Anatomical Pathology Flashcards
What are the infective causes of Granulomatous lymphadenitis?
Mycobaterial infection
Toxoplamosis- Toxoplasma Gondii
What are the non-infective causes of Granulomatous lymphadenitis?
Sarcoidosis (schuamann bodies)
Crohn’s disease
reaction to tumour antigen
foreign body reaction - often occurs as a response to silicone compounds used in plastic surgery and joint replacement
What are the infective causes of necrotizing lymphadenitis?
Lymphogranuloma venereum- Chlamydial
Cat scratch disease- Bartonella henselae
Virus-herpes and CMV
What are the non-infective causes of necrotizing lymphadenitis?
Kikuchi’s disease
Systemic lupus erythematosus
What are the infective causes of Follicular hyperplasia?
Syphillis
What are the non-infective causes of Follicular hyperplasia?
Rheumatoid Arthritis
Describe the histological features of HIV-associated lymphadenopathy.
initially, follicles are hyperplastic and often markedly irregular in shape
Florid reactive hyperplasia (may be serrated, serpentine, or dumb-bell shaped)
containing macrophages and plasma cells
in some follicles, there is focal destruction of the dendritic reticulum cell meshwork which is associated with an invagination/implosion of mantle zone lymphocytes into germinal centers (‘follicular-lysis’)
imparts a moth-eaten appearance also called explosive follicular hyperplasia
later stages – eventual profound loss of germinal centre B-cells and depletion of paracortical T-cells
May have other opportunistic infections/malignancies present e.g. TB,CMV, Kaposi sarcoma, lymphoma
What are the risk factors associated with lymphomas?
- Infection.
- Cachexia.
- Organ infiltration e.g. lungs.
- Complications of treatment.
- specifically related to therapeutic measures.
– Corticosteroids and immunosuppressives
– Endocrine dysfunction
Second malignancies: acute myeloid leukemia, high-grade non-Hodgkin lymphomas, bone and soft tissue sarcomas, and breast cancer.
- specifically related to therapeutic measures.
What are the risk factors associated with non-Hodgkins?
Viruses e.g. EBV, HTLV1, HHV8, HIV
Immunodeficiency
Primary – X-linked immunodeficiency
Secondary – AIDS, transplantation
Discuss the epidemiology of Burkitt’s Lymphoma.
Endemic - most common in Central Africa. Children 4-8 yrs. Presents with enlarged jaws, ovaries. Nodal enlargement not characteristic. Strong association with EBV infection.
Non-Endemic (Western) - intestinal involvement is most common (ileum) with mesenteric nodes. Older children,
AIDS associated
Describe how Hodgkins Lymphoma spreads.
Hodgkin lymphoma is a disease that spreads predominantly through lymphatics, and the tendency in most cases is for the tumour to spread to contiguous groups of lymph nodes.
Define Hypersplenism and list its treatment.
the term is applied to an association between peripheral blood pancytopenia and splenic enlargement
Splenectomy
Describe the morphology of congestive splenomegaly.
Cut Surface
beefy-red colour with inconspicuous white pulp
contains scattered firm brown nodules – Gamna Gandy bodies - represent areas of healed infarction - composed of fibrous and elastic tissue with abundant haemosiderin and dystrophic calcification
Describe how a systemic infection would affect the spleen.
may cause moderate splenomegaly
characterised by congestion and macrophage hyperplasia
white pulp- usually prominent
Describe how a bacterial infection would affect the spleen.
in response to infections e.g. bacterial endocarditis or localised abscesses
neutrophils can accumulate in the sinuses and medullary cords
if extreme – ‘acute septic splenitis’
becomes soft because of proteolytic enzyme action
