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Heme - Amanda > Lymphadenopathies > Flashcards

Lymphadenopathies Flashcards

1
Q

Where does VDJ rearrangement (somatic recombination) of B cells occur?

A

BM

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2
Q

After somatic hypermutation in BM, B cells go to:

A

Interfollicular/pericortical areas of lymphatic tissues

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3
Q

What three things occur in germinal center?

A

Antigen presentation, somatic hypermutation, class switching

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4
Q

What is Bcl-2?

A

Anti-apoptotic gene expressed by B cells in germinal centers that are selected to mature

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5
Q

What happens to B cell after maturation in germinal center?

A

Moves out to periphery to be plasma cell or memory B cell

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6
Q

Would you expect to find naive B cells in periphery?

A

Yes, small amount kept just outside mantle zone in marginal zone

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7
Q

What presents antigen to B cells in germinal centers?

A

FDC

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8
Q

Where does T cell gene rearrangement occur?

A

Thymus

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9
Q

Where does T cell antigen presentation occur?

A

Paracortex of lymph nodes/lymphatic tissues

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10
Q

What are tingible macrophages? Where are they found?

A

Macrophages in GC that clean up dead B cells which did not react with antigen/reacted with self antigen

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11
Q

Stain lymph node with CD20 mab. Where would you expect to see binding?

A

GC and mantle zone (B cells)

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12
Q

Stain lymph node with CD10 mab. Where would you expect to see binding?

A

GC (some B cells)

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13
Q

Stain lymph node with CD5/3 mab. Where would you expect to see binding?

A

Paracortex (T cells)

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14
Q

Infection or malignancy: Swollen, painful nodes

A

Infx

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15
Q

Infection or malignancy: Swollen node + weight loss + anemia

A

Malignancy

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16
Q

Infection or malignancy: Two nontender, swollen nodes

A

Malignancy

17
Q

Reactive follicular hyperplasia associated with:

A

Bacterial infx

18
Q

Paracortical expansion typical of what type of diseases?

A

Viral infx

19
Q

Two causative agents of infectious mononucleosis:

A

CMV and EBV

20
Q

Peripheral blood of pt with infectious mononucleosis would look like:

A

Large mononuclear (no shit) cells with big nuclei

21
Q

What are the large, mononuclear cells seen in PB of infectious mononucleosis? What’s their function?

A

T cells attacking EBV-infected B cells and pharyngeal epithelial cells

22
Q

Reactive T cells of infectious mononucleosis reside in:

A

Paracortex

23
Q

Which two cells types would you expect to be most elevated on CBC on pt with infectious mono?

A

N. segs and lymphocytes

24
Q

Pt with fever, malaise, knots in neck, anorexia, cold sweats, pharyngeal exudate. What test would you order?

A

Monospot for inf mono

25
Q

As well as causing inf mono, EBV has been implicated in which three other diseases?

A

Burkitt’s Nasopharyngeal carcinoma Lymphomas in immunosuppressed pt

26
Q

Key lymph node finding in patient with SLE?

A

Lupus lymphadenitis: zones of necrosis (cells’ nuclei will no longer stain)

27
Q

Characteristics of dermatopathic lymphadenopathy

A

Small germinal centers with prominent mantle zones

Cells with lots of clear space (cytoplasm) and dark pigments (melanin) = histiocytes

28
Q

What’s a histiocyte?

A

Skin-based macrophage

29
Q

Why do the aggregates of histiocytes in dermatopathic lymphadenopathies have dark pigments in them?

A

Lymph nodes receive lots of drainage from skin lesions, which contains dead skin cells that contain melanin

30
Q

Three diseases in which you would expect to see aggregates of histiocytes in lymph nodes:

A

Pemphigus

Eczema

Psoriasis

(any chronic skin disease)

31
Q

Where would one expect to see lymph nodes with histiocytes in pt with dermatopathic lymphadenopathy?

A

Proximal to the lesion

32
Q

Normal or reactive?

A

Normal - Normal size and appearance of germinal centers in the cortex, surrounded by a lymph node capsule and adjacent peri-lymph node adipose tissue.

33
Q

Normal or reactive?

A

Reactive -F ollicular hyperplasia. Multiple large and small follicles with deeply stained mantle zones.

34
Q
A

Infectious mononucleosis (large, reactive T cells attacking infected B cells and pharyngeal epithelial cells)

35
Q

Burned out follicles

A

HIV (late phase)

36
Q

Why does late phase HIV cause follicular burn out of lymph nodes?

A

CD4+ required for normal germinal centers

37
Q

What does lymph node look like in late phase HIV?

A

No germinal centers

Histiocytes replace germinal centers

38
Q

Heterophile Abs

A

Inf mono

39
Q

What is lymphadenitis?

A

Increased number of WBCs in lymph nodes, usually due to infx or inflammation

Heme - Amanda (3 decks)

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