Lymph Node Pathology

Question 1

Causes of lymphadenopathy

Answer 1

Reactive to infection
Malignant tumour
Multisystem disorders eg sarcoidosis, SLE, RA

Question 2

Lymphomas

Answer 2

due to mutations in a lymphocyte that has led the bone marrow and taken up residence in a lymph node.

tend to present with solid mass lesions, particularly enlarged lymph nodes

usually painless

Question 3

Hodgkin Lymphomas

Answer 3

1 in 3 lymphomas

peak in 15-35y and second peak in over 55y

Question 4

hodgkin lymphomas risk factors

Answer 4

EBV history
immunosuppression
family history

Question 5

hodgkin lymphoma presentation

Answer 5

lymphadenopathy
B symptoms
asymmetrical
spreads contiguously
alcohol induced LN pain

REED STERNBERG CELLS

Question 6

Non-hodgkin lymphoma

Answer 6

2 in 3 lymphomas
majority (~90%) from B lymphocytes (can be indolent (but no cure) or aggressive) and minority form T lymphocytes (usually aggressive BUT can be curable)

symmetrical
spread discontinuously
extra nodal manifestations

Question 7

Staging of lymphoma

Answer 7

Ann Arbor

I - one lymph node region
II - >2 lymph node regions
III - lymph node regions on both sides of the diaphragm
IV - extra nodal sites

A: no B symptoms
B: B symptoms present

Question 8

Sarcoidosis

Answer 8

multi system disease of unknown aetiology

characterised by non-caseating granulomas

theory that it is an inflammatory response to some unidentified environmental agent in a susceptible host

Question 9

Organs involved in sarcoidosis

Answer 9

lymph nodes
lungs
skin
eyes
lacrimal and silvery gland
nervous system

Question 10

Acute sarcoidosis

Answer 10

most patients

associated with manifestations that include bilateral hilar lymphadenopathy, anterior uveitis and a CNVII palsy

it has a good prognosis, typically spontaneous resolution within 1-2y of diagnosis and no long-lasting consequences

Question 11

chronic sarcoidosis

Answer 11

about 5% of patients

tends to persist and lead to permanent organ damage

associated with lupus pernio, pulmonary fibrosis and posterior uveitis

higher risk of developing permanent organ damage

Question 12

investigations of sarcoidosis

Answer 12

ESR raised
hypercalcaemia
serum ACE raised
biopsy

Question 13

Treatment of NHL

Answer 13

RCHOP

rituximab
cyclophosphamide
hydroxydaunorubicin
oncovin (vincristine)
prednisolone

Question 14

Treatment of HL

Answer 14

ABVD

adriamycin
bleomycin
vinblastine
dacarbazine