lymphadenopathy + lymphoma Flashcards
lymph nodes + spleen
forms of secondary lymphoid tissues
both provide a location for cells of immune system (lymphoid + acessary)
both are filters for circulatory fluids - lymph + blood
lymphatics
blind ended vessels that permit passive unidirectional flow (valves) of lymphatic fluid
- different nodes drain particular territories
return fluid from EXTRAcellular connective tissues (lymph) to circulation
- prevent excessive accumulation in tissue - oedema
- important for fluid haemostasis
what does the flow of lymph through lymphatic channels permit?
cell, microorganism + molecules within lymph can interact with immune system + illicit immune response -> protective fucntion
cell traffic + trapping
- immune + inflammatory
- malignant cells
2 groups of nodes
superficial - cervical, axillary, inguinal -> can be palpated
internal - mediastinal, para-aortic -> viewed radiologically
virchows node/trosiers sign = left supraclavicular -> gastric/abdominal malignancy
drainage through lymph nodes
afferent channels drain through the capsule to peripheral sinus, then filtered
- immune reaction can be triggered
efferent vessel leaves from hilum, drains to
- cisterna chyll/thoracic duct
- left jugular, subclavian
sentinel lymph node
first lymph node to which cancer cells are most likely to spread, identified by dye or radioactive isotopes
if neg - tumour is localised
if pos - tumour has spread, further Ix
metastatic cells will be identified first in the subcapsular sinus
cell populations in lymph nodes
lymphocytes
-B cells - assoc with follicles + germinal centres
— plasma cells - mainly in medulla
- T cells
—T helper cell, T cytotoxic cells
natural killer cells
mononuclear phagocytes - macrophages, antigen presenting cells + dendritic
endothelial cells
how does a positive lymph node in lymphoma present compared to viral/bacterial infection + metastatic carcinoma?
rubbery/soft, compared to hard in others
viral/bacterial = tender
lymphoma/metastatic = NOT tender
lymphoma smooth surface, metastatic = irregular
invesigating lymphadenopathy
if malignancy suspected ask surgeon to biopsy - fine needle aspiration is INSUFFICIENT
- need a big sample to assess architechture of lesion
- lymphoma not seen on CT
assessing lymph node pathology
histology appearance
immunochemistry of solid node - surface proteins, brown = positive
immunophenotyping of blood/marrow - liquid phase
genetic analysis - FISH
molecular analysis - reed sternberg cells in Hodgkins
what are the 3 main immune reaction in a lymph node + what causes these?
predominant B cell respones -> autoimmune, infections
predominant phagocytic response -> non-specific, draining a tumour site
predominant T-cell response -> viral infections, drugs (phenytoin), dematopathic
caseating granulomas
infection until proved otherwise
-> likely microbacterial
lymphomas
group of cancers that affect the lymphocytes inside the lymphatic system
-> these cancerous cells proliferate within nodes causing lymphadnopathy
malignant tumour derived from cells of immune system
many diff forms + varying course/prognosis
hodgkins lymphoma
proliferation of lymphocytes
different types - classical + nodular lymphocyte predominant
also of B cell origin
bimodal age distribution with peaks aged 20 + 75yrs
usually v good prognosis
hodgkins lymphoma risk factors
HIV
EPV
autoimmune conditions - rheumatoid arthritis, sarcoidosis
fam history
hodgkins lymphoma presentation
lymphadenopathy - neck, axilla, inguinal
- non tender + rubbery
- *pain in lymph nodes when drink alcohol
fatigue, SOB
weight loss, fever, night sweats
itching
cough - medistinal mass
recurrent infections
hodgkins lymphoma investigation findings
normocytic anaemia
eosinophilia
LDH raised (not specific)
lymph node biopsy
- Reed-Sternberg cell
– abnormally large B cells that have multiple nuclei that have nucleoli inside them - gives “owl” apearance (face with large eyes)
staging of hodgkins lymphoma
Ann Arbor
I: single lymph node
II: 2 or more lymph nodes/regions on the same side of the diaphragm
III: nodes on both sides of the diaphragm
IV: spread beyond lymph nodes
Each stage may be subdivided into A or B
A = no systemic symptoms other than pruritus
B = weight loss > 10% in last 6 months, fever > 38c, night sweats (poor prognosis)
hodgkins lymphoma Mx
chemo + radio
chemo - risk of leukaemia + infertility
radio - risk of cancer, damage to tissues + hypothyroidism
non-hodgkins lymphomas examples
Burkitt lymphoma - assoc with EPV, malaria, HIV
MALT lymohoma - affect muscosa-assoc lymphoid tissue, usally stomach, assoc with H. Pylori
Diffuse large B cell lymphoma - rapidly growing painless mass in patients over 65yrs
non-hodgkins lymphoma
diverse group of disease
B cell lymphoma - commonest NHL (90%), low + high grade forms
T cell lymphomas - less common, more complex classification
typically occurs in elderly
Non-hodgkins risk factors
HIV, EPV
H.Pyloris - MALT lymphoma
hepatitis B or C infection
exposire to pesticides + trichlorethylene (used in industrial processes)
fam history
differences between Hodgkins + non-Hodgkins presentation
- Alcohol induced pain in node -> Hodgkin’s
- Reed-Sternberg cells -> Hodgkins
- “B” symptoms occur earlier in Hodgkin’s
- Extra-nodal disease more common in Non-Hodgkin’s
extra nodal features in non-hodgkins lymphoma
gastric - dyspepsia, dysphagia, abdo pain
bone marrow (pancytopenia, bone pain)
lungs, skin, central nervous system (nerve palsies)
prognosis of lymphomas
Hodgkins – v treatable with chemo
High grade B cell NHL – aggressive but curable
Low grade B cell NHL – not curable but indolnent
Burkitts lymphoma – v aggressive B cell lymphoma, relapse v quickly
Mantle cell lymphoma
Marginal zone NHL – quick growing + curable
