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Pathology > Lymph > Flashcards

Lymph Flashcards

1
Q

Describe the normal function and anatomy of lymph nodes

A
  • Normal lymphoid tissue= muscosa of gut, salivary glands and resp tract
  • Haemopoeitic system= lymph nodes spleen bone marrow
  • Has a cortex with primary and secondary follicles containing B cells
  • Medulla has lymph sinuses blood vessels and b cell components
  • Lymph carries antigens from afferent lymphatic to intranodal sinuses to exit via efferent lymphatic into medulla
  • T cells found in follicles in medulla for cell mediated response -
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2
Q

Describe the features and causes of lymphadenopathy

A
  • In response to an antigen or can be caused by lymphoma/ metastatic cancer
  • Can be localised or generalised

Causes
Infectious disease - Viral : Infectious mononucleosis , hepatitis, HIV, measles, rubella
-Bacterial: Streptococci, Brucellois, TB, Syphilis
-Fungal: Histoplasmosis, cryptococcosis
-Chlamydia:
-Parasitic : Toxoplasmosis

Immune disorders: RA, SLE, primary biliary cirrhosis, Drug hypersensitivity, graft vs host disease

Malignancy

Others: Sarcoid, dermatopathic lymphadenitis

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3
Q

What investigations would you conduct in lymphadenopathy

A
  • General examination of all lymph nodes and ENT examination
  • Full blood picture
  • Serology - EBV, CMV, HIV, Toxoplasma, ANA , Anti ds DNA
  • CXR, USS, CT MRI, PET - size and extent of lymph node enlargement and organ abnormalities
  • Fine needle aspiration cytology and biopsy
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4
Q

What are some non-neoplastic conditions that can cause lymphadenopathy

A
  • Hyperplasia
  • Acute non-specific lymphadenitis- staph infection, typhoid, anthrax
  • Chronic non-specific lymphadenitis
  • Granulomatous inflammation - sarcoid, TB, fungal infection , Hodgkin’s, Crohns
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5
Q

Describe the features of infectious mononucleosis

A
  • Young adults and children
  • Fever, sore throat, lymphadenopathy, splenomegaly
  • Monospot test serology: Anti EBV antibodies
  • Peripheral blood: Atypical lymphocytes
  • Biopsied only when clinical features are atypical/ suspicious of malignancy
  • Follicular and sinus hyperplasia with plasma cells and immunoblasts
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6
Q

Describe the features of sarcoidosis

A
  • Common in scandainavia and african americans
  • Non specific clinical features
  • Can involve any organ most common= lungs, lymph nodes, eyes ,skin, liver
  • Histology shows: Non-caseating granulomata, eputhelioid cells, Lanhhan’s giant cells and lymphocytes. Asteroid bodies - calcified structures
  • Will have raise ACE and serum calcium
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7
Q

What is the difference between lymphoma and leukaemia

A
  • Lymphoma- solid tumour - nodules or localised masses

- Leukaemi- liquid tumour- systemic and diffuse at outset- mainly based in bone marrow and can evolve in lymph nodes

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8
Q

Discuss the features of Hogkin’s lymphoma

A
  • 2 diseases - classical hodgkin lymphoma, and nodular lymphocyte predominant hodgkin lymphoma
  • These 2 diseases have different RS cells, different clinical presentation and different site involvement
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9
Q

What are the more aggressive vs indolent forms of non-hodgkins lymphoma

A

Indolent

  • Lymphocytic lymphoma (B)
  • Follicular lymphoma (B)
  • Longer survival

Aggressive

  • Lymphoblastic lymphoma (B or T)
  • Burkitt’s lymphoma (B)
  • Diffuse large B-cell lymphoma (B)
  • Mantle cell lymphoma (B)
  • More chance of cure
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10
Q

Describe the molecular pathology behind lymphomas

A
  • Lymphomas come from a single cell and are clonal proliferations with either antigen receptor (T cell) or immunoglobulin (B cell) gene rearrangements
  • B non hodgkins lymphoma is far more common
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11
Q

Describe the features of Chronic lymphocytic leukaemia / small lymphocytic lymphoma

A
  • Commonest leukaemia
  • Usually around 60 yrs and more common in males
  • Asymptomatic
  • Lymphadenopathy and hepatosplenomegaly
  • Autoimmune abnormalities: Hypogammaglobulinaemia, thrombocytopenia and haemolytic anaemia
  • Morphology: Small lymphocytes, tumour cells stain with CD5 and pan B markers
  • Trisomy 12 del 13q
  • Absolute lymphocytosis (increased lymphocytes on FBC
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12
Q

Describe the features of follicular lymphoma

A
  • 45% adult NH lymphomas
  • Painless lymphadenopathy, lndolent disease, middle aged
  • Involves speen, BM and liver
  • Tumour B cells called centoblasts and centrocytes express CD10 and bca2 and pan B markers
  • Molecular abnormality- t14;18- blocks apoptosis so increased cell survival
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13
Q

Describe the features of mantle cell lymphoma

A
  • Made of small cells but aggressive
  • Involvement of peripheral blood, bone marrow, lymph nodes and spleen
  • Rarer form of NHL
  • GI involvement forms polyps
  • Generalised enlarged lymph nodes and spleen
  • Proliferation of small lymphoid cells that stain with pan B, CD5 and cyclin D1
  • T (11:14) leading to expression of cyclin D1
  • Poor prognosis
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14
Q

Describe the features of Burkitt’s lymphoma

A
  • HIV associated
  • Can present as leukaemia or lymphoma - nodal or extra nodal abdominal disease
  • Children young adults with jawbone mass, ilieocaecal mass
  • Intermediate cells with rapid division and macrophages- very high turnover - stain with pan B, CD10 and surface IgM
  • Cured with high dose aggressive chemo
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15
Q

Describe the features of diffuse large B cell lymphoma

A

Aggressive
Any age
large b cells, diffuse growth pattern and express pan B antigens
T(14:18) or Bcl6 gene abnormality
-Speical types are AIDS related or body cavity based d

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16
Q

Describe the features of T cell lymphoma

A
  • Less common and more aggressive
  • Worse than B cell NHL
  • Lymphadenopathy , skin rash, pruritits , weight loss , fever
  • All tumours will show T cell receptor rearrangement and express pan T(CD3 and CD2)
  • Types of T cell lymphoma: Mycosis fungicides, peripheral TCL
17
Q

Describe the features of Hodgkin’s lymphoma

A

Reed sternberg cells= classical

  • 2 types- Nodular lymphocyte predominant HL (stain with CD 20 and B cell markers) and classical HL (stain with CD15 and CD30)
  • Most are B cell lymphomas but don’t all express B cell markers
18
Q

Describe the features of classical hodgkins lymphoma

A

4 variants that all stain with CD15 and CD30

  1. Nodular sclerosis: Young adults and women- lower cervical, supraclavicular and mediastinal lymph nodes - very good prognosis- lacunar RS cells and sclerotic bands
  2. Mixed cellularity- heterogeneous cellular infiltrate- overall good prognosis class RS cells

3, Lymphocyte rich- Isolated cervical or axillary lymphadenopathy - very good prognosis RS cells that remember histiocytes

  1. Lymphocyte depleted- poorer prognosis higher stage in older men
19
Q

How is Hodgkins / non Hodgkins nodes staged

A

-Ann Arbor staging system

Stage 1 - A single lymph node, region or organ
Stage 2- 2 or more LN regions on the same side of the diaphragm
Stage 3- Both sides of diaphragm affects +/- the spleen or extra lymphatic organ
Stage 4- Disseminated disease and bone marrow involvement

A- absence of constitutional symptoms
B-presence of constiutional symptoms - fever night sweats weight loss

20
Q

Discuss the factors of acute lymphoblastic leukaemia

A

Children and young adults
Most have blood and bone marrow involvement- bone marrow pain and failure - Pre b cells
Adolescent boys with mediastinal mass- Pre T cells
Blast cells on morphology
Translocations of t12:21, t9;22 and more
Abrupt onset, marrow failure, bone pain , LN testes and CNS involved

21
Q

Describe the features of myeloma

A
  • Tumour of plasma cells
  • Older adults - presentation= bone infiltration, pathological fractures, pain, hypercalcaemia
  • Immunosupression and infection
  • Excess production and immunoglobulins - renal failure and amyloidosis
  • Bone marrow replacement- anaemia, thrombocytopenia, leukopenia
  • Morphology: Sheets or mature and immature plasma cells in bone marrow
  • Urine will show Bence-jones proteins, M component (IgG or IgA) decreased normal immunoglobulins

Pathology (12 decks)

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