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| Haematologic malignancies (in lymph nodes) are dealt with in other articles - see ''[[haematopathology]]'' and ''[[lymphoma]]''. | | Haematologic malignancies (in lymph nodes) are dealt with in other articles - see ''[[haematopathology]]'' and ''[[lymphoma]]''. |
| | |
| | ==Overview== |
| | Clinical: |
| | *Lymphadenopathy. |
| | |
| | Differential diagnosis:<ref>URL: [http://path.upmc.edu/cases/case289.html http://path.upmc.edu/cases/case289.html]. Accessed on: 14 January 2012.</ref> |
| | *Infectious - fungal, mycobacterial, viral, protozoal (Toxoplasma), bacterial (Chlamydia, Rickettsia, Bartonella)). |
| | *Neoplastic - lymphoma, carcinoma. |
| | *Endocrine - [[hyperthyroidism]]. |
| | *Trauma. |
| | *Autoimmune - [[SLE]], [[RA]], [[dermatomyositis]]. |
| | *Inflammatory - drugs (phenytoin). |
| | *Idiopathic - [[sarcoidosis]]. |
|
| |
|
| ==Overview in a table== | | ==Overview in a table== |
| {| class="wikitable" | | {| class="wikitable sortable" |
| ! Entity | | ! Entity |
| ! Key feature | | ! Key feature |
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| | image ? | | | image ? |
| |- | | |- |
| | Metastasis | | | [[Lymph node metastasis]] |
| | foreign cell population, usu. in subcapsular sinuses | | | foreign cell population, usu. in subcapsular sinuses |
| | +/-nuclear atypia, +/-malignant architecture | | | +/-nuclear atypia, +/-malignant architecture |
| | dependent on tumour type (see ''[[IHC]]'') | | | dependent on tumour type (see ''[[IHC]]'') |
| | dependent on morphology | | | dependent on morphology, [[endometriosis]] (mimics adenocarcinoma), ectopic decidua (mimics [[SCC]]) |
| | [http://commons.wikimedia.org/wiki/File:Crc_met_to_node1.jpg CRC met], [http://commons.wikimedia.org/wiki/File:Breast_carcinoma_in_a_lymph_node.jpg Breast met], [http://commons.wikimedia.org/wiki/File:Lymph_node_with_papillary_thyroid_carcinoma.jpg PTC met] | | | [[Image:Crc_met_to_node1.jpg|thumb|center|125px| CRC metastasis]] [[Image:Breast_carcinoma_in_a_lymph_node.jpg|thumb|center|125px | Breast metastasis]] |
| |- | | |- |
| | Progressive transformation of germinal centers | | | [[Progressive transformation of germinal centers]] |
| | large (atypical) germinal centers | | | large (atypical) germinal centers |
| | poorly demarcated germinal center (GC)/mantle zone interfaces, expanded mantle zone | | | poorly demarcated germinal center (GC)/mantle zone interfaces, expanded mantle zone |
| | IHC to r/o ''nodular lymphocyte predominant [[Hodgkin lymphoma]]'' (NLPHL) | | | IHC to r/o ''nodular lymphocyte predominant [[Hodgkin lymphoma]]'' (NLPHL) |
| | NLPHL, follicular hyperplasia | | | NLPHL, follicular hyperplasia |
| | [http://commons.wikimedia.org/wiki/File:Progressive_transformation_of_germinal_centres_-1-_very_low_mag.jpg], [http://commons.wikimedia.org/wiki/File:Progressive_transformation_of_germinal_centres_-1-_low_mag.jpg] | | | [[Image:Progressive transformation_of_germinal_centres_-1-_very_low_mag.jpg|thumb|center|150px | PTGC - very low mag.]] |
| |- | | |- |
| | [[Toxoplasmosis]] | | | [[Toxoplasmosis]] |
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| | IHC for toxoplasma | | | IHC for toxoplasma |
| | NSRFH, HIV/AIDS, [[Hodgkin's lymphoma]] | | | NSRFH, HIV/AIDS, [[Hodgkin's lymphoma]] |
| | [http://commons.wikimedia.org/wiki/File:Toxoplasmosis_lymphadenopathy_-_low_mag.jpg], [http://commons.wikimedia.org/wiki/File:Toxoplasmosis_lymphadenopathy_-b-_high_mag.jpg] | | | [[Image:Toxoplasmosis_lymphadenopathy_-_low_mag.jpg|thumb|center|150px | TL - low mag.]] |
| |- | | |- |
| | [[Kikuchi disease]] (histiocystic necrotizing lymphadenitis) | | | [[Kikuchi disease]] (histiocystic necrotizing lymphadenitis) |
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| | histiocytes, [[necrosis]] | | | histiocytes, [[necrosis]] |
| | IHC for large cell lymphoma (CD30 + others) | | | IHC for large cell lymphoma (CD30 + others) |
| | SLE (has (blue) hematoxylin bodies in necrotic areas), large cell lymphomas | | | [[SLE]] (has (blue) hematoxylin bodies in necrotic areas), large cell lymphomas |
| | [http://commons.wikimedia.org/w/index.php?title=File:Histiocytic_necrotizing_lymphadenitis_-_very_high_mag.jpg] | | | [[Image:Histiocytic_necrotizing_lymphadenitis_-_very_high_mag.jpg |thumb|center|150px| HNL - very high mag.]] |
| |- | | |- |
| | Cat-scratch disease | | | [[Cat-scratch disease]] |
| | PMNs in necrotic area | | | PMNs in necrotic area |
| | "stellate" (or serpentine) shaped microabscesses, granulomas | | | "stellate" (or serpentine) shaped microabscesses, granulomas |
| | B. henselae, [[Dieterle stain]] | | | B. henselae, [[Dieterle stain]] |
| | [[HIV]]/AIDS, NSRFH | | | [[HIV]]/AIDS, NSRFH |
| | [http://commons.wikimedia.org/wiki/File:Cat_scratch_disease_-_very_low_mag.jpg] | | | [[Image:Cat_scratch_disease_-_very_low_mag.jpg|thumb|center|150px|Cat scratch - very low mag.]] |
| |- | | |- |
| | Dermatopathic lymphadenopathy | | | [[Dermatopathic lymphadenopathy]] |
| | melanin-laden histiocytes | | | melanin-laden histiocytes |
| | histiocytosis | | | [[histiocytosis]] |
| | S100+ve (interdigitating dendritic cells), CD1a+ve (Langerhans cells) | | | [[S-100]]+ve (interdigitating dendritic cells), CD1a+ve (Langerhans cells) |
| | DDx ? | | | [[cutaneous T-cell lymphoma]] |
| | [http://commons.wikimedia.org/wiki/File:Dermatopathic_lymphadenopathy_-_low_mag.jpg], [http://commons.wikimedia.org/wiki/File:Dermatopathic_lymphadenopathy_-_intermed_mag.jpg] | | | [[Image:Dermatopathic_lymphadenopathy_-_intermed_mag.jpg |thumb|center|150px| DL - intermed. mag.]] |
| |- | | |- |
| | Kimura disease | | | [[Kimura disease]] |
| | eosinophils | | | eosinophils |
| | angiolymphoid proliferation (thick-walled blood vessels with hobnail endothelial cells) | | | angiolymphoid proliferation (thick-walled blood vessels with [[hobnail]] endothelial cells) |
| | IHC ? | | | IHC ? |
| | eosinophilic granuloma | | | [[Langerhans cell histiocytosis]], drug reaction, [[angiolymphoid hyperplasia with eosinophilia]] |
| | [http://commons.wikimedia.org/wiki/File:Kimura_disease_-_very_high_mag.jpg] | | | [[Image:Kimura_disease_-_very_high_mag.jpg|thumb|center|150px|Kimura disease - very high mag.]] |
| |- | | |- |
| | [[Langerhans cell histiocytosis]] | | | [[Langerhans cell histiocytosis]] |
| | abundant histiocytes with reniform nuclei | | | abundant histiocytes with reniform nuclei |
| | often prominent eosinophilia | | | often prominent eosinophilia |
| | S100+, CD1a+ | | | [[S-100]]+, CD1a+ |
| | Kimura disease (eosinophilia), Rosai-Dorfman disease | | | [[Kimura disease]] (eosinophilia), [[Rosai-Dorfman disease]] |
| | [http://commons.wikimedia.org/w/index.php?title=File:Langerhans_cell_histiocytosis_-_very_high_mag.jpg] | | | [[Image:Langerhans_cell_histiocytosis_-_very_high_mag.jpg|thumb|center|150px|LCH - very high mag.]] |
| |- | | |- |
| | Rosai-Dorfman disease | | | [[Rosai-Dorfman disease]] |
| | sinus histiocytosis | | | sinus histiocytosis |
| | emperipolesis (intact cell within a macrophage) | | | emperipolesis (intact cell within a macrophage) |
| | S100+, CD1a- | | | [[S-100]]+, CD1a- |
| | Langerhans cell histiocytosis | | | Langerhans cell histiocytosis |
| | [http://commons.wikimedia.org/w/index.php?title=File:Emperipolesis_-_very_high_mag.jpg] | | | [[Image:Emperipolesis_-_very_high_mag.jpg |thumb|center|150px | RDD - very high mag.]] |
| |- | | |- |
| | Systemic lupus erythematosus lymphadenopathy | | | [[Systemic lupus erythematosus]] lymphadenopathy |
| | (blue) hematoxylin bodies | | | (blue) hematoxylin bodies |
| | necrosis, no PMNs | | | necrosis, no PMNs |
| | IHC for large cell lymphoma (CD30 + others) | | | IHC for large cell lymphoma (CD30 + others) |
| | Kikuchi disease, large cell lymphomas | | | [[Kikuchi disease]], large cell [[lymphoma]]s |
| | [http://commons.wikimedia.org/wiki/File:Systemic_lupus_erythematosus_lymphadenopathy_-_high_mag.jpg] | | | [[Image:Systemic_lupus_erythematosus_lymphadenopathy_-_high_mag.jpg|thumb|center|150px | SLEL - high mag.]] |
| |- | | |- |
| | [[Castleman disease]], hyaline vascular variant | | | [[Castleman disease]], hyaline vascular variant |
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| | IHC - to r/o [[mantle cell lymphoma]] | | | IHC - to r/o [[mantle cell lymphoma]] |
| | mantle cell lymphoma, [[HIV]]/AIDS | | | mantle cell lymphoma, [[HIV]]/AIDS |
| | [http://commons.wikimedia.org/wiki/File:Castleman_disease_-_intermed_mag.jpg], [http://commons.wikimedia.org/wiki/File:Castleman_disease_-_high_mag.jpg] | | | [[Image:Castleman_disease_-_intermed_mag.jpg|thumb|center|150px | CD - intermed. mag.]] |
| |- | | |- |
| | Castleman disease, plasma cell variant | | | Castleman disease, plasma cell variant |
| | thick mantle cell layer | | | thick mantle cell layer |
| | sinus perserved, interfollicular plasma cells, mitoses in GC | | | sinus perserved, interfollicular plasma cells, mitoses in GC |
| | HHV-8 | | | [[HHV-8]] |
| | HIV/AIDS | | | HIV/AIDS |
| | image ? | | | image ? |
| | |- |
| | | [[Intranodal palisaded myofibroblastoma]] |
| | | spindle cells with nuclear palisading |
| | | [[RBC extravasation]], fibrillary bodies with a central vessel "amianthoid fibers" |
| | | SMA+, cyclin D1+ |
| | | [[schwannoma]] |
| | | [[Image:Intranodal_palisaded_myofibroblastoma_-_very_high_mag.jpg|thumb|center|150px|IPM - very high mag.]] |
| | |- |
| <!-- | entity | | <!-- | entity |
| | key feature | | | key feature |
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| |} | | |} |
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| ==Metastasis== | | ==Lymph node metastasis== |
| ===General===
| | {{Main|Lymph node metastasis}} |
| *Determination of ''lymph node status'' is probably the most common indication for the examination of lymph nodes.
| |
| *It is a good idea to look at the tumour (if available) ...before looking at the LNs for mets.
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|
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|
| ===Microscopic=== | | ==Kaposi sarcoma== |
| Features:
| | {{Main|Kaposi sarcoma}} |
| *Foreign cell population - '''key feature'''.
| | *One of the few non-lymphoid primary lymph node tumours.<ref name=pmid1918406>{{Cite journal | last1 = Bigotti | first1 = G. | last2 = Coli | first2 = A. | last3 = Mottolese | first3 = M. | last4 = Di Filippo | first4 = F. | title = Selective location of palisaded myofibroblastoma with amianthoid fibres. | journal = J Clin Pathol | volume = 44 | issue = 9 | pages = 761-4 | month = Sep | year = 1991 | doi = | PMID = 1918406 | PMC = 496726 }}</ref> |
| **Classic location: subcapsular sinuses.
| |
| *+/-Cells with cytologic features of malignancy. | |
| **Nuclear pleomorphism (variation in size, shape and staining).
| |
| **Nuclear atypia:
| |
| ***Nuclear enlargement.
| |
| ***Irregular nuclear membrane.
| |
| ***Irregular chromatin pattern, esp. asymmetry.
| |
| ***Large or irregular nucleolus.
| |
| **Abundant mitotic figures.
| |
| *+/-Cells in architectural arrangements seen in malignancy; highly variable - dependent on tumour type and differentiation.
| |
| **+/-Gland formation.
| |
| **+/-Single cells.
| |
| **+/-Small clusters of cells.
| |
| | |
| Notes:
| |
| #Cytologic features of malignancy may not be present; some tumours, e.g. gallbladder carcinoma, do not always have overt cytologic features of malignancy.
| |
| #*The diagnosis is based on the fact that they are foreign to the lymph node ''and'' architecturally consistent with a well-differentiated malignancy.
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| #[[Endometriosis]] may mimic metastatic disease.
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|
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|
| Images:
| | ==Melanocytic nevi== |
| *[http://commons.wikimedia.org/wiki/File:Breast_carcinoma_in_a_lymph_node.jpg Breast carcinoma LN metastasis (WC)].
| | {{Main|Melanocytic lesions}} |
| *[http://commons.wikimedia.org/wiki/File:Lymph_node_with_papillary_thyroid_carcinoma.jpg Thyroid carcinoma LN metastasis (WC)]. | | :See: ''[[Dermatopathic lymphadenopathy]]''. |
| *[http://commons.wikimedia.org/wiki/File:Crc_met_to_node1.jpg Colorectal carcinoma LN metastasis (WC)].
| | *Benign melanocytic nevi can be found in lymph nodes.<ref name=pmid1918406>{{Cite journal | last1 = Bigotti | first1 = G. | last2 = Coli | first2 = A. | last3 = Mottolese | first3 = M. | last4 = Di Filippo | first4 = F. | title = Selective location of palisaded myofibroblastoma with amianthoid fibres. | journal = J Clin Pathol | volume = 44 | issue = 9 | pages = 761-4 | month = Sep | year = 1991 | doi = | PMID = 1918406 | PMC = 496726 }}</ref> |
|
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|
| ==Progressive transformation of germinal centers== | | ==Progressive transformation of germinal centers== |
| {{Main|Progressive transformation of germinal centers}} | | {{Main|Progressive transformation of germinal centers}} |
| *Abbreviated as ''PTGC''. | | *Abbreviated as ''PTGC''. |
|
| |
| ===General===
| |
| *Benign.
| |
| *Classically in younger patients.
| |
| *Associated with nodular lymphocyte predominant [[Hodgkin's lymphoma]] (NLPHL); NLPHL found in up to 5% in a 7 year follow-up.<ref name=pmid12145465>{{cite journal |author=Verma A, Stock W, Norohna S, Shah R, Bradlow B, Platanias LC |title=Progressive transformation of germinal centers. Report of 2 cases and review of the literature |journal=Acta Haematol. |volume=108 |issue=1 |pages=33–8 |year=2002 |pmid=12145465 |doi= |url=}}</ref>
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|
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| Clinical:
| |
| *Asymptomatic lymphadenopathy.
| |
|
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| ===Microscopic===
| |
| Features:
| |
| *Follicular hyperplasia (many follicles).
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| *'''Focally''' large germinal centers with:
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| **Poorly demarcated germinal center (GC)/mantle zone interfaces (as GCs infiltrated by mantle zone lymphocytes) -- '''key feature'''.<ref name=pmid12145465/>
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| **Expanded mantle zone.
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|
| |
| Images:
| |
| *[http://commons.wikimedia.org/wiki/File:Progressive_transformation_of_germinal_centres_-1-_very_low_mag.jpg PTGCs - very low mag. (WC)].
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| *[http://commons.wikimedia.org/wiki/File:Progressive_transformation_of_germinal_centres_-1-_low_mag.jpg PTGCs - low mag. (WC)].
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|
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|
| ==Reactive follicular hyperplasia== | | ==Reactive follicular hyperplasia== |
| ===General===
| | {{Main|Reactive follicular hyperplasia}} |
| *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>
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| | |
| ===Microscopic===
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| Features:<ref name=Ref_ILNP179>{{Ref_ILNP|179}}</ref>
| |
| *Enlarged follicles, follicle size variation - '''key feature''' with:
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| **Large germinal centers (pale on H&E).
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| ***Mitoses common.
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| ***Variable lymphocyte morphology.
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| ***Tingible-body macrophage (large, pale cells with junk in the cytoplasm).
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| ***Germinal centers (GCs) have a crisp/sharp edge.
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| ***Normal dark/light variation of GCs; superficial aspect light, deeper aspect darker.
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| **Rim of small (inactive) lymphocytes.
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| IHC:
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| *BCL2 -ve.
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| | |
| Image: [http://pleiad.umdnj.edu/hemepath/normal_node/normal_node.html Normal lymph node (umdnj.edu)].
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|
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| ==Diffuse paracortical hyperplasia== | | ==Diffuse paracortical hyperplasia== |
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| ==Sinus histiocytosis== | | ==Sinus histiocytosis== |
| ===General===
| | :Should '''not''' be confused with ''[[sinus histiocytosis with massive lymphadenopathy]]'', also known as Rosai-Dorfman disease. |
| *Benign.
| | {{Main|Sinus histiocytosis}} |
| | |
| ===Microscopic===
| |
| Features:<ref name=Ref_ILNP179>{{Ref_ILNP|179}}</ref>
| |
| *Sinuses distended with histiocytes - '''key feature'''.
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| *Plasma cells increased.
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| Notes:
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| *Sinus histiocytosis should prompt consideration of Rosai-Dorfman disease.
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| **Look for large nuclei (~2x lymphocyte) with prominent nucleoli.
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|
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| ==Kikuchi disease== | | ==Kikuchi disease== |
| ===General===
| | *[[AKA]] ''histiocytic necrotising lymphadenitis'' (HNL).<ref name="pmid15570824">{{cite journal |author=Kaushik V, Malik TH, Bishop PW, Jones PH |title=Histiocytic necrotising lymphadenitis (Kikuchi's disease): a rare cause of cervical lymphadenopathy |journal=Surgeon |volume=2 |issue=3 |pages=179–82 |year=2004 |month=June |pmid=15570824 |doi= |url=}}</ref> |
| *AKA ''histiocytic necrotising lymphadenitis'' (HNL),<ref name="pmid15570824">{{cite journal |author=Kaushik V, Malik TH, Bishop PW, Jones PH |title=Histiocytic necrotising lymphadenitis (Kikuchi's disease): a rare cause of cervical lymphadenopathy |journal=Surgeon |volume=2 |issue=3 |pages=179–82 |year=2004 |month=June |pmid=15570824 |doi= |url=}}</ref> and ''Kikuchi-Fujimoto disease''. | | *[[AKA]] ''Kikuchi-Fujimoto disease''. |
| *Rare disease that may mimic [[cancer]], esp. [[lymphoma]]. | | {{Main|Kikuchi disease}} |
| **May cause fever & systemic symptoms.<ref name=pmid20121621>{{cite journal |author=Hutchinson CB, Wang E |title=Kikuchi-Fujimoto disease |journal=Arch. Pathol. Lab. Med. |volume=134 |issue=2 |pages=289–93 |year=2010 |month=February |pmid=20121621 |doi= |url=}}</ref>
| |
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| Epidemiology:<ref name=pmid20121621/>
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| *Usually <40 years old.
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| *Asian.
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| *Female:Male = 3:1.<ref>URL: [http://emedicine.medscape.com/article/210752-overview http://emedicine.medscape.com/article/210752-overview]. Accessed on: 3 June 2010.</ref>
| |
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| Treatment:
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| *Usually self-limited.<ref name=pmid20121621/>
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| *Oral corticosteroids.
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| | |
| DDx:
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| *Non-Hodgkin lymphoma.
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| *Systemic lupus erythematosus.
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| **Hematoxyphil bodies in necrotic foci.
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| ***Dark blue irregular bodies on H&E.
| |
| | |
| ===Micrograph===
| |
| Features (the three main features - just as the name suggests):<ref>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 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.</ref>
| |
| *Histiocytes.
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| **May be crescentic.
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| *Necrosis (due to apoptosis) - paracortical areas.<ref name=pmid20121621/>
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| **Necrosis without neutrophils - '''key feature'''.
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| *Lymphocytes (CD8 +ve).
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| *Plasmacytoid dendritic cells.
| |
| | |
| Notes:
| |
| *Dendritic cell - vaguely resembles a macrophage:<ref>URL: [http://www.healthsystem.virginia.edu/internet/hematology/hessedd/benignhematologicdisorders/normal-hematopoietic-cells/dendritic-cell.cfm?drid=214 http://www.healthsystem.virginia.edu/internet/hematology/hessedd/benignhematologicdisorders/normal-hematopoietic-cells/dendritic-cell.cfm?drid=214]. Accessed on: 3 June 2010.</ref>
| |
| **Long membrane projections - '''key feature'''.
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| **Abundant blue-grey cytoplasm, +/- ground-glass appearance.
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| **Nucleus: small, ovoid, usu. single nucleolus.
| |
| | |
| Images:
| |
| *[http://commons.wikimedia.org/w/index.php?title=File:Histiocytic_necrotizing_lymphadenitis_-_intermed_mag.jpg Kikuchi disease - intermed mag (WC)].
| |
| *[http://commons.wikimedia.org/w/index.php?title=File:Histiocytic_necrotizing_lymphadenitis_-_high_mag.jpg Kikuchi disease - high mag (WC)].
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| *[http://commons.wikimedia.org/w/index.php?title=File:Histiocytic_necrotizing_lymphadenitis_-_very_high_mag.jpg Kikuchi disease - very high mag (WC)].
| |
| | |
| ===IHC===
| |
| *CD68 +ve.
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| *CD8 +ve - usu. predominant.
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| *CD4, CD20, CD3, and CD30 - mixed.
| |
| **Done to excluded lymphoma; esp. large cell lymphomas;<ref name=pmid19577167>{{cite journal |author=Good DJ, Gascoyne RD |title=Atypical lymphoid hyperplasia mimicking lymphoma |journal=Hematol. Oncol. Clin. North Am. |volume=23 |issue=4 |pages=729–45 |year=2009 |month=August |pmid=19577167 |doi=10.1016/j.hoc.2009.04.005 |url=}}</ref> should show a mixed population of lymphocytes.
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| *Others:
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| **CD56 -ve.
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|
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|
| ==Systemic lupus erythematosus lymphadenopathy== | | ==Systemic lupus erythematosus lymphadenopathy== |
| ===General===
| | {{Main|Systemic lupus erythematosus lymphadenopathy}} |
| *Lymphadenopathy associated with systemic lupus erythematosus (SLE).
| |
| | |
| ===Microscopic===
| |
| Features:<ref name=pmid9406250>{{Cite journal | last1 = Kojima | first1 = M. | last2 = Nakamura | first2 = S. | last3 = Itoh | first3 = H. | last4 = Yoshida | first4 = K. | last5 = Asano | first5 = S. | last6 = Yamane | first6 = N. | last7 = Komatsumoto | first7 = S. | last8 = Ban | first8 = S. | last9 = Joshita | first9 = T. | title = Systemic lupus erythematosus (SLE) lymphadenopathy presenting with histopathologic features of Castleman' disease: a clinicopathologic study of five cases. | journal = Pathol Res Pract | volume = 193 | issue = 8 | pages = 565-71 | month = | year = 1997 | doi = | PMID = 9406250 }}</ref>
| |
| *Necrosis.
| |
| *Hematoxylin bodies (in necrotic foci).
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| **Dark blue irregular bodies on H&E.
| |
| | |
| Images:
| |
| *[http://commons.wikimedia.org/wiki/File:Systemic_lupus_erythematosus_lymphadenopathy_-_high_mag.jpg SLE lymphadenopathy - high mag. (WC)].
| |
| *[http://commons.wikimedia.org/wiki/File:Systemic_lupus_erythematosus_lymphadenopathy_-_very_high_mag.jpg SLE lymphadenopathy - very high mag. (WC)].
| |
| | |
| DDx:
| |
| *Kikuchi disease.
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|
| |
|
| ==Castleman disease== | | ==Castleman disease== |
| ===General===
| |
| *[[AKA]] ''angiofollicular lymph node hyperplasia'', ''giant lymph node hyperplasia''.<ref>URL: [http://www.mayoclinic.com/health/castleman-disease/DS01000 http://www.mayoclinic.com/health/castleman-disease/DS01000]. Accessed on: 17 June 2010.</ref> | | *[[AKA]] ''angiofollicular lymph node hyperplasia'', ''giant lymph node hyperplasia''.<ref>URL: [http://www.mayoclinic.com/health/castleman-disease/DS01000 http://www.mayoclinic.com/health/castleman-disease/DS01000]. Accessed on: 17 June 2010.</ref> |
| *Benign.
| |
| *Abbreviated '''CD'''. | | *Abbreviated '''CD'''. |
| | | {{Main|Castleman disease}} |
| ===Classification===
| |
| CD is grouped by histologic appearance:<ref name=Ref_ILNP228>{{Ref ILNP|228}}</ref>
| |
| #Hyaline vascular (HV) variant (described by Castleman).
| |
| #*Usually unicentric.
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| #*Typically mediastinal or axial.
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| #*More common than plasma cell variant; represents 80-90% of CD cases.
| |
| #*May be associated with follicular dendritic cell neoplasia.<ref name=Ref_WMSP_596>{{Ref WMSP|596}}</ref>
| |
| #Plasma cell (PC) variant.
| |
| #*Usually multicentric, may be unicentric.
| |
| #*Abundant plasma cells.
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| #*Associated with HHV-8 infection (the same virus implicated in ''Kaposi's sarcoma'').
| |
| | |
| Notes:
| |
| *The subclassification of CD is in some flux. Some authors advocate splitting-out ''HHV-8'' and ''multicentric'' as separate subtypes.<ref name=pmid19546611>{{Cite journal | last1 = Cronin | first1 = DM. | last2 = Warnke | first2 = RA. | title = Castleman disease: an update on classification and the spectrum of associated lesions. | journal = Adv Anat Pathol | volume = 16 | issue = 4 | pages = 236-46 | month = Jul | year = 2009 | doi = 10.1097/PAP.0b013e3181a9d4d3 | PMID = 19546611 }}</ref>
| |
| | |
| ===Microscopic===
| |
| ====Hyaline-vascular variant (HVV)====
| |
| Features:<ref>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 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.</ref><ref name=Ref_ILNP236>{{Ref ILNP|236}}</ref>
| |
| *Pale concentric (expanded) mantle zone lymphocytes - '''key feature'''.
| |
| **"Regressed follicles" - germinal center (pale area) is small.
| |
| *"Lollipops":
| |
| **Germinal centers fed by prominent (radially penetrating sclerotic) vessels; lollipop-like appearance.
| |
| *Two germinal centers in one follicle.
| |
| *Hyaline material (pink acellular stuff on H&E) in germinal center.
| |
| *Sinuses effaced (lost).
| |
| *Mitoses absent.
| |
| | |
| Images:
| |
| *[http://commons.wikimedia.org/wiki/File:Castleman_disease_-_high_mag.jpg CD HVV - "lollipop" sign - high mag. (WC)].
| |
| *[http://commons.wikimedia.org/wiki/File:Castleman_disease_-_intermed_mag.jpg CD HVV - showing expanded mantle zone - intermed. mag. (WC)].
| |
| | |
| ====Plasma cell variant====
| |
| Features:<ref name=Ref_ILNP236>{{Ref ILNP|236}}</ref>
| |
| *Interfollicular sheets of plasma cells - '''key feature'''.
| |
| *Active germinal centers - mitoses present.
| |
| *Sinus perserved.
| |
| | |
| ===IHC===
| |
| Hyaline-vascular variant:
| |
| *Stains to exclude [[mantle cell lymphoma]]:
| |
| **Cyclin D1.
| |
| | |
| Plasma cell variant:
| |
| *HHV-8 +ve.
| |
|
| |
|
| ==Cat-scratch disease== | | ==Cat-scratch disease== |
| ===General===
| | *[[AKA]] ''cat scratch fever''. |
| *[[AKA]] ''Cat-scratch fever''. | | {{Main|Cat scratch disease}} |
| *Infection caused ''Bartonella henselae'',<ref name=pmid19332922>{{Cite journal | last1 = Jerris | first1 = RC. | last2 = Regnery | first2 = RL. | title = Will the real agent of cat-scratch disease please stand up? | journal = Annu Rev Microbiol | volume = 50 | issue = | pages = 707-25 | month = | year = 1996 | doi = 10.1146/annurev.micro.50.1.707 | PMID = 8905096 }}</ref> a gram-negative bacilla (0.3-1.0 x 0.6-3.0 micrometers) in chains, clumps, or singular.<ref name=Ref_ILNP110>{{Ref ILNP|110}}</ref>
| |
| *Treatment: antibiotics.
| |
| | |
| ===Clinical===
| |
| Features:<ref name=Ref_ILNP113>{{Ref ILNP|113}}</ref>
| |
| *Usually unilateral.
| |
| **May be disseminated in individuals with immune dysfunction.
| |
| *Contact with cats.
| |
| | |
| ===Micrograph===
| |
| Features:<ref name=Ref_ILNP113>{{Ref ILNP|113}}</ref>
| |
| *Necrotizing granulomas with:
| |
| **Neutrophils present in microabscess (necrotic debris) - '''key feature'''.
| |
| ***Microabscesses often described as "stellate" (star-shaped).
| |
| *+/-Multinucleated giant cells.
| |
| | |
| Notes:
| |
| *May involve capsule or perinodal tissue.
| |
| | |
| Stains:
| |
| *Warthin-Starry stain +ve.
| |
| *B. henselae IHC stain +ve.
| |
| | |
| Images:
| |
| *[http://www.webpathology.com/image.asp?case=386&n=1 Cat-scratch disease (webpathology.com)].
| |
| *[http://www.webpathology.com/image.asp?n=2&Case=386 Cat-scratch disease - high mag. (webpathology.com)]
| |
| *[http://commons.wikimedia.org/wiki/File:Cat_scratch_disease_-_very_low_mag.jpg CSD - very low mag. - showing serpentine shaped microabscesses (WC)].
| |
| *[http://commons.wikimedia.org/wiki/File:Cat_scratch_disease_-b-_high_mag.jpg CSD - high mag. - showing neutrophilic abscesses (WC)].
| |
|
| |
|
| ==Toxoplasma lymphadenitis== | | ==Toxoplasma lymphadenitis== |
Line 419: |
Line 242: |
|
| |
|
| ==Dermatopathic lymphadenopathy== | | ==Dermatopathic lymphadenopathy== |
| ===General===
| | {{Main|Dermatopathic lymphadenopathy}} |
| *Lymphadenopathy associated with a skin lesion - '''key feature'''.
| |
| *May be benign or malignant (e.g. T-cell lymphoma).
| |
| | |
| ===Microscopic===
| |
| Features:<ref name=ILNP226>{{Ref ILNP|226}}</ref>
| |
| *Abundant histiocytes & special histiocytes - in loose irregular clusters - located in the sinuses, i.e. sinus histiocytosis - '''key feature''':
| |
| **Do ''not'' form granuloma; may be similar to ''toxoplasma''.
| |
| *Plasma cells (medulla).
| |
| *Eosinophils.
| |
| | |
| Images:
| |
| *[http://commons.wikimedia.org/wiki/File:Dermatopathic_lymphadenopathy_-_low_mag.jpg DL - low mag. (WC)].
| |
| *[http://commons.wikimedia.org/wiki/File:Dermatopathic_lymphadenopathy_-_intermed_mag.jpg DL - intermed. mag. (WC)].
| |
| | |
| 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== | | ==Kimura lymphadenopathy== |
| ===General===
| | {{Main|Kimura disease}} |
| *[[AKA]] ''eosinophilic lymphogranuloma'', ''Kimura disease''.
| |
| *Chronic inflammatory disorder - suspected to be infectious.
| |
|
| |
|
| Clinical:
| | ==Rosai-Dorfman disease== |
| *Usually neck, periauricular. | | *Abbreviated ''RDD''. |
| *Peripheral blood eosinophilia. | | *[[AKA]] ''sinus histiocytosis with massive lymphadenopathy'', abbreviated ''SHML''. |
| *Increased blood IgE.
| | {{Main|Rosai-Dorfman disease}} |
|
| |
|
| ===Epidemiology=== | | ==Langerhans cell histiocytosis== |
| *Males > females.
| | {{Main|Langerhans cell histiocytosis}} |
| *Young.
| |
| *Asian.
| |
| | |
| ===Microscopic===
| |
| Features:<ref name=Ref_ILNP190>{{Ref ILNP|190}}</ref>
| |
| *Angiolymphoid proliferation.
| |
| **Thick walled blood vessels with (plump) hobnail endothelial cells.<ref>URL: [http://emedicine.medscape.com/article/1098777-diagnosis http://emedicine.medscape.com/article/1098777-diagnosis]. Accessed on: 8 August 2010.</ref>
| |
| *Eosinophils - abundant - '''key feature'''.
| |
| | |
| Notes:
| |
| *Abundant eosinophils: consider Langerhans cell histiocytosis.
| |
|
| |
|
| Images:
| | ==Lymph node hyalinization== |
| *[http://commons.wikimedia.org/wiki/File:Kimura_disease_-_very_high_mag.jpg Kimura disease - very high mag. (WC)]. | | *[[AKA]] ''hyalinized lymph node''. |
| *[http://commons.wikimedia.org/wiki/File:Kimura_disease_-_high_mag.jpg Kimura disease - high mag. (WC)].
| |
| *[http://commons.wikimedia.org/wiki/File:Kimura_disease_-_intermed_mag.jpg Kimura disease - intermed. mag. (WC)].
| |
| | |
| ===IHC===
| |
| *Used to rule-out a clonal population.
| |
| | |
| ==Rosai-Dorfman disease==
| |
| ===General=== | | ===General=== |
| *[[AKA]] ''sinus histiocytosis with massive lymphadenopathy'', abbreviated ''SHML''.<ref name=pmid17183839>{{cite journal |author=Agarwal A, Pathak S, Gujral S |title=Sinus histiocytosis with massive lymphadenopathy--a review of seven cases |journal=Indian J Pathol Microbiol |volume=49 |issue=4 |pages=509–15 |year=2006 |month=October |pmid=17183839 |doi= |url=}}</ref> | | *Benign. |
| *Super rare.
| | *Associated with aging.<ref name=pmid12973685>{{Cite journal | last1 = Taniguchi | first1 = I. | last2 = Murakami | first2 = G. | last3 = Sato | first3 = A. | last4 = Fujiwara | first4 = D. | last5 = Ichikawa | first5 = H. | last6 = Yajima | first6 = T. | last7 = Kohama | first7 = G. | title = Lymph node hyalinization in elderly Japanese. | journal = Histol Histopathol | volume = 18 | issue = 4 | pages = 1169-80 | month = Oct | year = 2003 | doi = | PMID = 12973685 }}</ref> |
| *Prognosis - good.
| |
|
| |
|
| ===Microscopic=== | | ===Microscopic=== |
| Features: | | Features: |
| *Sinus histiocytosis: | | *Hyaline material (acellular pink stuff on H&E) within a [[lymph node]]. |
| **Histiocytes - abundant.
| |
| ***Singular large round nuclei<ref>DB. 24 August 2010.</ref> ~2x the size of resting lymphocyte.
| |
| ****Prominent nucleolus - visible with 10x objective.
| |
| ***Abundant cytoplasm.
| |
| *Emperipolesis (from ''Greek'': ''em'' = inside, ''peri'' = around, ''polemai'' = wander about<ref>Stedman's Medical Dictionary. 27th Ed.</ref>):
| |
| **Histiocytes contain other whole cells: neutrophils, lymphocytes, plasma cells.
| |
| ***The "eaten" cell is within a vacuole;<ref>{{cite journal |author=Viswanathan P, Raghunathan K, Majhi U, Pandit RV, Shanthi R, Rajkumar T|title=Emperipolesis : an electron microscopic characteristic in RDD (Rosai-Dorfaman disease) : a case report |volume= |issue=1|pages=14-6 |year=1997 |month= |pmid= |doi= |url=http://www.ijmpo.org/article.asp?issn=0971-5851;year=1997;volume=18;issue=1;spage=14;epage=16;aulast=Viswanathan;type=0}}</ref> thus, it should have a clear halo around it.
| |
| ***Thought to be related to ''peripolesis''; the attachment of a cell to another.<ref name=pmid1577151>{{cite journal |author=Lyons DJ, Gautam A, Clark J, ''et al.'' |title=Lymphocyte macrophage interactions: peripolesis of human alveolar macrophages |journal=Eur. Respir. J. |volume=5 |issue=1 |pages=59–66 |year=1992 |month=January |pmid=1577151 |doi= |url=}}</ref>
| |
|
| |
|
| Images:
| | Subdivided into:<ref name=pmid12973685/> |
| *[http://commons.wikimedia.org/wiki/File:Emperipolesis_-_very_high_mag.jpg Emperipolesis in SHML (WC)]. | | *Mediastinal-type. |
| *[http://commons.wikimedia.org/wiki/File:Rosai-Dorfman_disease_-_very_high_mag.jpg Rosai-Dorfman disease (WC)]. | | **Usually in medullary sinus. |
| *[http://commons.wikimedia.org/wiki/File:Rosai-dorfman.jpg Rosai-Dorfman disease - S100 showing emperipolesis (WC)]. | | **Onion peel-like appearance. |
| | *Pelvic-type hyalinization. |
| | **Discrete round, eosinophilic, glassy appearance at low power, whirled/fibrous at high power. |
| | **+/-Calcification. |
|
| |
|
| DDx: | | DDx: |
| *Other histiocytosis: | | *[[Amyloidosis]] - cotton candy-like appearance, usu. no calcifications. |
| **Langerhans cell histiocytosis.
| |
| **Erdheim-Chester disease.
| |
| *Infection, e.g. Rhinoscleroma (nasopharynx), xanthomatous pyelonephritis.
| |
| *Xanthomatous change.
| |
| | |
| ===IHC===
| |
| *CD68 +ve.
| |
| *S100 +ve.
| |
| **Useful for seeing emperipolesis.
| |
| *CD1a -ve.
| |
| **CD1a positive in Langerhans cell histiocytosis.
| |
| | |
| ==Langerhans cell histiocytosis==
| |
| {{Main|Langerhans cell histiocytosis}}
| |
|
| |
|
| ===Microscopic=== | | ====Images==== |
| Features:
| | <gallery> |
| *Langerhans cells histiocytes - '''key feature'''.
| | Image: Hyalinized lymph node -- intermed mag.jpg | Hyalinized LN - intermed. mag. |
| **Clusters of cells (histiocytes) with a reniform (kidney-shaped) nucleus and abundant foamy cytoplasm. | | Image: Hyalinized lymph node - alt -- intermed mag.jpg | Hyalinized LN - intermed. mag. |
| | Image: Hyalinized lymph node -- high mag.jpg | Hyalinized LN - high mag. |
| | Image: Hyalinized lymph node -- very high mag.jpg | Hyalinized LN - very high mag. |
| | </gallery> |
| | www: |
| | *[http://www.flickriver.com/photos/euthman/sets/72157594513987154/ Lymph node with amyloidosis - several images (flickriver.com)]. |
|
| |
|
| See ''[[Langerhans cell histiocytosis]]'' for details.
| | ===Sign out=== |
| | *Not reported. |
|
| |
|
| ==See also== | | ==See also== |
Line 534: |
Line 296: |
|
| |
|
| [[Category:Haematopathology]] | | [[Category:Haematopathology]] |
| | [[Category:Lymph node pathology|Lymph node pathology]] |