Difference between revisions of "Lymph nodes"

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Haematopathology and lymphoma is dealt with in the ''[[haematopathology]]'' article.  This article covers the basics of lymph nodes.  Lymph node pathology is dealt with in the ''[[lymph node pathology]]'' article.
Haematopathology and lymphoma is dealt with in the ''[[haematopathology]]'' article.  This article covers the basics of lymph nodes.  Lymph node pathology is dealt with in the ''[[lymph node pathology]]'' article.


==Clinical==
=Clinical=
===Normal (clinical)===
===Normal (clinical)===
*Round.
*Round.
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**What qualifies for "large" depends on the location in the body.
**What qualifies for "large" depends on the location in the body.


==Gross pathologic exam==
=Gross pathologic exam=
Normal:
Normal:
*Firm (relative to adipose tissue).
*Firm (relative to adipose tissue).
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**Subtle lobulation (~1 mm) on section suggestive of ''follicular lymphoma''.<ref>DB. 5 August 2010.</ref>
**Subtle lobulation (~1 mm) on section suggestive of ''follicular lymphoma''.<ref>DB. 5 August 2010.</ref>


=Microscopic=
==LN architecture==
==LN architecture==
Lymph node architecture (superficial to deep):<ref name=Ref_WFH4_206-8>{{Ref WFH4|206-8}}</ref>
Lymph node architecture (superficial to deep):<ref name=Ref_WFH4_206-8>{{Ref WFH4|206-8}}</ref>
Line 178: Line 179:




==Pathology==
=Pathology=
{{Main|Lymph node pathology}}
{{Main|Lymph node pathology}}
LNs are very important in [[cancer staging]] and are, in many contexts, sampled routinely.   
LNs are very important in [[cancer staging]] and are, in many contexts, sampled routinely.   
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*[[Malignant melanoma#Sentinel lymph node panel|Malignant melanoma]] - first context in which SLN sampling was done.
*[[Malignant melanoma#Sentinel lymph node panel|Malignant melanoma]] - first context in which SLN sampling was done.


==See also==
=See also=
*[[Haematopathology]].
*[[Haematopathology]].
*[[Lymph node pathology]].
*[[Lymph node pathology]].

Revision as of 12:06, 21 March 2013

Lymph nodes, abbreviated LNs, are very important in pathology. They are the site of metastases and/or may be the site of a primary tumour, i.e. lymphoma.

Haematopathology and lymphoma is dealt with in the haematopathology article. This article covers the basics of lymph nodes. Lymph node pathology is dealt with in the lymph node pathology article.

Clinical

Normal (clinical)

  • Round.
  • "Soft".
  • Mobile.

Pathologic (clinical) - associations

  • Rubbery = suggestive of lymphoma.
  • Tender (hurts when ya touch it) = suggestive of infection.
  • Fixed (immobile) = suggestive of cancer, usually carcinoma.
  • Hard = suggestive of cancer.
  • "Large" - cancer or infection.
    • What qualifies for "large" depends on the location in the body.

Radiologic

  • Ellipical (as opposed to spherical) = may be cancer.
  • "Large" = could be cancer or infection.
    • What qualifies for "large" depends on the location in the body.

Gross pathologic exam

Normal:

  • Firm (relative to adipose tissue).
  • Glistening surface when cut.

Pathologic:

  • White lesions, especially irregular = suggestive of carcinoma.
  • White, glistening, with lobulated surface - "fish flesh" = suggestive of lymphoma.
    • Subtle lobulation (~1 mm) on section suggestive of follicular lymphoma.[1]

Microscopic

LN architecture

Lymph node architecture (superficial to deep):[2]

  • Capsule.
  • Subcapsular sinus.
    • Place where metastatic cells often are found.
    • In a normal LN the vessels should be "open", i.e. have a discernible lumen.
  • Cortex:
    • Follicles (superficial).
    • Paracortex (deep).
    • Cortical sinuses.
  • Medulla:
    • Medullary cords.
    • Medullary sinuses.

Notes:

  • Trabeculae - segment the LN radially, i.e. are spoke-like structures.

LN follicles

Types of follicles:[3]

  1. Primary follicle - no germinal center (pale area).
  2. Secondary follicle - have a germinal center (pale area) and mantle zone (rim of darker staining lymphocytes).

Germinal centre

Architecture:

  • Paler at capsular aspect.
  • Darker at medullary aspect.

Image:

Location and cell types

Germinal centers:[5]

  • Site of B lymphocyte proliferation; follicle center cells.
    • Centroblasts - usually superficial aspect. (??? deeper ???)
      • Darker, larger, nucleoli.
    • Centrocytes (mid germinal center).
      • Cells with cleavage.
    • Centrocytes (transforming to immunoblasts) - usually deeper aspect. (??? superficial ???)
      • Cells with cleavage.
  • Tingible body macrophages - mid germinal center.
  • Follicular dendritic cells.

Paracortex:[6]

  • Site of T lymphocytes.
  • Interdigitating dendritic cell.

Medullary cords (site of immunoglobulin synthesis):

  • B lymphocytes.
  • Plasma cells.

Mantle zone:

  • Memory B cells.
  • Usually asymmetrical; thicker, i.e. more mantle cells, at capsular aspect.[7]

B cell cycle

B cell cycle/maturation:[5]

  1. Centroblast (CB):
    • Appearance:[8]
      • Large cells.
      • Round nucleus, dark.
      • Nucleolus (nucleoli).
      • Mitotically active.
    • Location:
      • Medullary aspect of germinal center.
  2. Centrocytes (CC), AKA cleaved cells.
    • Appearance:
      • Cleaved nucleus
      • NOT mitotically active.
    • Location:
      • Mid germinal center.
  3. Immunoblasts or memory B cells.
    • Appearance:
      • Small lymphocytes.
    • Location:
      • Peripheral blood, mantle zone.

Notes:

  • Immunoblasts may be T cells or B cells; it is not possible to tell on morphologic grounds, i.e. without IHC.
  • Memory device: centrocytes are light (it nearly rhymes).

Image:

Cell types

Follicular dendritic cells:[9]

  • Classically found in pairs.
  • Large nucleus with:
    • Basketweave chromatin pattern.
    • Small central nucleolus.

Lymphocytes

  • See B cell cycle section.

Cell types - table

Cell Location Key feature Other morphologic IHC Other Image
Centroblast germinal center nucleolus large cell, darker staining CD10+, BCL6+ ??? other ? image ?
Centrocyte germinal center cleavage small cell, light staining CD10+, BCL6+ ??? other ? image ?
Follicular dendritic cell (FDC) germinal center mesh-like chromatin, usu. beside another one large cell, unremarkable/small nucleolus CD21+, CD23+ other ? image ?
Tingible body macrophage germinal center abundant bubbly pale cytoplasm (with junk) large cell CD68+ other ? image ?


Pathology

Main article: Lymph node pathology

LNs are very important in cancer staging and are, in many contexts, sampled routinely.

Sentinel lymph nodes

  • Abbreviated SLN.
  • LN sampling is associated with morbidity; thus, selective LN sampling is preferred.
  • The most important LNs in a LN chain, in the context of cancer, are the ones that are adjacent to the tumour; these are known as sentinel lymph nodes.

Use:

See also

References

  1. ↑ DB. 5 August 2010.
  2. ↑ Young, Barbara; Lowe, James S.; Stevens, Alan; Heath, John W.; Deakin, Philip J. (2000). Wheaters Functional Histology (4th ed.). Churchill Livingstone. pp. 206-8. ISBN 978-0004881973.
  3. ↑ Young, Barbara; Lowe, James S.; Stevens, Alan; Heath, John W.; Deakin, Philip J. (2000). Wheaters Functional Histology (4th ed.). Churchill Livingstone. pp. 208. ISBN 978-0004881973.
  4. ↑ URL: http://www.pathpedia.com/education/eatlas/histology/lymph_node/images.aspx. Accessed on: 29 October 2012.
  5. ↑ 5.0 5.1 Young, Barbara; Lowe, James S.; Stevens, Alan; Heath, John W.; Deakin, Philip J. (2000). Wheaters Functional Histology (4th ed.). Churchill Livingstone. pp. 210. ISBN 978-0004881973.
  6. ↑ Young, Barbara; Lowe, James S.; Stevens, Alan; Heath, John W.; Deakin, Philip J. (2000). Wheaters Functional Histology (4th ed.). Churchill Livingstone. pp. 211. ISBN 978-0004881973.
  7. ↑ DG. 17 August 2010.
  8. ↑ URL: http://www.healthsystem.virginia.edu/internet/hematology/HessEDD/BenignHematologicDisorders/normal-hematopoietic-cells/Secondary-lymphoid-organs-and-tissues.cfm. Accessed on: 31 January 2010.
  9. ↑ Wright CA, Nayler SJ, Leiman G (August 1997). "Cytopathology of follicular dendritic cell tumors". Diagn. Cytopathol. 17 (2): 138–42. PMID 9258622. http://www3.interscience.wiley.com/journal/57062/abstract?CRETRY=1&SRETRY=0.

External links

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