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Haematology > Lymph Node & Spleen > Flashcards

Lymph Node & Spleen Flashcards

1
Q

What type of tissue is the lymph nodes & spleen

A

Secondary/peripheral lymphoid tissue

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2
Q

What other secondary lymphoid tissue are there apart from the lymph nodes & spleen

A

Tonsils/ adenoids
Peyer’s patches in intestine

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3
Q

Describe the structure of lymph nodes

A

Encapsulated collections of lymphoid tissue
Ovoid/bean shaped

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4
Q

Where are lymph nodes found

A

They are distrusted along the course of lymphatic vessels

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5
Q

What are the two distinct groups of lymph nodes & how can they be examined

A
  • Superficial node groups (e.g. in the cervical, axillary and inguinal regions) can be palpated.
  • Internal node groups (e.g. mediastinal, para-aortic) can be viewed radiologically
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6
Q

What two structures make up the lymphatic system

A

Lymphatic vessels & lymph nodes

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7
Q

What is the role of the lymphatic system in the innate vs adaptive

A

Innate - stores innate immune cells
Links both - antigen presenting cells traffic
Adaptive - develops & activates lymphocytes & memory cells

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8
Q

What is the role of the afferent channels in lymph nodes

A

Afferent channels drain lymph through the capsule into the supcapsular sinus

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9
Q

What does lymphadenopathy mean

A

enlargement of lymph node

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10
Q

Lymphadenopathy aetiology

A

Local inflammation - TB, toxoplasma, cat scratch disease
Systemic inflammation - Viral, autoimmune, CTD
Malignancy - lymphoma, metastatic
Others e.g. sarcoidosis

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11
Q

What is a sentinel lymph node

A

The first lymph node to which cancer cells are most likely to spread

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12
Q

How is a sentinel lymph node identified

A

By dye or radioactive isotopes

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13
Q

What is the importance of identifying sentinel lymph nodes in malignancy

A

By identifying which lymph node the cancer is most likely to spread to the lymph node can be examined and check for cancer

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14
Q

Describe the flow of lymph through the lymph node

A

Afferent lymphatic vessel =>
Subcapsular sinus =>
Trabecular sinus =>
Medullary cords & sinus =>
(Merge at hilum to form…)
Efferent lymphatic vessel

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15
Q

Identify the structures/parts of a lymph node

A

Capsule & trabecula
Subcapsular & trabecular sinuses
Inner & outer cortex
Lymphatic nodule (follicle) & germinal centre
Medulla & medullary sinuses

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16
Q

What is the purpose of lymph draining through the node

A

It allows antigenic material to interact with fixed lymphoid tissue for an immune response

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17
Q

Where do the medullary sinuses of a lymph node merge to form efferent lymphatics

A

Hilum

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18
Q

What is the lymph node capsule made of

A

fibrous connective tissue

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19
Q

Accumulation of what cell type would you expect to see in the sinuses of reactive lymph nodes (due to infection/foreign antigens etc)

A

Antigen presenting cells - histiocytes & dendritic cells

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20
Q

What are the three main regions of a lymph node

A

Cortex
Paracortex
Medulla

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21
Q

What cell is present in the lymph node cortex and how are they arranged

A

B lymphocytes arranged in follicles

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22
Q

What cell is present in the lymph node paracortex and how are they arranged

A

Mainly T lymphocytes, form part of interfollicular tissue

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23
Q

What is the lymph node medulla

A

Cord & sinuses draining into the hilum

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24
Q

What is the germinal centre of the lymph node

A

It is a specialised structure within the lymph node follicle
It is where B cells proliferate & mature to produce antibodies
It produces both plasma & memory B cells

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25
Q

Where are B cells located in the lymph node

A
  • B cells mainly follicles & germinal centres
  • Except plasma cells that are mainly in medulla
  • Some B cells can also be found in the interfollicular tissue
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26
Q

Where are T cells present in the lymph node

A

Interfollicular tissue

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27
Q

Summarise the cell populations found in lymph nodes

A

B cells, T cells, NK cells
Macrophages, APCs, dendritic cells
Endothelial cells

28
Q

Primary vs secondary follicles

A

Primary
- Small, quiescent lymphocytes
- Unstimulated
- No germinal centre

Secondary
- Activated follicles
- Reactive
- Have germinal centre

29
Q

Summarise the journey of a naive B cell in the lymph node follicle

A

Clonal expansion
Somatic hypermutation
Affinity maturation & positive selection
Antigen engulfing & presenting
Differentiation

30
Q

How are follicular dendritic cells different from dendritic cells

A

They are mesenchymal in origin

31
Q

What is the 3 main functions of follicular dendritic cells

A
  • Provide architectural support to germinal centres
  • Facilitate debris removal by secreting bridging factors
    Note: bridging factors attract macrophages to the site
  • Present antigens to naive B cells (with T helper cells assist)
32
Q

Describe the initial steps in the follicle that begin the formation of mature B cells (plasma/memory)

A

In the follicle

  1. Antigen-antibody complexes captured by FDCs
  2. FDCs present antigens (with T helper cell assist) to naive B cells

In the dark zone of germinal centre

  1. B cells undergo clonal expansion
  2. B cells then undergo somatic hypermutation
    5a. Affinity maturation is achieved => B cells enter light zone
    5b. Affinity maturation not achieved => B cells apoptose

In the light zone of germinal centre

  1. B cell division slows down
  2. B cells bind & internalise the antigen of FDCs
  3. Antigen is then displayed on B cell MHC II molecule
  4. This attracts T cells that help the B cell proliferate & mature
33
Q

What are the three outcome options of the positively selected B cells in the light zone of the germinal centre

A
  • Differentiate into plasma cells
  • Differentiate into memory B cells
  • Renter dark zone & proliferate to regulate germinal centre formation
34
Q

What is a centroblast

A

Proliferating B cell in the dark zone

35
Q

What is a centrocyte

A

B cell in the light zone

36
Q

Compare how the name of the B cell changes depending on the area of the follicle they are in & their stage of development

A

Follicle (prior to antigen presentation) - naive B cells
Dark zone (prior to positive selection) - centroblast
Light zone (prior to differentiation) - centrocyte
After differentiation - Plasma or memory B cell

37
Q

What cells are likely to be in the medullary cords

A

Plasma cells, B cells, Macrophages

38
Q

What cells are likely to be in the medullary sinuses

A

Histiocytes, reticular cells

39
Q

What are the four tonsils

A

Pharyngeal tonsils
Tubal tonsils
Palatine tonsils
Lingual tonsils

40
Q

How do tonsils differ from lymph nodes

A

No capsule, instead have a ‘crypt’ (with overlying stratified squamous epithelium)

41
Q

Name 3 signs of a reactive lymph node

A
  • Stimulated germinal centres
  • Interfollicular expansion
  • Distended sinuses (histiocytosis)
42
Q

Lymphadenopathy vs lymphadenitis

A

Lymphadenopathy - swollen lymph node
Lymphadenitis - swollen lymph node due to inflammation e.g. infection

43
Q

Granulomatous lymphadenitis - what is it, what causes it and why should it be approached with caution

A
  • granulomatous inflammation of lymph nodes
  • causes include TB (ceseating), sarcoidosis (non-ceseating)
  • caution: can mask malignancy
44
Q

What would a B cell response in lymph nodes suggest (2)

A

Autoimmune condition (including IgG4 RD)
Infection

45
Q

What would a T cell response in lymph nodes suggest

A

Viral infection
Drugs e.g. phenytoin
Dermatopathic

46
Q

What would a phagocytic/granulomatous response in lymph nodes suggest

A

Tumour related
Dermatopathic
Granulomatous disease (sarcoidosis, TB)

47
Q

What does a generalised lymphadenopathy suggest

A
  • Systemic inflammatory/ immunological process
  • Widespread malignancy (severe metastatic or lymphoma)
48
Q

Where is the spleen anatomically located

A

Left upper quadrant of abdomen

49
Q

What are the two surfaces of the spleen

A

Diaphragmatic surface
Visceral surface

50
Q

What structures/organs are in contact with the visceral surface of the spleen (4)

A

Left kidney
gastric fundus
Pancreas tail
Splenic flexure of colon

51
Q

What artery supplies the spleen & what is it a branch of

A

Splenic artery
Branch of coeliac trunk

52
Q

What vein drains the spleen

A

Splenic vein
(Forms portal vein with superior mesenteric vein)

53
Q

What is the spleen parenchyma split into

A

Red pulp & white pulp

54
Q

Is the spleen encapsulated

A

Yes

55
Q

What does the red pulp contain

A

Sinusoids & cords

56
Q

Describe the structure of the sinusoids in the red pulp

A
  • Fenestrated endothelial cell lining
  • Supported by hoops of reticulin
57
Q

What cells do the cords of the red pulp of the spleen contain

A

Monocytes/ Macrophages!!!
& some fibroblasts
& cells in transit - RBCs, WBCs etc

58
Q

What supports the sinusoids in spleen

A

Hoops of reticulin

59
Q

What is the function of the red pulp of the spleen

A
  • Filters the blood (foreign material, damaged cells etc) &
  • Facilitates immune response to antigens
60
Q

What is the white pulp of the spleen made up of (2)

A

-Peri-arteriolar lymphoid sheath (PALS) - CD4+ lymphoid cells
-Lymphoid follicles - B cells

61
Q

What is the difference in antigen presentation in the lymph nodes vs spleen

A

Lymph node - via APCs in blood
Spleen - via blood that stimulates APCs in the white pulp

62
Q

Describe the direction of blood flow through the spleen

A

Splenic artery =>
White pulp =>
Red pulp =>
Splenic vein

63
Q

Where does B vs T cell maturation occur

A

B cell - bone marrow
T cell - thymus

64
Q

Where does B vs T cell activation occur

A

Both occur in secondary lymphoid tissue e.g. spleen, lymph nodes

65
Q

Name the 2 main lymph node groups in the neck & where the supply

A
  • Cervical nodes - Located in the neck and back
  • Submandibular nodes - Located below the mandible
  • Supraclavicular nodes - Located just above clavicle
  • Axillary nodes - Located in the armpits
  • Mesenteric nodes - Located deep in abdomen (intestine membrane)
  • Inguinal nodes - Located in the groin
  • Popliteal nodes - Located in popliteal fossa

Haematology (32 decks)

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