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Lymph Nodes (Heme) > Lymph Node ( I and II) > Flashcards

Lymph Node ( I and II) Flashcards

1
Q

In a lymph node, what cells predominate in the dark zone and what types of cells predominate in the light zone?

A

Dark zone: Centroblasts

Light zone: Centrocytes

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2
Q

What cell type predominates in germinal centers and what stain can help demonstrate that?

A

A: B cells

CD20 will be positive in within germinal centers

Note: there should only be a few scattered reactive T cells within germinal centers. These are a normal component to the GC.

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3
Q

What lymphoma develops from the T cells that are normally found within the germinal centers (follicular T cells)?

A

A: Angioimmunoblastic T cell lymphoma

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4
Q

What are two good stains to identify a germinal center and how do we distinguish them?

A

BCL-6: nuclear stain

CD10: cytoplasmic stain

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5
Q

What do CD21 and BCL-2 stain?

A

CD21: Follicular dendritic cells of the GC

BCL-2: negative in reactive GC

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6
Q

What does IgD stain within a lymph node?

A

It stains the Mantle Zones

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7
Q

What cells and structures are found with the cortex of lymph nodes?

A

B-cells

Primary and secondary follicles

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8
Q

What cells and structures are seen in the paracortex?

A

T-cells

Blood vessels

Interfollicular zone

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9
Q

What cells are found in the medullary cords of lymph nodes?

A

Plasma cells

T-cells

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10
Q

What cells are found in the sinuses of lymph nodes?

A

Monocytes

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11
Q

What disease entities should you consider whenever you see Follicular Hyperplasia?

A

Non-specific

Castleman disease

Progressively transformed GC

HIV-related lymphadenopathy

Rheumatoid lymphadenopathy

Syphilitic lymphadenopathy

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12
Q

What disease entities should you think of when you have a Paracortical Infiltrate?

A

Viral infections, NOS

Post-vaccine lymphadenitis

Infectious mononucleosis (EBV)

Drug induced hypersensitivity

Dermatopathic lymphadenitis

Histiocytic necrotizing lymphadenitis

Systemic lupus erythematosus

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13
Q

What disease entities do you think of when you see an infiltrate in the sinuses of lymph nodes?

A

Sinus histiocytosis

Langerhans cell histiocytosis

Sinus histiocytosis with bilateral lymphadenopathy (Rosai Dorfmann Disease)

Hemophagocytic Syndrome

Vascularization of sinuses

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14
Q

What are features of Rheumatoid lymphadenopathy ?

A

Follicular hyperplasia

Polytypic plasma cells

Neutrophils in the sinuses

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15
Q

What are features of Syphilitic lymphadenopathy?

A

Follicular pattern

Thickened lymph node capsule

Plasma cells

**IMP: perform a Warthin Starry stain

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16
Q

Irregularly shaped and variably sized follicles that extend from the cortex all the way into the medulla of the lymph node are characteristic of?

A

Follicular hyperplasia

17
Q

What features both morphologically and immunohistochemically favor a lymph node with Follicular Hyperplasia?

A

Polymoprhic cells

Increased mitosis ( inc. Ki-67)

Macrophages

BCL-2 negative GC

t(14;18) negative

Architecture preserved

Variation in size of GC

No back to back follicles

18
Q

What features both morphologically and immunohistochemically favor a lymph node with Follicular Lymphoma?

A

Monotonous cells (loss of light and dark zone distinction)

Decreased mitosis

Decreased macrophages

BCL-2 positive GC

t(14;18) positive

Architecture is effaced

Little variation in the GC shape and size

Back to back follicles

19
Q

What is the term for germinal centers that are decreased in size?

A

Atretic

20
Q

What is the disease entity with the following description:

  • Frequently presents within the mediastinum
  • Characterized by atretic GC (sometimes have 2 GC in one follicle)
  • Concentric layering of the Mantle Zone
  • Radially penetrating arterioles into GC
  • Interfollicular plasmacytoid monocytes (CD123 positive)
A

Castleman Lymphadenopathy

Notes Below:

  • Multiple GC = Twinning
  • Concentric layers = Onion skinning
  • Radial arteries = Lollipop sign
  • Also will see increased paracortical vascularity
21
Q

How is Castleman disease classified ?

A

Unicentric and Multicentric

22
Q

What are the features of Unicentric Castleman Disease?

A
  • Hyaline deposits or plasma cells in the paracortex
    • Plasma cells usually polytypic but can sometimes have monotypic
  • Increased follicular dendritic cells in GC
    • (+): CD21, CD23, and CD35

Treatment: surgical excision

23
Q

What are the features of Multicentric Castleman disease?

A
  • Frequent HHV8 infection
    • generally more plasmablastic
  • Increased serum IL-6
    • HHV8 encodes for IL-6
  • Patients have worse prognosis and are treated with steroids or chemotherapy
  • Increased incidence of plasmablastic lymphoma, Kaposi sarcoma, and primary effusion lymphoma
24
Q

What are some disease associations seen with Multicentric Castleman Disease?

A
  • HIV
  • Wiskott-Aldrich Syndrome
  • Pemphigus
  • Myasthenia gravis
  • POEMS syndrome
    • Polyneuropathy
    • Organomegaly
    • Endocrinopathy
    • Monoclonal gammopathy
    • Skin lesions
25
Q

What are the three patterns seen in HIV lymphadenopathy?

A
  • Follicular Hyperplasia:
    • usually early in the disease course
    • Irregualr GCs (markedly enlarged), naked GCs
    • Follicle lysis, monocytoid B-cells
  • Follicular Involution (D/D: lymphoma)
    • Regressed GCs
    • Thin mantle zones
    • Histiocytes and immunoblasts
  • Lymphocyte Depletion
    • Small lymph nodes
    • No follicles
    • Histiocytes
    • Erythrophagocytosis
26
Q

What disease entity is described by these features:

  • Follicular hyperplasia
  • Epithelioid histiocytes near the GC
  • Monocytoid B-cell hyperplasia
A

Toxoplasmosis Lymphadenitis

27
Q

What are key clinical features of Toxoplasma lymphadenitis ?

A
  • T. gondii is a parasitic protozoan in which the cat is the definitive host and source of human infection
  • People can be asymptomatic or have fever and enlarged cervical lymph nodes
  • 50% of adults have antibodies to T. gondii
28
Q
A

Lymph Nodes (Heme) (1 decks)

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