Benign/Reactive Lymphadenopathies

Question 1

Most of the B-cells that enter a follicle (or germinal center) do what?
Become memory B-cells
Become plasma cells
Undergo apoptosis
Re-arrange their VDJ regions
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Answer 1

Undergo apoptosis

Question 2

Of the following, in what anatomic location does VDJ gene rearrangement of B-cell receptors take place?
Bone marrow
Lymph node, paracortex
Lymph node, germinal center
Lymph node, mantle zone
Peripheral blood

Answer 2

Bone marrow

Question 3

Of the following, in what anatomic location does B-cell somatic hypermutation take place?
Bone marrow
Lymph node, paracortex
Lymph node, germinal center
Lymph node, mantle zone
Peripheral blood

Answer 3

Lymph node, germinal centers

Question 4

Maturity of WBCs has a positive or negative relationship with aggressiveness of malignancy?

Answer 4

Negative, an inverse correlation. The less mature the cell, the more aggressive the neoplasm.

Question 5

Which part of a lymph node expands in response to a typical viral infection?

Answer 5

paracortex

Question 6

Which of these is not a feature to be expected in a reactive lymph node?
Many germinal centers
Effacement of normal architecture
Paracortical expansion
Necrosis
Tingible body macrophages

Answer 6

effacement of normal architecture (malignancy)

note: necrosis could be due to lupus during a reactive episode. Necrosis is ALWAYS pathological

Question 7

In a reactive germinal center (one responding to an infection/inflammation) there are (more or less) mitoses?
In a malignant germinal center, a follicular lymphoma, there are (more or less) mitoses?

Answer 7

Reactive: more (still diversity of cell types present)
Malignancy: less (all look alike, not proliferating as rapidly)

Question 8

What changes would you expect to see in the lymph node under low power microscope in infectious mononucleosis?

Answer 8

paracortical expansion