Lymph node and spleen Flashcards
Lymph node effaced by nodules of mixed inflammation divided by broad fibrous bands, with lacunar cells (Reed–Sternberg cells suspended in a retracted space or halo).
Classical Hodgkin’s lymphoma (nodular sclerosing type)
Differential diagnosis:
Nodular lymphocyte predominant Hodgkin lymphoma
Plan:
Correlate with clinical history and radiology
IPX to support Dx: CD30 and 15, CD20 and 45, PAX5, CD3, EBER (expect positivity with CD30 and 15 with weak PAX5 positivity, nodular lymphocyte predominant would be CD30/15 negative, CD230 and 45 positive)
Next steps: Discuss at MDT
Bone lesion with clusters, nodules or sheets of plasma cells which may be atypical
Plasma cell myeloma
Differential diagnosis:
Solitary plasmacytoma of bone
Lymphoplasmacytic lymphoma
Reactive plasmacytosis
Plan:
Correlate with clinical history and radiology (?hypercalcaemia ?renal impairment ?anaemia ?presence of multiple lytic bone lesions ?serum/urine monoclonal protein ?bone marrow trephine findings)
IPX to support Dx: CD138, CD38, kappa and lambda light chains (expect positive, with light chain restriction)
IPX to discount DDx: CD20, PAX5 (for lymphoma).
Next steps: Synoptic report, discuss at MDT
Lymph node effaced by a nodular proliferation of back to back follicles, which contain a mixture of centrocytes (small lymphocytes with cleaved nuclei) and centroblasts (larger with vesicular chromatin and nucleoli). Follicles lack tingible body macrophages.
Follicular lymphoma
Differential diagnosis:
Mantle cell lymphoma
Marginal zone lymphoma
Reactive follicular hyperplasia
Plan:
Correlate with clinical history and radiology (?lymphadenopathy ? involvement of other organs ?blood counts)
Correlate with concurrent flow cytometry findings
Examine further sections (e.g. for pattern of involvement, presence of diffuse growth, grade)
IPX to support Dx: CD20, CD10, BCL2, BCL6 (expect positive). CD23 (may show disrupted FDC meshwork)
IPX to discount DDx: Cyclin D1, CD5 (mantle cell lymphoma), CD45 (marginal zone lymphoma),
Molecular: PCR or FISH for IGH-BCL-2 translocation
Next steps: Synoptic report, discuss at MDT
Lymph node effacted by a diffuse, homogenous population of small lymphocytes with round, regular nuclei with ‘soccer ball’ clumped chromatin. May have vague pseudofollicles (proliferation centres) containing slightly larger prolymphocytes.
Small cell lymphoma / chronic lymphocytic leukemia
Differential diagnosis:
Mantle cell lymphoma
Marginal zone lymphoma
Follicular lymphoma
Plan:
Correlate with clinical history and blood tests (?circulating lymphocytosis)
Correlate with concurrent flow cytometry findings
IPX to support Dx: CD20 and PAX5, CD5, CD23 (expect positive)
IPX to discount DDx: Cyclin D1, CD10, BCL6, BCL2, CD43
Next steps: Synoptic report, discuss at MDT.
Lymph node with large suppurative (containing neutrophils) necrotising ‘stellate’ granulomas
Cat-scratch disease (Bartonella henselae)
Differential diagnosis:
Other infectious agents (e.g. TB, and atypical mycobacteria, fungi, tularemia, syphilis)
Kikuchi lymphadenitis
Plan:
Correlate with clinical history and radiology (?cat exposure ?distribution of lymphadenopathy)
Correlate with concurrent microbiologic testing - if not done, parrafin block can be used for PCR
Special stains: Warthin-Starry (may highlight organisms). Also gram stain, PAS and GMS, ZN and modified ZN (Wade-Fite) - to look for other organisms.
IPX to support Dx: B. henselae
Lymph node effaced by sheets of large cells with pleomorphic nuclei with vesicular chromatin and prominent nucleoli.
Diffuse large B cell lymphoma
Stomach with lamina propria infiltrated with monocytoid lymphocytes (with a rim of pale cytoplasm) and plasma cells, with frequent infiltration of lymphocytes into epithelium (lymphoepithelial lesion)
MALT lymphoma (parotid, GI)
Lymph node with increased vascularity between follicles, with individual follicles having expanded mantle zone with concentrically arranged lymphocytes (‘onion skin’) and atrophic germinal centre replaced with hyalinization / hyalinized blood vessels. Germinal centres of adjacent follicles may fuse ‘twinning’ and a blood vessel traversing the mantle into the hyalinized germinal centre may create a ‘lollipop’ sign.
Castleman’s disease (hyaline vascular type)
Plan:
Correlate with clinical history and radiology (?lymphadenopathy)
