Lymph nodes

Question 1

5 categories of lymphadenopathy

Answer 1

1. Normal
2. Hyperplastic (reactive)
3. Lymphadenitis (inflammatory)
4. Lymphoma
5. Metastasis to LN

Question 2

T/F - submandibular LNs are preffered for FNAs

Answer 2

False - they are usually reactive (constantly draining)

Perform lymph panel instead

Question 3

Which cells should you find in a normal LN

Answer 3

MIXED CELL POPULATION

• Small mature: 90%
• Medium sized/prolymphocytes: 5%
• Lymphoblasts: 2%
• A few mast cells, eosinophils etc

Question 4

Is this a healthy LN? Why?

Answer 4

Yes - mixed cell population

• Small, mature lymphocytes
• Medium sized lymphocytes (prolymphocytes)
• Etc

Question 5

A LN with an increasing number of prolymphocytes and plasma cells is…

Answer 5

Reactive

(small mature lymphoctyes still dominate)

Question 6

What’s this?

Answer 6

Mott cell

• Activated plasma cell
• Dots are where immunoglobulins were —> dissolved due to staining

Question 7

Whats a lymphoglandular body? Do these indicate a LN is abnormal

Answer 7

Pockets of cytoplasm that pinch of lymphoctyes, forming independent structure

Dont necessarily indicate LN abnormal —> more common in LN pathology

Question 8

Is this LN normal? Why?

Answer 8

No- reactive

• Increased prolymphocytes
• Increased plasma cells
• Lymphoglandular bodies

Question 9

A LN is infilitrated with non-degenerate neutrophils. What is this condition called?

Answer 9

Sterile lymphadenitis

Question 10

Causes of reactive/hyperplastic LN

Answer 10

Drainage of infected site

• LN is healthy —> not inflammed, not infected, not neoplastic!

Question 11

A LN has many degenerate neutrophils and some intracellular organisms. What is the condition?

Answer 11

Septic lymphadenitis

Question 12

What is granulomatous lymphadenitis

Answer 12

Influx to LN of:

• Mycobacteria
• Fungi
• Protozoa (toxoplasma)
• Foreign body

Question 13

Is this a normal LN?

Answer 13

No - influx of neutrophils. Lymphadenitis

Septic (degenerative)?

Question 14

A lymph node has >50% of cells that are lymphoblasts or prolymphocytes. What do you suspect

Answer 14

Lymphoma –> diagnostic if over 50%

(suspected at >30%)

Question 15

Staging of lymphma (5)

Answer 15

1. Single LN
2. Multiple regional LN
3. Generalized lymphadenopathy
4. (stage 3) + liver and spleen
5. Involves bone marrow

Question 16

Lymphoma originates in….

Leukemia originates in…

Answer 16

Lymphoma: LN

Leukemia: bone marrow

Question 17

Is this a healthy LN?

Answer 17

No - homogenous, immature cell population

Lymphoma

Question 18

Tests used to subtype lymphoma

Answer 18

• Behaviour: responsiveness to chemo (B-cells respond, T-cells dont)
• Flow cytometry - CD proteins
  
  • ​T-cells: CD3
  • B-cells: CD79a
• PARR - PCR for antigen receptor rearrangements
• Karyotyping (abnormal chromatin patterns)

Question 19

Is this a normal LN?

Answer 19

No - this shows epithelial cells in LN. Indicates metastasis to LN