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FIP > 21. Benign Lymphoid Proliferations > Flashcards

21. Benign Lymphoid Proliferations Flashcards

1
Q

List the lymphoid organs

A
  1. lymph nodes
  2. spleen
  3. thymus
  4. bronchial associated lymphoid tissue (BALT)
  5. gastrointestinal associated lymphoid tissue (GALT)
  6. Waldeyer ring
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2
Q

Examples of primary lymphoid tissues

A
  1. T cells
    - cell mediated immunity
    - matured in thymus
  2. B cells
    - humoral immunity
    - matured in bone marrow
  3. Null cells
    - not B or T cell marker responsive
  4. NK cells
    - may react with T cells
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3
Q

What is lymphopenia

A

abnormally low levels of lymphocytes

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4
Q

Causes of lymphopenia

A
  1. advanced HIV infection
  2. congenital immune deficiency syndrome
  3. steroid
  4. chemotherapeutic drugs
  5. autoimmune diseases
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5
Q

What is lymphocytosis

A

excessive level of lymphocytes

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6
Q

Causes of lymphocytosis

A
  1. viral infection (most often)
    - infectious mononucleosis
  2. bacterial infections (rare)
    - whooping cough
    - TB
    - brucellosis
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7
Q

Type of lymphocytes in blood

A
  1. T lymphocyte
  2. B lymphocyte
  3. Null cells
  4. NK cells
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8
Q

How do we recognise lymphocytes as either T or B or null

A

immunohistochemistry or flow cytometry

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9
Q

Types of WBC neoplastic disorder

A
  1. leukemia
    - cancer of bone marrow, blood, blast cells
    - acute/chronic and myeloid/lymphoid
    - if myeloid/lymphoid cells become malignant, it is known as ‘blasts’
  2. lymphomas
    - lymph nodes, tumour
    - Hodgkins, non-Hodgkins (myeloma)
  3. premalignant conditions
    - myeloproliferative syndrome
    - myelodysplastic syndrome
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10
Q

Basic lymphocyte markers

A
  1. CD45 stains most lymphocytes
  2. T-lymphocyte - CD20, CD79
  3. B-lymphocyte - CD3, CD2, CD4, CD5, CD8
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11
Q

Explain T-cell cytotoxicity

A
  1. cytotoxic T-cell
    - in infected cell, antigen associates with class I MHC molecule
    - T cell recognises the combination
  2. T helper cell
    - in antigen presenting cell, antigen associates with class II MHC molecule
    - helper T cell recognises the combination
    - activate B cells
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12
Q

Explain B-cell immunity

A
  1. antigen recognition
  2. activation of B lymphocytes
  3. Proliferation
  4. differentiation
    outcome:
    a) antibody secretion by antibody secreting plasma ceells
    b) isotope switching by IgG-expressing B cell
    -IgM to IgG
    c) Affinity maturation by high-affinity IgG-expressing B cell
    d) memory B cell by high-affinity IgG-expressing B cell
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13
Q

Types of mononuclear phagocytic cells

A
  1. monocytes
    - differentiate into macrophages
  2. histiocytes
    - phagocytosis and cytokine production
  3. macrophage
    - histiocytes with more phagocytic function
  4. multinucleated giant cell
  5. dendritic cell
    - antigen presenting cell to T cell
  6. langerhan cell
    - antigen presenting cell
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14
Q

What are the clinical signs of lymphoid tissue proliferation

A
  • lymphadenopathy
  • splenomegaly
  • hepatomegaly
  • thymic enlargement
  • marrow expansion
  • masses in naropharynx, GIT
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15
Q

Clinical features of lymphoid tissue proliferation

A
  1. Malignant
    - single, firm, painless large node
  2. Benign
    - soft, tender node
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16
Q

Causes of an enlarged node

A
  1. Benign
    - benign reactive hyperplasia
  2. Malignant
    - primary lymphoma/leukemia
    - secondary malignancy
    - metastatic carcinoma
    - metastatic sarcoma
    - metastatic melanoma
17
Q

What are the patterns in a benign reactive lymph node

A
  1. cortex follicular hyperplasia
    - mainly B cells
  2. sinus histiocytosis
    - dilated sinuses, containing histiocytes, lymphocytes, antigen presenting cells
  3. paracortical hyperplasia
    - mainly T cells
  4. granulomatous reaction
    - TB, sarcoidosis, Crohn’s disease, foreign body reaction, syphilis, connective tissue disorder
18
Q

What is follicular hyperplasia

A

Activation of B cells within germinal centre formation in cortex of node

  • non specific reaction
  • infection/immune stimulation
19
Q

Causes of benign reactive node

A
  1. infection
    - bacterial
    - viral
    - parasitic
    - protozoal
  2. granulomas
    - TB
    - sarcoidosis
    - Crohn’s disease
    - histoplasmosis
    - bruncellosis
    - infectious mononucleosis
    - syphilis
    - cat scratch disease
  3. deposits
    - amyloidosis
  4. immune reaction
    - rheumatoid arthritis
    - systemic lupus erythematosus
  5. storage disorders
    - Gaucher’s disease
20
Q

What is

a) acute reactive lymphadenitis
b) chronic reactive lymphadenitis

A

a) lymphadenopathy usually secondary to bacterial or viral infection in the area drained by the lymph node
- clinically enlarged and tender
b) response to chronic antigen exposure
- e.g. collagen vascular disease

21
Q

Histological features of actue reactive lymphadenitis

A
  • preservation of the architecture
  • follicular hyperplasia
  • neutrophilic infiltrate and abscess formation
22
Q

Example of collagen vascular disease/Immune-mediated disease

A
  1. RA
    - generalised lymphadenopathy
    - follicular hyperplasia
  2. Sjoren’s syndrome
    - follicular hyperplasia
    - increased risk of lymphoma
  3. SLE
    - cervical lymphadenopathy
    - follicular hyperplasia
23
Q

Types of granuloma

A
  1. Caseating
    - TB
    - fungal infections - histoplasmosis, cryptococcus, blastomycosis, cat scratch disease
    - rheumatoid nodules
    - Wegener’s granulatosis
  2. Non-caseating
    - sarcoid
    - beryllium
    - hypersensitivity
    - drug reactions
    - leprosy
    - Crohn’s disease
    - chronic granulomatous disease
    - Hodgkins lymphoma

FIP (24 decks)

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