Lymphadenopathy Flashcards
Follicles are round or irregular and may be confluent
Follicular Hyperplasia
Describe flow of lymph from the afferent to efferent lymphatics.
Afferent –> lymph node –> subcapsular sinus –> radial sinuses –> efferent lymphatics
common B cell reaction which can cause enlarged lymph nodes and is predominantly characterized by (1) hyperplasia and multiple (2) cells within the (3)
- germinal center 2. plasma 3. medullary cords REFERS TO Follicular hyperplasia
common in lymph nodes draining (1) but are also seen, albeit less frequently, in lymph nodes draining inflammatory and infectious lesions.
- cancers refers to Sinus histiocytosis
Within the lymph node the stellate shaped (1) with long cytoplasmic processes present antigens to B cells and transfer antiapoptotic signals to B lymphocytes with higher affinity binding antibodies.
- follicular dendritic cells (FDCs)
reactive hyperplasias
mostly B cell reactions (follicular), but also T cell (interfollicular) and macrophage (sinus histiocytosis)
follicular hyperplasia with plump pink macrophages in the interfollicular areas.
Toxoplasmosis
Circulating lymphocytes enter lymph nodes through the (1) of the (2) in the (3) of the lymph nodes.
- tall endothelial cells 2. postcapillary venules 3. paracortex
(1) lymphadenopathy tends to be rapid and painful
- benign
This is a mechanism for lymphocytes to produce tighter binding antibodies.
FDCs transfer antiapoptotic signals to B lymphocytes with higher affinity binding antibodies
Cat scratch disease has (1) hyperplasia and suppurative granulomas with (2).
- follicular 2. neutrophils and macrophages
The B cells develop in the (1) of humans
- bone marrow
lymph nodes associated with venereal and leg infections
inguinal lymph nodes
After activation and clonal expansion in germinal centers, B lymphocytes migrate to the B cell-dependent (1) of the lymph nodes to become (2) or to exit lymph nodes as (3)
- medullary cords
- Ig-secreting plasma cells
- memory B lymphocytes
CD8+ cells are activated by association with (1) HLA
suppressor/cytotoxic cells. Limit expansion of activated
B cells and stop their immune response
- class I
Lymph nodes that drain acute bacterial infections can have (1)
- suppurative (neutrophilic) or necrotizing lymphadenitis.
regional sites for the immune system to respond to microbes or other stimuli.
Lymph nodes
When activated by antigen and stimulated by an appropriate (1) cell, B cells develop into plasma cells that synthesize and export (2). At this stage, they no longer display (3) on the surface membrane
- T helper cell
- immunoglobulins
- heavy or light Ig chains
germinal center hyperplasia and multiple plasma cells within the medullary cords.
Follicular hyperplasia
plasma cells migrate to?
medullary cords
(1) lymphadenopathy tends to be slower and painless
- malignant
(1) look like plasma cells and are also seen in reactive disorders.
- Plasmacytoid lymphs
increased macrophages in the subcapsular and trabecular sinuses.
Sinus Histiocytosis
B lymphocytes travel to the (1) and T lymphs then travel predominantly to the deeper (2).
- germinal centers 2. paracortex
interfollicular or diffuse hyperplasias
T cell reactions
A well-defined mantle of (1) surrounds the follicles, sharply separating them from the interfollicular regions
- normal small B lymphocytes
macrophages containing erythrocytes and hemosiderin pigment in sinus histiocytosis
autoimmune hemolytic anemia
The T cells differentiate and mature in the (1) where self-reacting lymphocytes (2) or (3) by other mechanisms.
- thymus 2. apoptose 3. develop tolerance
numerous (1) line the subcapsular sinus
- macrophages
Where is metastatic cancer first seen and why?
subcapsular sinus of lymph because that’s where the lymph enters and the cancer cells are trapped there
Hyperplasia of secondary follicles (germinal centers) and plasmacytosis of medullary cords
Follicular hyperplasia
(1) patients can have interfollicular hyperplasia producing lymphadenopathy and can show focal or generalized (2) within the lymph nodes along with prominent (3)
- SLE 2. necrosis 3. immunoblasts.
The B cell precursors in the bone marrow have not undergone immunoglobulin heavy chain rearrangement but express precursor markers including (2), and express (3) in their nuclei.
- CD19, CD10 (also called CALLA-common ALL antigen 3. Terminal transferase (TdT)
More mature B lymphocytes then migrate to the (1) of the lymph nodes and become either (2)
- medullary cord 2. immunoglobulin secreting plasma cells or memory B cells.
macrophages containing anthracotic pigment in sinus histiocytosis: (1) lymph nodes
- mediastinal
follicular hyperplasia and suppurative granulomas with neutrophils and macrophages.
Cat scratch disease Lymphogranuloma venereum and tularemia
Lymphocyte development follows a sequential gain and loss of (1) which can serve as receptors for antigens or sites for interaction with other cell types.
- cytoplasmic and surface antigens
After immunoglobulin gene rearrangement the precursor B cells express (1) in the (2) and then undergo activation and clonal expansion in the (3) where they express (4) and undergo class switching.
- IgM 2. cytoplasm 3. germinal center 4. surface immunoglobulin
Generalized lymphadenopathy can be a result of ?
systemic infections, hyperthyroidism, drug reactions and collagen vascular diseases like SLE.
small lymphocytes with cleaved nuclei
centrocytes found in germinal center
Scattered benign macrophages, with abundant pale cytoplasm containing pyknotic nuclear and cytoplasmic debris, impart the characteristic “starry sky” pattern
benign follicles
The (1) of the lymph nodes contains both primary follicles which are not yet antigen responsive and secondary follicles known as (2) which are antigen responsive.
- cortex 2. germinal centers
Large granular lymphocytes often have (1) and are generally either (2) cells or (3)
- pink cytoplasmic granules 2. natural killer (NK) 3. suppressor T lymphocytes
Follicles are primarily in the (1), have a well-defined (2) and can be round or irregular and have scattered (3) within the germinal centers.
- cortex 2. mantle 3. benign macrophages
For this reason we can identify the differentiation stage or type of lymphocyte using the (1) which are called (2)
- surface antigens 2. CDs (stands for cluster of differentiation).
posterior auricular lymphadenopathy
rubella
Germinal centers can be identified because they contain ?
tingible body macrophages centroblasts centrocytes
Lymphocytes are derived from the (1) cells that give rise to all hematopoietic lineages but they differentiate into different types.
- pluripotent stem
clusters of pink epithelioid macrophages and
follicular hyperplasia
Toxoplasmosis
(1) can be characterized as CD34-CD4+CD8-
- T4 cell
memory B cells migrate to?
exit the lymph node
Lymphogranuloma venereum and tularemia produce (1) hyperplasia with (2) that are identical to cat scratch disease histologically.
- follicular 2. suppurative granulomas
In contrast to follicular and interfollicular hyperplasias of lymphocytes, macrophage immune responses in lymph nodes tend to produce (1) with increased macrophages in the subcapsular and trabecular sinuses.
- sinus histiocytosis
Viral infections which present with interfollicular hyperplasias include (1)
- zoster, measles, CMV, and mono
(1) have abundant often bluish cytoplasm and are seen in reactive disorders, especially (2)
- Atypical lymphocytes 2. infectious mononucleosis.
lymph nodes associated with toxoplasmosis
posterior cervical lymph nodes
can be used to either count or sort lymphocytes based on one or even several markers
fluorescent activated cell sorter (FACS) machine
T cell reactions are more commonly associated with (1) and are present in the deeper cortex than where the follicular hyperplasias are usually found.
- interfollicular hyperplasias
Plasma cells are terminally differentiated B cells that have a characteristic morphology: nuclei have (1) at the nuclear membrane (2) and the cytoplasm is (3) in color with a (4) due to the very active (5)
- clumped chromatin 2. clockface chromatin 3. abundant, blue-purple 4. paranuclear clear zone 5. Golgi complex.
Sinus histiocytes are derived from (1)
- blood monocytes
prominent immunoblasts and plasma cells and focal-to-massive necrosis along with hyperplasia of the paracortex
SLE
Toxoplasmosis has (1) hyperplasia with plump pink (2) in the interfollicular areas.
- follicular 2. macrophages
When antigens associate with (1) HLA, CD4+ release (2) and develop into helper/inducer cells
- class II
- IL-1 and IL-2
(1) lymph nodes generally enlarge rapidly because of increased swelling and increased blood flow and can be very painful due to the rapid enlargement.
- Suppurative and necrotizing
atypical lymphocytes with abundant, bluish cytoplasm
reactive disorders such as infectious mononucleosis
(1) can be increased in lymph nodes in either benign or malignant disorders.
- Large granular lymphocytes
If lymphocytes are incubated with fluorescent antibodies that detect specific CDs then an instrument called a (1) can be used to either count or sort lymphocytes based on one or even several markers
- fluorescent activated cell sorter (FACS)
macrophages with phagocytosed nuclear and cytoplasmic debris
tingible body macrophages found in germinal center
They often have pink cytoplasmic granules and are generally either natural killer (NK) cells or suppressor T lymphocytes
Large granular lymphocytes
follicular hyperplasias
B cell reactions
Lymph nodes are located along (1) and have a (2) surrounding an outer (3) and an inner (4)
- lymphatic channels 2. fibrous capsule 3. cortex 4. medulla
There are (1) present near the germinal centers.
- clear interfollicular areas
T4 (helper) and T8 (suppressor) lymphocytes are lymphocytes which express (1) respectively.
- CD4 and CD8
lymph nodes associated with scalp infections
occipital lymph nodes
large lymphocytes with round nuclei
centroblasts found in germinal center
Most of the reactive hyperplasias are predominantly (1) reactions and the degree of lymph node enlargement is dependent on the age of the patient (2) generally have more acute lymph node enlargement than (3), immunocompetence of the host (immunosuppressed individuals may have (4) lymph nodes even in disease), and the type of immune reaction.
- B cell 2. children 3. adults 4. smaller
Lymphocytic stem cells in thymus: thymic hormones induce (1) surface receptors: bind sheep RBCs. Next T cell receptor genes recombine: single antigen. Migrate from thymus to (2)
- CD2
- lymph nodes, spleen, blood
Stem cells express?
CD34
A 19 year old college sophomore has a sore throat, temp 102 F., anemia, and splenomegaly.
Lymph node histology?
Mono–> Lymph node histology: these are predominantly B-cell disorders, so mostly see follicular patterns (follicular hyperplasias).
A 57 year old woman with 4 cats developed enlarged lymph
nodes in her left axilla after being scratched on her left arm;
Lymph node histo?
Catch scratch fever;
Histology: follicular hyperplasia and suppurative granulomas; Granulomas contain neutrophils and macrophages
A 29 year old woman has a viral prodrome followed by
splenomegaly and enlarged posterior cervical lymph nodes;
ID disease and lymph node histo:
toxoplasmosis, which can appear quite similar to infectious mono;
Prominent follicular hyperplasia and small collections of epithelioid macrophages
A 36 year old woman with a malar rash, multiple arthralgias, and
a positive ANA has enlarged cervical and axillary lymph nodes;
lymph node histo
SLE–> interfollicular
A 25 year old man has slower developed firm lumps in his neck
and axilla on the right side.
Lypmph node histo;
Lymph node histology: this could be lymphoma or Hodgkin’s lymphoma, so will expect to see a loss of lymph node architecture, not a classic hyperplasia but rather an infiltration.
