The degree of involvement of spleen in CLL/SLL is variable. Some patients develop symptomatic splenomegaly. In the case shown here, the patient presented with severe discomfort and abdominal fullness that worsened after a meal. Physical examination showed massive nontender splenomegaly. This low magnification photomicrograph shows nodular expansion of white pulp which grossly corresponds to small whitish nodules scattered throughout the spleen. The red pulp is congested.