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The '''lymph node''', abbreviated '''LN''', is very important in pathology.  It is the site of mets and may be the site of a primary lesion, i.e. lymphoma.
'''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.
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. [[Grossing]] is covered in ''[[lymph node grossing]]''.


==LN architecture==
=Clinical=
Lymph node architecture (superficial to deep):<ref>Wheater's FH. 4th Ed. PP.206-8.</ref>
===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=
{{Main|Lymph node grossing}}
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]]''.<ref>Bailey, D. 5 August 2010.</ref>
 
=Microscopic=
==Lymph node architecture==
Lymph node architecture (superficial to deep):<ref name=Ref_WFH4_206-8>{{Ref WFH4|206-8}}</ref>
*Capsule.
*Capsule.
*Subcapsular sinus.  
*Subcapsular sinus.  
**Place where metastatic cells often are found.
**Place where metastatic cells often are found.
**In a normal LN the vessels should be "open", i.e. have a discernible lumen.
*Cortex:
*Cortex:
**Follicles (superficial).
**Follicles (superficial).
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Notes:
Notes:
*Trabeculae - segment the LN radially, i.e. are spoke-like structures.
*[[Trabeculae]] - segment the LN radially, i.e. are spoke-like structures.


==LN follicles==
==Lymph node follicles==
Types of follicles:<ref>Wheater's FH. 4th Ed. P.208.</ref>
Types of follicles:<ref name=Ref_WFH4_208>{{Ref WFH4|208}}</ref>
#Primary follicle - no germinal center (pale area).
#Primary follicle - no germinal center (pale area).
#Secondary follicle - have a ''germinal center'' (pale area) and ''mantle zone'' (rim of darker staining lymphocytes).
#Secondary follicle - have a ''germinal center'' (pale area) and ''mantle zone'' (rim of darker staining lymphocytes).


===Germinal centre===
===Germinal centre===
Architecture: '''CHECK THE FOLLOWING!!!'''
Architecture:  
*Paler at capsular aspect.
*Paler at capsular aspect.  
*Darker at medullary aspect.
*Darker at medullary aspect.
Image:
*[http://www.pathpedia.com/education/eatlas/histology/lymph_node/normal-lymph-node-histology-%5B10-ln01-10h%5D.jpeg?Width=600&Height=450&Format=4 Secondary follicle (pathpedia.com)].<ref>URL: [http://www.pathpedia.com/education/eatlas/histology/lymph_node/images.aspx http://www.pathpedia.com/education/eatlas/histology/lymph_node/images.aspx]. Accessed on: 29 October 2012.</ref>


==Location and cell types==
==Location and cell types==
Germinal centers:<ref>Wheater's FH. 4th Ed. P.210.</ref>
Germinal centers:<ref name=Ref_WFH4_210>{{Ref WFH4|210}}</ref>
*Site of B lymphocyte proliferation; ''follicle center cells''.
*Site of B lymphocyte proliferation; ''follicle center cells''.  
**Centrocytes transforming to immunoblasts (superficial aspect - paler).
**Centroblasts - usually superficial aspect. (??? deeper ???)
***Darker, larger, nucleoli.
**Centrocytes (mid germinal center).
**Centrocytes (mid germinal center).
**Centroblasts (deeper aspect - darker).
***Cells with cleavage.
**Centrocytes (transforming to immunoblasts) - usually deeper aspect. (??? superficial ???)
***Cells with cleavage.
*''Tingible body macrophages'' - mid germinal center.
*''Tingible body macrophages'' - mid germinal center.
*''Follicular dendritic cells''.
*''Follicular dendritic cells''.


Paracortex:<ref>Wheater's FH. 4th Ed. P.211.</ref>
Paracortex:<ref name=Ref_WFH4_211>{{Ref WFH4|211}}</ref>
*Site of T lymphocytes.
*Site of T lymphocytes.
*''Interdigitating dendritic cell''.
*''Interdigitating dendritic cell''.
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Mantle zone:
Mantle zone:
*Memory B cells.
*Memory B cells.
*Usually asymmetrical; thicker, i.e. more mantle cells, at capsular aspect.<ref>DG. 17 August 2010.</ref>
==Cell types==
Follicular dendritic cells:<ref name=pmid9258622>{{cite journal |author=Wright CA, Nayler SJ, Leiman G |title=Cytopathology of follicular dendritic cell tumors |journal=Diagn. Cytopathol. |volume=17 |issue=2 |pages=138–42 |year=1997 |month=August |pmid=9258622 |doi= |url=http://www3.interscience.wiley.com/journal/57062/abstract?CRETRY=1&SRETRY=0}}</ref>
*Classically found in pairs.
*Large nucleus with:
**Basketweave chromatin pattern.
**Small central nucleolus.
Lymphocytes:
*See ''B lymphocytes'' section.


==B cell cycle==
===B lymphocytes===
B cell cycle/maturation:<ref>Wheater's FH. 4th Ed. P.210.</ref>
*B cells are best understood in the context of their maturation.
 
B cell cycle/maturation:<ref name=Ref_WFH4_210>{{Ref WFH4|210}}</ref>
#Centroblast (CB):
#Centroblast (CB):
#*Appearance:<ref>URL: [http://www.healthsystem.virginia.edu/internet/hematology/HessEDD/BenignHematologicDisorders/normal-hematopoietic-cells/Secondary-lymphoid-organs-and-tissues.cfm http://www.healthsystem.virginia.edu/internet/hematology/HessEDD/BenignHematologicDisorders/normal-hematopoietic-cells/Secondary-lymphoid-organs-and-tissues.cfm]. Accessed on: 31 January 2010.</ref>
#*Appearance:<ref>URL: [http://www.healthsystem.virginia.edu/internet/hematology/HessEDD/BenignHematologicDisorders/normal-hematopoietic-cells/Secondary-lymphoid-organs-and-tissues.cfm http://www.healthsystem.virginia.edu/internet/hematology/HessEDD/BenignHematologicDisorders/normal-hematopoietic-cells/Secondary-lymphoid-organs-and-tissues.cfm]. Accessed on: 31 January 2010.</ref>
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Notes:
Notes:
*Immunoblasts may be T cells or B cells; it is not possible to tell on morphologic grounds, i.e. without IHC.
*Immunoblasts may be T cells or B cells; it is not possible to tell on morphologic grounds, i.e. without IHC.
*Memory device: centro'''''cytes''''' are ''light'' (it nearly rhymes).


Image:
Image:
*[http://www.healthsystem.virginia.edu/internet/hematology/HessEDD/BenignHematologicDisorders/normal-hematopoietic-cells/Secondary-lymphoid-organs-and-tissues.cfm Lymphoid organs (healthsystem.virginia.edu)].
*[http://www.healthsystem.virginia.edu/internet/hematology/HessEDD/BenignHematologicDisorders/normal-hematopoietic-cells/Secondary-lymphoid-organs-and-tissues.cfm Lymphoid organs (healthsystem.virginia.edu)].


==Cell types==
===Cell types - table===
Follicular dendritic cells:<ref name=pmid9258622>{{cite journal |author=Wright CA, Nayler SJ, Leiman G |title=Cytopathology of follicular dendritic cell tumors |journal=Diagn. Cytopathol. |volume=17 |issue=2 |pages=138–42 |year=1997 |month=August |pmid=9258622 |doi= |url=http://www3.interscience.wiley.com/journal/57062/abstract?CRETRY=1&SRETRY=0}}</ref>
 
*Classically found in pairs.
{| class="wikitable"
*Large nucleus with:
! Cell
**Basketweave chromatin pattern.
! Location
**Small central nucleolus.
! 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 ?
|-
<!-- | cell
| location
| key feature
| other morphologic
| IHC
| other
| image -->
|}
 
 
=Pathology=
{{Main|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'''.
*In lymph node positive disease, the most radioactive lymph node may be negative; this happens ~13% of the time in melanoma.<ref name=pmid11314933>{{Cite journal | last1 = McMasters | first1 = KM. | last2 = Reintgen | first2 = DS. | last3 = Ross | first3 = MI. | last4 = Wong | first4 = SL. | last5 = Gershenwald | first5 = JE. | last6 = Krag | first6 = DN. | last7 = Noyes | first7 = RD. | last8 = Viar | first8 = V. | last9 = Cerrito | first9 = PB. | title = Sentinel lymph node biopsy for melanoma: how many radioactive nodes should be removed? | journal = Ann Surg Oncol | volume = 8 | issue = 3 | pages = 192-7 | month = Apr | year = 2001 | doi =  | PMID = 11314933 }}</ref>
 
Use:
*[[Sentinel lymph node sampling in breast cancer|Breast cancer]] - very common.
*[[Malignant melanoma#Sentinel lymph node panel|Malignant melanoma]] - first context in which SLN sampling was done.


Lymphocytes
===Lymph node metastasis===
*See ''B cell cycle'' section.
{{Main|Lymph node metastasis}}
*Cancer that has spread to a lymph node.


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


==External links==
=References=
{{reflist|2}}
 
=External links=
*[http://pleiad.umdnj.edu/hemepath/normal_node/normal_node.html Lymph node architecture (umdnj.edu)].
*[http://pleiad.umdnj.edu/hemepath/normal_node/normal_node.html Lymph node architecture (umdnj.edu)].
==References==
{{reflist|2}}


[[Category:Haematopathology]]
[[Category:Haematopathology]]
Michael
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