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Cytodiagnostics (Spring 2016) > L7: The Cytological Evaluation Of Lymphoid Tissue (Black) > Flashcards

L7: The Cytological Evaluation Of Lymphoid Tissue (Black) Flashcards

1
Q

Where do neoplastic cells usually enter the LN?

A

Through the afferent lymphatic into the cortex

-early metastatic dz often found in the subcapsular sinus

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2
Q

preferred aspiration/biopsy sites of LN

A

Popliteal and prescaps

-avoid: submandibular, centers of very large lymph nodes (may be necrotic)

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3
Q

Categories of lymph node

A
  • normal
  • reactive (lymphoid hyperplasia)
  • inflammation (lymphadenitis)
  • lymphoid neoplasia (lymphoma)
  • metastatic dz
  • edema (lymphedema)
  • hemorrhage
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4
Q

Sizing of lymphoid cells

A

Small: nucleus 1-1.4x RBC, dark purple chromatin
Intermediate: 1.5-2x
Large/lymphoblast: >2x, w/ variable chromatin lighter purple, variable distinct nucleoli

Normal LN has 75-90% small, 5-10% intermediate,

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5
Q

Typical appearance of plasma cells

A
  • royal blue cytoplasm
  • perinuclear clearing
  • eccentric round nucleus
  • cartwheel nucleus
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6
Q

Chars. Of reactive lymphoid hyperplasia

A
  • small, well-differentiated lymphocytes still predominate
  • increased intermediates
  • increased larges (but
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7
Q

Causes of LN enlargement

A
  • reactive lymphoid hyperplasia (2ary to regional antigenic stim.)
  • lymphadenitis (neutrophilic, eosinophilic, pyogranulomatous)
  • lymphoma
  • metastatic neoplasia
  • edema (lymphedema)
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8
Q

Types of lymphadenitis

A
  • neutrophilic
  • eosinophilic
  • pyogranulomatous
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9
Q

Chars. Of neutrophilic lymphadenitis

A

> 5% nucleated cells neuts

-Etiology: bacterial, necrosis, draining area of trauma, neoplasia (SCC), immune-mediated

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10
Q

Chars. Of eosinophilic lymphadenitis

A

> 3% eosinophils

-etiology: parasitic, hypersensitivity, MCT, T cell lymphoma, some carcinomas, feline eosinophilic skin dz, etc.

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11
Q

Chars. Of pyogranulomatous lymphadenitis

A
  • aka histiocytic lymphadenitis
  • macs overrepresented
  • MNGcs
  • etiology: atypical bacteria, fungal, protozoal, salmon fluke poisoning dz, FIP, prototheca, oomycete, neoplastic, vasculitis, hemosiderosis, etc.
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12
Q

Chars. Of Reactive lymphoid hyperplasia

A
  • POLYCLONAL lymphocyte proliferation induced by infectious, auto-immune dz, etc.
  • results in PLEOMORPHIC lymphoid pop.
  • multiple nodes affected
  • many etiologies possible
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13
Q

Chars. Of Lymphoma

A

-neoplastic transformation and unregulated growth of lymphocytes
-MONOCLONAL/MONOMORPHIC population
-presence of aberrant markers
-loss of polymorphism
-usually >50% lymphoblasts (suspicious when >30%)**
-

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14
Q

Differentiating b/w benign and neoplastic lymphoid proliferation: presence of LGL in circulation could be?

A

E. Canis or leukemia

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15
Q

lymphocyte-rich thoracic fluid with a mediastinal mass could be?

A

Chylous effusion

Small cell lymphoma or thymoma

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16
Q

predominance of lymphoblasts in splenic aspirate could be either:

A

Germinal center of lymphoid follicle or lymphoma

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17
Q

presence of expanded small lymph. Pop. In feline GI aspirate could be either:

A

Inflamm. Bowel dz.

Small cell lymphoma

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18
Q

Tests to differentiate lymphoma vs. reactive lymphoid hyperplasia

A

PARR
Flow cytometry
Histopath
Immunohistochemistry

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19
Q

PARR =

A

PCR for Ag receptor rearrangement

  • determines clonality of lymphocytes present
  • detects T cell receptors in T cells and immunoglobulin receptors in B cells
  • 75-80% sensitivity in dogs
  • 60-65% sensitivity in cats
  • chronic Ag stim. Can cause false positives
20
Q

Immunophenotyping

A
  • IDs phenotype of cells for prognostication
  • est. degree of lymphoid diversity and marker abnormalities w/n a population
  • includes flow cytometry, IHC, ICC
21
Q

Hypercalcemia of malignancy

A
  • paraneoplastic syndrome
  • assoc. with T cell lymphoma
  • tumor cells produce PTHrp
  • assoc. with poorer prognosis
22
Q

Hyperglobulinemia

A
  • paraneoplastic syndrome assoc. w/ myelomas or some B cell lymphomas
  • excess prod. Of immunoglobulin heavy chains and/or light chains
23
Q

Canine lymphoma most often presents as multicentric lymphoma and is most common lymphoma in dogs

A

:)

24
Q

Predominant cell type in canine lymphoma

A

Immature large lymphocytes (lymphoblasts)

  • deeply basophilic cytoplasm
  • 2-5x size of RBC
  • diffuse chromatin
  • occasional perinuclear clear zone
25
Q

Steroids can decrease # of lymphoblasts! Take sample before giving lymphotoxic drugs

A

:)

26
Q

Chars. Of FELINE lymphoma

A
  • same dx criteria
  • > 50% lymphoblasts
  • most DON’T involve peripheral LN
  • “distinctive peripheral LN hyperplasia” can mimic
  • usually see more well-differentiated lymphs
  • forms: alimentary (most common), hepatic, Hodgkin’s-like, and FeLV-associated
27
Q

3 forms of Feline GI (alimentary) lymphoma

A

3 forms:

1) Small cell
- older FeLV cats
- FelV
- looks like IBD; requires histopath
2) Large granular
- hepatic involvement
- originates as intestinal intraepithelial lymphocytes (cytotoxic T cell or NK cell)**
- focal accumulation of eccentric granules**
- granules don’t stain in Diff Quick
- may be confused with MCT
3) Large cell
- usually B cell
- may present as a mass

28
Q

CHars. Of alimentary feline lymphoma

A

Aspirates of hepatic, mediastinal, internal LN, nasal, KID, CNS, laryngeal and tracheal, ocular, retrobulbar, and skin yields dense pop. Of lymphoid cells

  • primarily lymphoblasts
  • 3 forms
29
Q

Chars. Of feline hepatic lymphoma

A
  • usually composed of small, well-diff. Lymphs

- similar to those seen in cats w/ lymphoplasmocytic cholangio-hepatitis

30
Q

Chars. Of Feline Hodgkin’s-like lymphoma

A
  • better prognosis
  • older cats
  • affects LN on the head/neck
  • may have mediastinal or thoracic mass
  • requires histo dx and IHC
  • neoplastic are NOT predominant (only 1-5%); look similar to macs
31
Q

Distinctive Peripheral Lymph Node Hyperplasia (DPLH)

A
  • YOUNG cats
  • mimics multicentric lymphoma**
  • no specific etiology
  • cytology: inc. lymphoblasts, dec. small and intermediate lymphs, few plasma cells
  • usually self-limiting
  • generalized lymphadenopathy
32
Q

Chars. Of FeLV-assoc. lymphoma

A
  • uncommon
  • younger cats
  • usually T cell
33
Q

Lymphoma in ferrets

A
  • adult and older usually
  • diffuse dz
  • GI and multicentric more common
  • frequently involves SP and mesenteric LN
  • T cell more common than B cell
  • Hodgkin’s-like lymphoma can occur in ferrets
34
Q

Lymphoma in horses

A
  • multicentric: thoracic and abd cavities, GI, and cutaneous dz most common
  • peripheral lymphadenomegaly NOT common
  • dependent edema common
  • T cell rich large B cell lymphoma most common form in horses (can cause waxing and waning serum progesterone conc.); requires histo
35
Q

Lymphoma in ruminants

A
  • either BLV/EBL-related or sporadic
  • juveniles more likely to get sporadic multicentric form
  • young >6mo - 2yr more likely to get sporadic thymic form –> resp. Distress, weight loss, cervical masses
  • cutaneous RARE
36
Q

Bovine Leukosis (Leukemia) Virus-assoc. malignant lymphoma

A

-aka “Enzootic Bovine Lymphoma”
-causes enlarged superficial and visceral LN, thymus, skin, abomasum, HT, SP, KID, etc.
-a cell-associated provirus that infects B cells
-integrates into host’s cell genome
-trans. By exposure to infected B lymphs
-

37
Q

Most common malignancy in pigs

A

Multicentric lymphoma

38
Q

Lymphoma in camelids

A
  • multicentric
  • aggressive, poor prog.
  • B cell > T cell
39
Q

Lymphoma in birds

A
  • sporadic, oncovirus-assoc.

- T cell lymphoma assoc. w/ Marek’s dz

40
Q

MCT commonly met to regional LN

A

:)

41
Q

Cytology of normal thymus

A
  • small lymphs predominate
  • thymic epithelium
  • mast cells present in moderate #
42
Q

Chars. Of thymic lymphoma

A
  • lymphoblasts most commonly the neoplastic cell population

- assoc. with paraneoplastic hypercalcemia

43
Q

Chars. Of thymoma

A
  • thymic epithelium = neoplastic cell pop.

- assoc. with hypercalcemia, megaesophagus, myasthenia gravis

44
Q

Normal spleen

A
  • fibrovascular stroma (mesenchymal cells + phagocytes)
  • stored iron (hemosiderin)
  • mixed lymphoid pop. Similar to LN
  • extramedually hematopoiesis
  • erythroblastic islands feed iron
45
Q

Potential pathologic findings in spleen aspirate

A
  • benign hyperplastic splenic change or nodule
  • hemorrhage
  • hematoma
  • inflammation (splenitis)
  • increased EV RBC destruction
  • neoplasia
46
Q

Types of neoplasia found in SP

A
  • lymphoma/leukemia
  • hemangioma/sarcoma
  • other mesenchymal tumors
  • histiocytic sarcoma
  • PCT
  • metastatic tumors (ie. MCT, carcinomas, sarcomas, neuroendocrine)
47
Q

Evidence of splenic hemorrhage on SP aspirate

A

Siderocalcific plaques

Cytodiagnostics (Spring 2016) (12 decks)

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