Lymphadenopathy

Question 1

Enlargement of Follicles

Answer 1

Rheumatoid Arthritis and early HIV

Follicular Dendritic cells are also CD4+

Question 2

Enlargement of Paracortex

Answer 2

Viral Infection - e.g. Mononuclearosis
Paracortex is where T-cells live.
Cortex is where B-cells live.

Question 3

Enlargement of Sinus Histiocytes

Answer 3

Lymph Node Draining Issue.

e.g. Cancer

Question 4

Lymphoma

Answer 4

Neoplastic proliferation of Lymphoid Cells forming a mass.
May arise in LN or in extranodal tissue.
60% Non-Hodgkins and 40% Hodgkins

Question 5

Follicular Lymphoma

Answer 5

Neoplastic SMALL B-cells (CD-20)
Follicle-like Nodules
Late Adulthood with painless LAD
[14;18] BCL2 into Ig-Heavy Chain 
Tx reserved; CTX, rituximab (anti-CD20)

Question 6

Mantle Cell Lymphoma

Answer 6

Neoplastic SMALL B-cells (CD-20)
Expansion of Mantle Zone
(region next to follicle)
Late Adulthood with Painless LAD
[11;14] Cyclin D1 to Ig-Heavy Chain
Cyclin D1 - G1/S cell cycle

Question 7

Marginal Zone Lymphoma

Answer 7

Neoplastic SMALL B-cells (CD20)
Expands Marginal Zone (outside Mantle)
Assoc Chronic Inflammatory States
(Marginal produced post germinal-center B-cells) Hashimoto thyroiditis, Sjogren’s, H Pylori gastritis (mucosal sites - MALToma)

Question 8

Burkitt Lymphoma

Answer 8

Intermediate Sized B Cells (CD20)
Assoc EBV; Child or Young adult
Extranodal mass; 2 Forms
African Form: Jaw Mass
Sporadic Form: Abdomen
[8;14] c-myc to Ig-Heavy Chain 
High Mitotic Rate - Starry Sky (Histo)

Question 9

Diffuse Large B-Cell Lymphoma

Answer 9

LARGE B-cells (CD20)
Grows in Diffuse Sheets
Most common NHL
Clinically Aggressive - not differentiated
Arise sporadic or Follicular Lymphoma
Late Adulthood, Enlarging Node or Extranodal

Question 10

Hodgkin Lymphoma

Answer 10

Neoplastic Prolif of Reed-Sternberg Cells
LARGE B-cell, multilobed nuclei, prominant nucleoli. CD-15 and CD-30. NO CD-20.
RS-cells secrete cytokines (fever, chills, etc), attract lymphos, plasma cells, macros, eosinos (they form actual mass).
May lead to fibrosis

Question 11

Nodular Sclerosis Hodgkins

Most common

Answer 11

Enlarging neck or mediastinal
young female
lymph node, broad bands of necrosis. 
"Cuts LN into follicules"
RS-cell in "big open spaces" - 'Lacunar'

Question 12

Considerations of “Other” subtypes of Hodgkin’s Lymphoma

• Lymphocyte Rich
• Mixed Cellularity
• Lymphocyte_depleted

Answer 12

Lymphocyte-rich is best prognosis
Mixed Cellularity associated with IL-5 (eosinophil abundant)
Lymphocyte-Depleted worst prognosis (elderly and HIV+)