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Pathology > Lymph Node > Flashcards

Lymph Node Flashcards

1
Q

What is contained in the cortex of the lymph node?

A

primary and secondary folliclesB-cells

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2
Q

What is contained in the medulla of lymph nodes?

A

lymph sinuses
blood vessels
small B-cell component

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3
Q

What is contained in the paracortex of lymph nodes?

A

mobile T lymphocyte pool

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4
Q

What is the function of lymphocytes?

A

long term constant defence by recognising self from non-self

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5
Q

How does lymph travel through the node?

A

through afferent vessels in the cortex, through the sinuses and exits through efferent vessels in medulla

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6
Q

How does lymph travel through the node?

A

through afferent vessels in the cortex, through the sinuses and exits through efferent vessels in medulla

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7
Q

What does lymph carry?

A

antigens

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8
Q

What do follicles or germinal centres contain?

A

large B cells (centroblasts) which mature into smaller B cells (centrocytes)

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9
Q

What causes B cells to divide and mature in follicles?

A

encountering antigens

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10
Q

What happens mature B cells

A

differentiate into plasma cells outside the follicles

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11
Q

What do plasma cells do?

A

produce antibodies

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12
Q

How do T cells work?

A

help B cells organise an antibody responsehave receptors that cause cell damage to the affected organs

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13
Q

Where are T cells found in the node?

A

between follicles and medulla (paracortex)

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14
Q

Where are macrophages in the node?

A

between sinuses and follicles

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15
Q

What stain is used to asses the lymph arcitecture?

A

H&E

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16
Q

What is immunochemistry?

A

use commercially available antibodies to detects antigens expressed on cell surfaces, cytoplasm or nucleus

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17
Q

What antibodies are on B cells?

A

CD19, 20 and 79asurface immunoglobulin

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18
Q

What antibodies are on T cells?

A

CD3, 4 and 8

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19
Q

Causes of lymphadenopathy

A

viralbacterialfungalchlamydiaparasiticrickettsialimmunologicmalignancy

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20
Q

Viral causes of lymphadenopathy

A

infectious mononucleosishepatitisHIVmeaslesrubella

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21
Q

Bacterial causes of lymphadenopathy

A

streptococcibucellosisTBsyphilis

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22
Q

Fungal causes of lymphadenopathy

A

histoplasmosiscryptococcosis

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23
Q

Chlamydia cause of lympohadenopathy

A

lymphogranuloma venereum

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24
Q

Parasitic cause of lymohadenopathy

A

toxoplasmosis

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25
Q

Rickettsial cause of lymophadenopathy

A

scrub typhus

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26
Q

Immunologic causes of lymphadenopathy

A

rheumatoid arthritisSLEprimary biliary cirrhosisdrug hypersensitivitygraft verseus host disease

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27
Q

Malignant causes of lymohadenopathy

A

haematologicalmetastases from other sites

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28
Q

Other causes of lymphadenopathy

A

sarcoidosisdermatopathic lymphadenitis

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29
Q

Investigations in lymphadenopathy

A

general and ENT examinationFBPserologychest X rayUSSCTMRIPETFNA and biopsy

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30
Q

Name the structures

A

largest cells: centroblastssmallest cells with dark nucleus and minimal cytoplasm: mature lymphocytes white arrow: centrocyte

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31
Q

What kinds of lymph hyperplasia are there?

A

follicularparacorticalsinuscombination

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32
Q

What happens in follicular hyperplasia?

A

follicular pattern accentuates

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33
Q

What happens in paracortical hyperplasia?

A

expansion of lymph node medulla

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34
Q

What happens in sinus histiocytosis?

A

infiltration of sinuses by histocytes

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35
Q

How do lymph nodes become perulent?

A

pus-filled nodes are seen after bacterial infection due to infiltration of neutrophils

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36
Q

What is a granuloma?

A

discrete collection of macrophages

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37
Q

When are granulomas seen in lymph nodes?

A

TBsarcoidosis

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38
Q

Who is mainly affected by infectious mononucleosis?

A

children and young adults

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39
Q

Clinical features of infectious mononucleosis

A 
fever
sore throat
lymphadenopathy
splenomegaly
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40
Q

Monospot test for infectious mononucleosis? (Serology findings)

A

anti EBV antibodies

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41
Q

What is seen in peripheral blood in infectious mononucleosis?

A

atypical lymphocytes

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42
Q

When is infectious mononucleosis biopsied?

A

when clinical features are atypical

when malignancy is quieried

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43
Q

What type of hyperplasia is seen in infectious mononucleosis?

A

follicular and sinus hyperplasia

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44
Q

What cells are involved in follicular and sinus hyperplasia in infectious mononucleosis?

A

plasma cells and immunoblasts

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45
Q

What lymphopathology is seen in the picture?

A 
infectious mononucleosis
large blast-like cells 
some small lymphocytes
plasma cells
blood vessels
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46
Q

Where does sarcoidosis commonly affect?

A

lungs
eyes
skin
lymph nodes

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47
Q

Who is commonly affected by sarcoidosis?

A

african americans

scandinavians

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48
Q

What is seen in histological diagnosis for sarcoidosis?

A

non-caseating or non-necrotic granulomata

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49
Q

What makes up the non-caseating granulomata in sarcoidosis?

A

epithelioid histocytes
Langerhans giant cells
sometimes calcified structures called asteroid bodies or Schaumann bodies

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50
Q

What laboratory abnormalities are seen in Sarcoidosis?

A

raised ACE levels

raised calcium levels

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51
Q

What diagnosis is seen in the picture?

A

sarcoidosis

single granulomata with ark central asteroid body

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52
Q

What condition is seen in the picture?

A

sarcoidosis

multiple pale discrete granulomas replacing normal lymph node

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53
Q

What is a lymphoma?

A

solid tumour of lymph nodes

tumour nodules]localised masses initially

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54
Q

What is a leukaemia?

A

liquid tumour
primarily based in bone marrow but can include lymph nodes
systemic and diffuse at outset

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55
Q

What are the 2 mai classes of lymphomas?

A

Hodgkin’s and Non-Hodgkins

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56
Q

What is the Reed-Sternberg (RS) cell?

A

distinctive neoplastic cell in Hodgkin’s lymphoma

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57
Q

What is Hodgkin’s lymphoma further divided into?

A

nodular lymphocyte predominant Hodgkin lymphoma and classical Hodgkin lymphoma

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58
Q

Morphological variants of Hodgkin lymphoma?

A

nodular sclerosing
lymphocyte rich
lymphocyte depleted
mixed cellularity

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59
Q

What is the behaviour of NH lymphoma?

A

clinically aggressive

indolent (causing little or no pain)

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60
Q

Lineage of NH lymphoma

A

T and B cell

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61
Q

Growth pattern of NH lymohoma

A

follicular

diffuse

62
Q

What are the indolent NH lymphomas?

A 
lymphocytic lymphoma (B)
follicular lymphoma (B)
63
Q

What are the aggressive NH lymphomas?

A

lymphoblastic lymphoma (B or T)
Burkitt’s lymphoma (B)
diffuse large B-cell lymphoma (B)
mantle cell lymphoma (B)

64
Q

What are the small lymphoid cells in B-cell NH lymphoma?

A

small lymphocytic lymphoma
mantle cell lymphoma
follicular lymphoma

65
Q

What is the lymphoma with intermediate cell size?

A

Burkitt’s lymphoma

66
Q

What is the large cell NH B lymphoma?

A

diffuse large B-cell lymphoma

67
Q

What is the most common leukaemia?

A

chronic lymphocytic leukaemia (CLL) / small lymphocytic lymphoma

68
Q

What is the absolute lymphocyte count in CLL?

A

> 4000/mm^3

69
Q

M:F ratio in CLL

A

2:1

70
Q

What are symptoms like in CLL?

A

often asymptomatic

71
Q

Physical examination findings in CLL?

A

lymphadenopathy

splenomegaly

72
Q

Haematological findings in CLL?

A

haemolytic anaemia
thrombocytopaenia
hypogammaglobulinaemia

73
Q

Morphological findings in peripheral blood/lymph node in CLL?

A

small mature lymphoid cells seen with larger cells (pro-lymphocytes)
tumour cells stain positively with CD5 and B-cell antibodies

74
Q

What is the frequently assoociated molecular abnormality seen?

A

trisomy 12

deletion 13q

75
Q

Median survival of CLL?

A

4-6 years

76
Q

What can CLL transform into?

A

more aggressive large cell lymphoma

77
Q

Follicular lymphoma frequency?

A

<45% adult lymphomas

78
Q

How does follicular lymphoma present?

A

painless lymphadenopathy

79
Q

What organs are involved in follicular lymphoma?

A

spleen
liver
bone marrow

80
Q

What are the tumour B cells in follicular lymphoma?

A

centroblasts

centrocytes

81
Q

What is expressed on tumour B cells in follicular lymphoma?

A

CD10
BCL2
pan B-cell markers

82
Q

What is the molecular abnormality in follicular lymphoma?

A

t(14:18)

83
Q

What does the t(14:18) in follicular lymphoma cause?

A

overexpression of BCL2

84
Q

What does overexpression of BCL2 cause in follicular lymphoma?

A

blocks apoptosis and causes increased cell survival

85
Q

What is the prognosis for follicular lymphoma?

A

non-curable disease
median survival 10 years
transformation to diffuse large B-cell lymphoma in 30-50%

86
Q

What kind of lymphoma is mantle cell lymohoma?

A

small cell agressive

87
Q

What is involved in mantle cell lymphoma?

A

peripheral blood
bone marrow
lymph nodes
spleen

88
Q

What is it called when the GI tract is involved in mantle cell lymphoma?

A

lymphomatoid polyposis (polyps)

89
Q

What is the molecular feature of mantle cell lymphoma?

A

t(11:14)

90
Q

What do the small lymphoid cells express in mantle cell lymphoma?

A

pan B
CD5
cyclin D1

91
Q

What does the t(11:14) cause in mantle cell lymphoma?

A

over-expression of cylcin D1

92
Q

What kind of lymphoma is Burkitt’s lymphoma?

A

intermediate cell size

aggressive but potentially curable

93
Q

How does Burkitt’s lymphoma present?

A

leukaemia or lymphoma

predominantly nordal or extra nodal (abdominal disease)

94
Q

Where is Burkitt’s lymphoma endemic

A

areas of Africa seen in children

95
Q

What part of the body is involved in Burkitt’s lymphoma in children?

A

jaw bone

96
Q

What virus is Burkitt’s lymphoma associated with in African areas?

A

Epstein-Barr virus

97
Q

What is the viral cause of Burkitt’s lymphoma in the west?

A

HIV

98
Q

How does Burkitt’s lymphoma usually present?

A

ileocecal masses

99
Q

What causes the starry sky appearance in Burkitt’s lymphoma?

A

large turnover of intermediate-sized B cells recruits macrophages

100
Q

What is the translocation associated with Burkitt’s lymphoma?

A

t(8:14)

101
Q

What gene is characteristic of Burkitt’s lymphoma?

A

c-myc

102
Q

What is involved in diffuse large B-cell lymphoma?

A

lymph nodes

visceral organs

103
Q

What are teh translocations associated with diffuse large B-cell lymphoma?

A

t(14:18)]BCL6 abnormalities

104
Q

What are symptoms associated with T-cell lymphomas?

A

pruritic/itchy skin rashes
weight loss
fever
lymphadenopathy

105
Q

What is expressed on the tumour T cells in T-cell lymphomas?

A

pan T
CD3
CD2

106
Q

What happens on a molecular level in T-cell lymphoma?

A

T-cell receptor rearrangement

107
Q

What are 3 common T-cell lymphomas?

A

microcyst fungoides
peripheral T-cell lymphoma
enteropathy-associated T-cell lymphoma (following long-standing coeliac disease)

108
Q

What is this NH lymphoma?

A

CLL with pro-lymphocytes

109
Q

What is this NH lymphoma?

A

follicular lymphoma

110
Q

What is this NH lymphoma?

A

mantle cell lymphoma (cyclin D1 expression)

111
Q

WHat is this NH lymphoma?

A

Burkitt’s lymphoma (starry sky appearance)

112
Q

What is this NH lymphoma?

A

diffuse large B-cell lymphoma

113
Q

What is this NH lymphoma?

A

mycosis fungoides

114
Q

Where does Hodgkin’s lymphoma usually affect?

A

single or multiple lymph nodes

115
Q

Where can Hodgkin’s lymphoma rarely affect?

A 
lymph nodes of:
gut
skin
mesenteric
Waldeyer's ring
116
Q

What is the neoplastic cell in Hodgkin’s lymphoma?

A

Reed-Sternberg

117
Q

What are the 2 types of Hodgkin’s lymphoma

A

classisal

nodular lymphocyte predominant

118
Q

What cells are Hodgkin’s lymphomas derived from?

A

B-cells (not all will express B-cell markers)

119
Q

What do the RS cells in HL stain with?

A

antibodies CD15 and 30

120
Q

What are the 4 morphological variants sof HL?

A

nodular sclerosis
mixed cellularity
lymphocyte rich
lymphocyte depleted

121
Q

Who is most affected by nodular scelrosis HL?

A

young adults and women

122
Q

Which nodes are commonly involved in nodular sclerosis HL?

A

lower cervical
supraclavicular
mediastinal

123
Q

What are the RS cells in nodular sclerosis HL like?

A

lacunar with sclerotic bands

124
Q

WhatRS cells are in mixed cellularity HL?

A

classic binuclear

125
Q

How does lymphocyte rich HL usually present?

A

isolated cervical or axillary lymphadenopathy

126
Q

What are the RS cells in lymphocyte rich HL?

A

lymphohistiocytic (LNH)

127
Q

How does lymphocyte depleted HL usually present?

A

high stage disease in older men

128
Q

What are the prognoses of HL like?

A

nodular sclerosis - excellent
mixed cellularity - good
lymphocyte rich - excellent
lymphocyte depleted - poor

129
Q

What do Hodgkin cells of nodular lymphocyte-predominant HL stain with?

A

CD20 and B-cell markers

130
Q

What is the name of the system to stage HL?

A

Ann Arbor

131
Q

What is stage I in Ann Arbor?

A

single lymph node/region/extralymphatic site/organ

132
Q

Stage II Ann Arbor

A

2 or more LN regions on same side of diaphragm

133
Q

Stage III Ann Arbor

A

both sides of diaphragm +/- spleeen or contiguous extralymphatic organ

134
Q

Stage IV Ann Arbor

A

disseminated disease and bone marrow development

135
Q

What do the A annd B stand for in Ann Arbor?

A

A: absence of constitutional symptoms
B: presence of constitutional symptoms (fever, night sweats, unexplained weight loss)

136
Q

Where do leukaemias arise?

A

bone marrow

137
Q

How is leukaemia classified?

A

myeloid/lymphoid

acute (blast)/chronic (cyte)

138
Q

What are the 4 types of leukaemia?

A

AML acute myeloid leukaemia
ALL acute lymphoid leukaemia
CML chronic myeloid leukaemia
CLL chronic lymphoid leukaemia

139
Q

What is the chromosome in CML?

A

philadelphia gene chromosomes 9 and 22

140
Q

When does ALL tyoically occur?

A

children and young adults

141
Q

What happens in pre-B ALL?

A

marrow filled with primitive blassts spill out into peripheral blood

142
Q

How does pre-B ALL present?

A

marrow failure and bone pain

143
Q

How does pre-T ALL present?

A

adolescent boys with mediastinal masses

144
Q

What is the morphology seen in ALL?

A

undifferentiated blassts

145
Q

What are the surface immunophenotypes in B-ALL

A

CD79a
CD 10
Tdt

146
Q

What are the surface ummuniphenotypes in T-ALL?

A

CD7
CD3
Tdt

147
Q

How does myeoloma usually present?

A

pathological fractures
pain
hypercalcaemia

148
Q

Haematologically what is seen in myeloma after marrow replacement by plasma cells and why?

A

thrombocytopenia
leukopenia
anaemia

plasma cells suppress normal haemopoiesis

149
Q

What can happen as a result of excess production and aggregation of IgGs produced by the plasma cells in myeloma treatment?

A

hyperviscosity
renal failure
amyloidosis

150
Q

What proteins are associated with myeloma?

A

Urine Bence-Jones preoteins

151
Q

What is the commonest cause of death in myeloma?

A

infections

renal failure

Pathology (5 decks)

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