease.
Splenic hypertrophy was found incidentally as a
concomitant pathology. The cause of splenomegaly
while the person was alive has not been identified.
4. Discussion and literature review
In literature, much attention is paid to the correlation
between spleen size and anthropometric data. Height
is one of the most important factors determining the
size of an individual's spleen. A larger height is
associated with a larger spleen (6–9, 12, 13, 15, 17).
Our study also showed a statistically significant but
weak correlation.
The size of the spleen can also be affected by various
diseases: cardiovascular, hepatic, hematological,
oncological, infectious, metabolic and storage
diseases, diabetes melitus and traumas (3, 4, 6, 7, 10,
16). This is also illustrated by the exceptional cases
we have described in which splenic hypertrophy was
found as an incidental finding in deceased patients
suffering from various diseases mentioned in the
literature. Although the cause of the splenic
enlargement remained unknown, all three patients
had significant medical conditions that could have
contributed to the splenic hypertrophy. It is
important to pay attention to the enlargement of the
spleen because of possible connections with serious
pathologies (18,19). When the spleen crosses the
midline, reaches the iliac crest, or weighs more than
1500 g, it is classified as large splenomegaly by most
writers. While splenomegaly is a common
observation in many disorders, only a few conditions
result in severe enlargement of the spleen. For
significant splenomegaly, a bone marrow biopsy and
flow cytometry are the suggested tests (20). The
spleen may grow dramatically as a result of
melanoma metastases. A spleenectomy is
recommended to stop the spleen from rupturing on
its own if the patient's overall health is good (21).
The negative correlation of spleen weight with age
obtained in our study is also described in the
literature. This means that the spleen decreases as a
person ages (9, 15, 16,). However, until a certain
age, the spleen, like other internal organs, tends to
increase. It has to do with the individual's own
growth. Studies in children and adolescents have
described spleen growth (4–8, 11, 12, 14). The most
significant changes in spleen size were observed in
children aged 0–3 years and 4–10 years (6, 11, 14).
Our research showed similar results. There was a
significant difference in spleen weight (lowest
weight) in the 1–10 years age group compared to all
other groups. There was also an increase in spleen
weight in the adolescent group.
In studies that did not only include children, the
results showed that the spleen still enlarges in adults
to certain age. From age 20 to age 39, the spleen was
enlarging (15). In one study, the highest spleen
weight was reported in the 36–45 age group and the
lowest in the 66–75 age group (9). Another study
distinguished between the sexes: men had the largest
spleen at 39 years and women at 44 years (11). The
results are presented slightly differently, but the ages
in the two studies do not contradict each other. Our
study showed that spleen weight was lower in the
age groups 41–50 years and older. These results
confirm what has been described in the literature.
Spleen length was greater at 31–40 years compared
to younger and older age groups. Width was greater
in the 31–40 age group than in the older age groups.
Thickness changes were also more pronounced in
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the 31–40 age group than in the older age groups,
and more pronounced in the 11–20 age group than
in the >50 age group. Changes in spleen volume
were greater in the 21–30 age group than in the >50
age group, and more pronounced in the 31–40 age
group than in the 41–50 age group (19). We have
only assessed the weight of the spleen among all the
spleen parameters, so we cannot confidently
compare our results with those described in this
study, which assessed other spleen parameters
(length, width, volume and thickness). Nevertheless,
we can assume that the results for weight would have
been similar to those we obtained in our study.
Publications describing post-mortem studies have
found that spleen weight correlates poorly with a
person's height, body weight and BMI. In men, there
was no significant difference in spleen weight
between underweight, normal weight and
overweight groups; a significant difference between
normal weight deceased and obese (22). In the
women's group, the results were slightly different.
There was a weak correlation between height,
weight and BMI; no difference between normal
weight, overweight and obesity; the spleen is lighter
in underweight (23). Another study, which did not
differentiate between groups in terms of the weight
of the deceased, generally found that in both men
and women, a higher weight of internal organs was
associated with a higher body weight. However, it is
recommended that normal viscera sizes are based on
sex (24). A significant positive correlation between
spleen weight and BMI of the deceased was
observed in the Malay, Chinese and Indian
populations, but only in men (25). Post-mortem
studies have further shown that blood loss leads to a
lower spleen weight in men, while congestion of
internal organs leads to an increase in spleen weight.
This was observed in a group of men (22). In
women, the differences are not significant (23).
In the field of forensic pathology, organ weight is
typically used as a determinant of disease processes
or pathologic states. However, the ability to predict
organ weights is important in medical fields that rely
on that data to evaluate the effects of radiation
exposure or to determine radiation doses for
therapeutic purposes (22). As bleeding and visceral
overload affect spleen weight in the literature
analysed (22, 23) and our study has shown that
differences in spleen weight are also observed in
different age groups, it is important to know the
limits of the normal range in order to make it easier
for clinicians to assess the presence of a pathology,
and also to serve as one of the criteria to be used by
forensic doctors when they suspect haemorrhage.
5. Conclusions
A negative weak statistically reliable correlation was
obtained when spleen weight was compared with the
age of the deceased. The spleen weight of the age
group 1–10 years was statistically significantly
different from the spleen weight of all other age
groups.
As the weight of the spleen can vary between age
groups, it is important to know the normal
parameters of this organ in order to suspect and
correctly diagnose pathology. If a larger than normal
spleen is detected, it is worth assessing whether the
patient has any comorbidities or accompanying
significant pathology.
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