Lymph node pathology
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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:[2]
- Enlarged follicles, follicle size variation - key feature with:
- Large germinal centers (pale on H&E).
- Mitoses common.
- Variable lymphocyte morphology.
- Tingible-body macrophage (large, pale cells with junk in the cytoplasm).
- Rim of small (inactive) lymphocytes.
- Large germinal centers (pale on H&E).
IHC:
- BCL-2 -ve.
Image: Normal lymph node (umdnj.edu).
Diffuse paracortical hyperplasia
General
- Benign.
Microscopic
Features:[2]
- Interfollicular areas enlarged - key feature.
- T cell population increased.
- Plasma cells.
- Macrophages.
- Large Reed-Sternberg-like cells.
Sinus histiocytosis
General
- Benign.
Microscopic
Features:[2]
- Sinuses distended with histiocytes - key feature.
- Plasma cells increased.
Kikuchi disease
General
- AKA histiocytic necrotising lymphadenitis (HNL),[3] and Kikuchi-Fujimoto disease.
- Rare disease that may mimic cancer, esp. lymphoma.
- May cause fever & systemic symptoms.[4]
Epidemiology:[4]
- Usually <40 years old.
- Asian.
- Female:Male = 3:1.[5]
Treatment:
- Usually self-limited.[4]
- Oral corticosteroids.
DDx:
- Non-Hodgkin lymphoma.
- Systemic lupus erythematosus.
Micrograph
Features (the three main features - just as the name suggests):[6]
- Histiocytes.
- May be crescentic.
- Necrosis (due to apoptosis) - paracortical areas.[4]
- Necrosis without neutrophils - key feature.
- Lymphocytes (CD8 +ve).
- Plasmacytoid dendritic cells.
Notes:
- Dendritic cell - vaguely resembles a macrophage:[7]
- 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.[8]
- 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: [9]
Microscopic
Features:[10]
- 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 Bartonella henselae,[11] a gram-negative bacilla (0.3-1.0 x 0.6-3.0 micrometers) in chains, clumps, or singular.[12]
- Treatment: antibiotics.
Clinical
Features:[13]
- Usually unilateral.
- May be desseminated in individuals with immune dysfunction.
- Contact with cats.
Micrograph
Features:[13]
- Necrotizing granulomas with:
- Neutrophils present in microabscess (necrotic debris) - key feature.
- Microabscesses often described as "stellate" (star-shaped).
- Neutrophils present in microabscess (necrotic debris) - key feature.
- +/-Multinucleated giant cells.
Notes:
- May involve capsule or perinodal tissue.
Stains:
- Warthin-Starry stain +ve.
- B. henselae IHC stain +ve.
Image(s):
Toxoplasma lymphadenitis
General
- Caused by protozoan Toxoplasma gondii.
Microscopic
Features:[13]
- Reactive germinal centers (pale areas - larger than usual).
- Often poorly demarcated - due to loose epithelioid cell clusters at germinal center edge - key feature.
- Epithelioid cells - perifollicular & intrafollicular.
- Loose aggregates of histiocytes (do not form round granulomas):
- Abundant pale cytoplasm.
- Nucleoli.
- Loose aggregates of histiocytes (do not form round granulomas):
- Monocytoid cells (monocyte-like cells) - in cortex & paracortex.
- Large cells in islands/sheets key feature with:
- Abundant pale cytoplasm - important.
- Well-defined cell border - important.
- Singular nucleus.
- Large cells in islands/sheets key feature with:
Notes:
- Monocytoid cells CD68 -ve.
Dermatopathic lymphadenopathy
General
- Lymphadenopathy associated with a skin lesion - key feature.
- May be benign or malignant (e.g. T-cell lymphoma).
Microscopic
Features:[14]
- Abundant histiocytes & special histiocytes - in loose irregular clusters key feature:
- Do not form granuloma; may be similar to toxoplasma.
- Plasma cells (medulla).
- Eosinophils.
Histiocytes & special histiocytes:
- Histiocytes:
- +/-Melanin pigment key feature (if present).
- Lipid-laden macrophages.
- Interdigitating dendritic cells:
- Need IHC to identify definitively.
- Langerhans cells:
- Classically have a kidney bean nuclei.
- Need IHC to identify definitively.
IHC:
- Interdigitating dendritic cells: S100 +ve, CD1a -ve.
- Langerhans cells: S100 +ve, CD1a +ve.
Kimura lymphadenopathy
General
- AKA eosinophilic lymphogranuloma, Kimura disease.
- Chronic inflammatory disorder - suspected to be infectious.
Clinical:
- Usually neck, periauricular.
- Peripheral blood eosinophilia.
- Increased blood IgE.
Epidemiology
- Males > females.
- Young.
- Asian.
Microscopic
Features:[15]
- Angiolymphoid proliferation.
- Eosinophils - abundant - key feature.
See also
References
- ↑ Ioachim, Harry L; Medeiros, L. Jeffrey (2008). Ioachim's Lymph Node Pathology (4th ed.). Lippincott Williams & Wilkins. pp. 174. ISBN 978-0781775960.
- ↑ 2.0 2.1 2.2 Ioachim, Harry L; Medeiros, L. Jeffrey (2008). Ioachim's Lymph Node Pathology (4th ed.). Lippincott Williams & Wilkins. pp. 179. ISBN 978-0781775960.
- ↑ 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.
- ↑ 4.0 4.1 4.2 4.3 Hutchinson CB, Wang E (February 2010). "Kikuchi-Fujimoto disease". Arch. Pathol. Lab. Med. 134 (2): 289–93. PMID 20121621.
- ↑ URL: http://emedicine.medscape.com/article/210752-overview. Accessed on: 3 June 2010.
- ↑ 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.
- ↑ URL: http://www.healthsystem.virginia.edu/internet/hematology/hessedd/benignhematologicdisorders/normal-hematopoietic-cells/dendritic-cell.cfm?drid=214. Accessed on: 3 June 2010.
- ↑ URL: http://www.mayoclinic.com/health/castleman-disease/DS01000. Accessed on: 17 June 2010.
- ↑ PMID 19546611
- ↑ 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.
- ↑ 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.
- ↑ Ioachim, Harry L; Medeiros, L. Jeffrey (2008). Ioachim's Lymph Node Pathology (4th ed.). Lippincott Williams & Wilkins. pp. 110. ISBN 978-0781775960.
- ↑ 13.0 13.1 13.2 Ioachim, Harry L; Medeiros, L. Jeffrey (2008). Ioachim's Lymph Node Pathology (4th ed.). Lippincott Williams & Wilkins. pp. 113. ISBN 978-0781775960.
- ↑ Ioachim, Harry L; Medeiros, L. Jeffrey (2008). Ioachim's Lymph Node Pathology (4th ed.). Lippincott Williams & Wilkins. pp. 226. ISBN 978-0781775960.
- ↑ Ioachim, Harry L; Medeiros, L. Jeffrey (2008). Ioachim's Lymph Node Pathology (4th ed.). Lippincott Williams & Wilkins. pp. 190. ISBN 978-0781775960.