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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
Where are B cells located in the lymph node
- 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
26
Where are T cells present in the lymph node
Interfollicular tissue
27
Summarise the cell populations found in lymph nodes
B cells, T cells, NK cells Macrophages, APCs, dendritic cells Endothelial cells
28
Primary vs secondary follicles
Primary - Small, quiescent lymphocytes - Unstimulated - No germinal centre Secondary - Activated follicles - Reactive - Have germinal centre
29
Summarise the journey of a naive B cell in the lymph node follicle
Clonal expansion Somatic hypermutation Affinity maturation & positive selection Antigen engulfing & presenting Differentiation
30
How are follicular dendritic cells different from dendritic cells
They are mesenchymal in origin
31
What is the 3 main functions of follicular dendritic cells
- 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
Describe the initial steps in the follicle that begin the formation of step mature B cells (plasma/memory)
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 3. B cells undergo clonal expansion 4. 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 6. B cell division slows down 7. B cells bind & internalise the antigen of FDCs 8. Antigen is then displayed on B cell MHC II molecule 9. This attracts T cells that help the B cell proliferate & mature
33
What are the three outcome options of the positively selected B cells in the light zone of the germinal centre
- Differentiate into plasma cells - Differentiate into memory B cells - Renter dark zone & proliferate to regulate germinal centre formation
34
What is a centroblast
Proliferating B cell in the dark zone
35
What is a centrocyte
B cell in the light zone
36
Compare how the name of the B cell changes depending on the area of the follicle they are in & their stage of development
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
What cells are likely to be in the medullary cords
Plasma cells, B cells, Macrophages
38
What cells are likely to be in the medullary sinuses
Histiocytes, reticular cells
39
What are the four tonsils
Pharyngeal tonsils Tubal tonsils Palatine tonsils Lingual tonsils
40
How do tonsils differ from lymph nodes
No capsule, instead have a ‘crypt’ (with overlying stratified squamous epithelium)
41
Name 3 signs of a reactive lymph node
- Stimulated germinal centres - Interfollicular expansion - Distended sinuses (histiocytosis)
42
Lymphadenopathy vs lymphadenitis
Lymphadenopathy - swollen lymph node Lymphadenitis - swollen lymph node due to inflammation e.g. infection
43
Granulomatous lymphadenitis - what is it, what causes it and why should it be approached with caution
- granulomatous inflammation of lymph nodes - causes include TB (ceseating), sarcoidosis (non-ceseating) - caution: can mask malignancy
44
What would a B cell response in lymph nodes suggest (2)
Autoimmune condition (including IgG4 RD) Infection
45
What would a T cell response in lymph nodes suggest
Viral infection Drugs e.g. phenytoin Dermatopathic
46
What would a phagocytic/granulomatous response in lymph nodes suggest
Tumour related Dermatopathic Granulomatous disease (sarcoidosis, TB)
47
What does a generalised lymphadenopathy suggest
- Systemic inflammatory/ immunological process - Widespread malignancy (severe metastatic or lymphoma)
48
Where is the spleen anatomically located
Left upper quadrant of abdomen
49
What are the two surfaces of the spleen
Diaphragmatic surface Visceral surface
50
What structures/organs are in contact with the visceral surface of the spleen (4)
Left kidney gastric fundus Pancreas tail Splenic flexure of colon
51
What artery supplies the spleen & what is it a branch of
Splenic artery Branch of coeliac trunk
52
What vein drains the spleen
Splenic vein (Forms portal vein with superior mesenteric vein)
53
What is the spleen parenchyma split into
Red pulp & white pulp
54
Is the spleen encapsulated
Yes
55
What does the red pulp contain
Sinusoids & cords
56
Describe the structure of the sinusoids in the red pulp
- Fenestrated endothelial cell lining - Supported by hoops of reticulin
57
What cells do the cords of the red pulp of the spleen contain
Monocytes/ Macrophages!!! & some fibroblasts & cells in transit - RBCs, WBCs etc
58
What supports the sinusoids in spleen
Hoops of reticulin
59
What is the function of the red pulp of the spleen
- Filters the blood (foreign material, damaged cells etc) & - Facilitates immune response to antigens
60
What is the white pulp of the spleen made up of (2)
-Peri-arteriolar lymphoid sheath (PALS) - CD4+ lymphoid cells -Lymphoid follicles - B cells
61
What is the difference in antigen presentation in the lymph nodes vs spleen
Lymph node - via APCs in blood Spleen - via blood that stimulates APCs in the white pulp
62
Describe the direction of blood flow through the spleen
Splenic artery => White pulp => Red pulp => Splenic vein
63
Where does B vs T cell maturation occur
B cell - bone marrow T cell - thymus
64
Where does B vs T cell activation occur
Both occur in secondary lymphoid tissue e.g. spleen, lymph nodes
65
Name the 2 main lymph node groups in the neck & where the supply
- 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 (31 decks)

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