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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

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
Steroids can decrease # of lymphoblasts! Take sample before giving lymphotoxic drugs
:)
26
Chars. Of FELINE lymphoma
- 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
3 forms of Feline GI (alimentary) lymphoma
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
CHars. Of alimentary feline lymphoma
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
Chars. Of feline hepatic lymphoma
- usually composed of small, well-diff. Lymphs | - similar to those seen in cats w/ lymphoplasmocytic cholangio-hepatitis
30
Chars. Of Feline Hodgkin's-like lymphoma
- 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
Distinctive Peripheral Lymph Node Hyperplasia (DPLH)
- 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
Chars. Of FeLV-assoc. lymphoma
- uncommon - younger cats - usually T cell
33
Lymphoma in ferrets
- 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
Lymphoma in horses
- 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
Lymphoma in ruminants
- 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
Bovine Leukosis (Leukemia) Virus-assoc. malignant lymphoma
-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
Most common malignancy in pigs
Multicentric lymphoma
38
Lymphoma in camelids
- multicentric - aggressive, poor prog. - B cell > T cell
39
Lymphoma in birds
- sporadic, oncovirus-assoc. | - T cell lymphoma assoc. w/ Marek's dz
40
MCT commonly met to regional LN
:)
41
Cytology of normal thymus
- small lymphs predominate - thymic epithelium - mast cells present in moderate #
42
Chars. Of thymic lymphoma
- lymphoblasts most commonly the neoplastic cell population | - assoc. with paraneoplastic hypercalcemia
43
Chars. Of thymoma
- thymic epithelium = neoplastic cell pop. | - assoc. with hypercalcemia, megaesophagus, myasthenia gravis
44
Normal spleen
- fibrovascular stroma (mesenchymal cells + phagocytes) - stored iron (hemosiderin) - mixed lymphoid pop. Similar to LN - extramedually hematopoiesis - erythroblastic islands feed iron
45
Potential pathologic findings in spleen aspirate
- benign hyperplastic splenic change or nodule - hemorrhage - hematoma - inflammation (splenitis) - increased EV RBC destruction - neoplasia
46
Types of neoplasia found in SP
- lymphoma/leukemia - hemangioma/sarcoma - other mesenchymal tumors - histiocytic sarcoma - PCT - metastatic tumors (ie. MCT, carcinomas, sarcomas, neuroendocrine)
47
Evidence of splenic hemorrhage on SP aspirate
Siderocalcific plaques

Cytodiagnostics (Spring 2016) (12 decks)

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