At autopsy, the spleen of a patient is noted to have a thickened capsule and many small, scarred areas. Microscopic examination of the scarred areas reveals fibrosis with hemosiderin and calcium deposition. This type of spleen is usually seen in conjunction with which of the following disorders?
The spleen shows the changes of chronic congestive splenomegaly, typically associated with hepatic cirrhosis. The described small scars are called Gandy-Gamma nodules which are due to the result of organization of old hemorrhages.

Hodgkin’s disease (choice B) produces large splenic nodules in which Reed-Sternberg cells can be found surrounded by mature lymphocytes, eosinophils, and neutrophils.
Rheumatoid arthritis (choice C) and many other chronic inflammatory disorders induce reactive hyperplasia of the spleen with formation of many large germinal centers in the splenic follicles.
Sickle cell anemia (choice D) produces many small (often triangularly shaped) infarctions in the spleen.
Hepatic cirrhosis
Hodgkin’s disease
Rheumatoid arthritis
Sickle cell anemia