Difference between revisions of "Lymph node pathology"

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m (→‎Cat-scratch disease: replace ',' with '.')
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*Associated with Hodgkin's lymphoma - non-classic type (nodular lymphocyte predominant Hodgkin's lymphoma).
*Associated with Hodgkin's lymphoma - non-classic type (nodular lymphocyte predominant Hodgkin's lymphoma).


===Micrograph===
===Microscopic===
Features:
Features:
*Large germinal centers - focally.
*Large germinal centers - focally.
**No mass lesions.
**No mass lesions.
==Reactive follicular hyperplasia==
===General===
*Many causes - including: bacteria, viruses, chemicals, drugs, allergens.
**In only approximately 10% can definitive cause be identified.<ref name=Ref_ILNP174>{{Ref_ILNP|174}}</ref>
===Microscopic===
Features:<ref name=Ref_ILNP174>{{Ref_ILNP|174}}</ref>
*Follicles of variable size, large follicles - '''key feature'''.
**Centroblast 3-4x resting lymphocytes.
Image: [http://pleiad.umdnj.edu/hemepath/normal_node/normal_node.html Normal lymph node (umdnj.edu)].


==Kikuchi disease==
==Kikuchi disease==

Revision as of 14:18, 3 August 2010

This article deals with lymph node pathology. An introduction to the lymph node is in the lymph nodes article.

Progressive transformation of germinal centers

General

  • Abbreviated as PTGC.
  • Benign.
  • Classically in younger patients.
  • Associated with Hodgkin's lymphoma - non-classic type (nodular lymphocyte predominant Hodgkin's lymphoma).

Microscopic

Features:

  • Large germinal centers - focally.
    • No mass lesions.

Reactive follicular hyperplasia

General

  • Many causes - including: bacteria, viruses, chemicals, drugs, allergens.
    • In only approximately 10% can definitive cause be identified.[1]

Microscopic

Features:[1]

  • Follicles of variable size, large follicles - key feature.
    • Centroblast 3-4x resting lymphocytes.

Image: Normal lymph node (umdnj.edu).

Kikuchi disease

General

  • AKA histiocytic necrotising lymphadenitis (HNL),[2] and Kikuchi-Fujimoto disease.
  • Rare disease that may mimic cancer, esp. lymphoma.
    • May cause fever & systemic symptoms.[3]

Epidemiology:[3]

  • Usually <40 years old.
  • Asian.
  • Female:Male = 3:1.[4]

Treatment:

  • Usually self-limited.[3]
  • Oral corticosteroids.

DDx:

  • Non-Hodgkin lymphoma.
  • Systemic lupus erythematosus.

Micrograph

Features (the three main features - just as the name suggests):[5]

  • Histiocytes.
    • May be crescentic.
  • Necrosis (due to apoptosis) - paracortical areas.[3]
    • Necrosis without neutrophils - key feature.
  • Lymphocytes (CD8 +ve).
  • Plasmacytoid dendritic cells.


Notes:

  • Dendritic cell - vaguely resembles a macrophage:[6]
    • Long membrane projections - key feature.
    • Abundant blue-grey cytoplasm, +/- ground-glass appearance.
    • Nucleus: small, ovoid, usu. single nucleolous.

Images:

IHC

  • CD68 +ve.
  • CD8 +ve.
  • CD4, CD20, CD3, and CD30 - mixed.
    • Done to excluded lymphoma; should show a mixed population of lymphocytes.

Castleman disease

General

  • AKA angiofollicular lymph node hyperplasia, giant lymph node hyperplasia.[7]
  • Benign.
  • Abbreviated CD.

Classification

CD is grouped by location/involvment:

  • Hyaline vascular variant.
    • Usually unicentric.
    • Typically mediastinal or axial.
  • Plasma cell variant.
    • Usually multicentric.
    • Abundant plasma cells.
    • Associated with HHV-8 infection (the same virus implicated in Kaposi's sarcoma).

Discussed here: [8]

Microscopic

Features:[9]

  • Pale concentric (expanded) mantle zone lymphocytes.
    • "Regressed follicle". (???)
  • "Lollipops" - germinal centers fed by prominent vessels; lollipop-like appearance.
  • Two germinal centers in one follicle.

Cat-scratch disease

General

  • AKA Cat-scratch fever.
  • Infection caused by spirochete Bartonella henselae.[10]
  • Treatment: antibiotics.

Micrograph

Features:

  • Palisading granulomas with neutrophils in the center.

Stains:

  • Warthin-Starry stain.

Image(s):

Dermatopathic lymphadenopathy

General

  • Lymphadenopathy associated with a skin lesion. (???)
  • May be benign of malignant (e.g. T-cell lymphoma).

Microscopic

  • May see melanin pigment. (???)

See also

References

  1. ↑ 1.0 1.1 Ioachim, Harry L; Medeiros, L. Jeffrey (2008). Ioachim's Lymph Node Pathology (4th ed.). Lippincott Williams & Wilkins. pp. 174. ISBN 978-0781775960.
  2. ↑ Kaushik V, Malik TH, Bishop PW, Jones PH (June 2004). "Histiocytic necrotising lymphadenitis (Kikuchi's disease): a rare cause of cervical lymphadenopathy". Surgeon 2 (3): 179–82. PMID 15570824.
  3. ↑ 3.0 3.1 3.2 3.3 Hutchinson CB, Wang E (February 2010). "Kikuchi-Fujimoto disease". Arch. Pathol. Lab. Med. 134 (2): 289–93. PMID 20121621.
  4. ↑ URL: http://emedicine.medscape.com/article/210752-overview. Accessed on: 3 June 2010.
  5. ↑ URL: http://www.ispub.com/journal/the_internet_journal_of_head_and_neck_surgery/volume_1_number_1_30/article_printable/kikuchi_s_lymphadenitis_in_a_young_male.html. Accessed on: 1 June 2010.
  6. ↑ URL: http://www.healthsystem.virginia.edu/internet/hematology/hessedd/benignhematologicdisorders/normal-hematopoietic-cells/dendritic-cell.cfm?drid=214. Accessed on: 3 June 2010.
  7. ↑ URL: http://www.mayoclinic.com/health/castleman-disease/DS01000. Accessed on: 17 June 2010.
  8. ↑ PMID 19546611
  9. ↑ URL: http://www.ispub.com/journal/the_internet_journal_of_otorhinolaryngology/volume_9_number_2_11/article/a_rare_case_of_castleman_s_disease_presenting_as_cervical_neck_mass.html. Accessed on: 15 June 2010.
  10. ↑ Jerris, RC.; Regnery, RL. (1996). "Will the real agent of cat-scratch disease please stand up?". Annu Rev Microbiol 50: 707-25. doi:10.1146/annurev.micro.50.1.707. PMID 8905096.
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