A 65-Year-Old Man Comes to the Physician Because of Several-Month

A 65-year-old man comes to the physician because of several-month history of progressive fatigue and abdominal pain. The patient has not seen a physician for many years. He does not use tobacco, alcohol, or illicit drugs. Physical examination shows pale mucous membranes and splenomegaly. Hemoglobin concentration is 9.1 g/dL and leukocyte count is 3,400/mm3. Peripheral blood smear shows nucleated red blood cells and teardrop poikilocytosis. Bone marrow aspiration is attempted but yields no marrow.  Which of the following histopathological features is most likely to be present in this patient's spleen?

A) Accumulation of macrophages with fibrillary cytoplasm
B) Diffuse neutrophilic infiltration and follicular necrosis
C) Dilated sinusoids and fibrous nodules with hemosiderin
D) Large islands of hematopoietic progenitor cells
E) Numerous noncaseating epithelioid granulomas

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