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Hemolymphatics > Lymphoreticular System > Flashcards

Lymphoreticular System Flashcards

1
Q

The Innate immune system is made up of what cells?

A

Macrophage, Natural Killer Cell, Dendritic cell, Neutrophil, Eosinophil, Basophil

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2
Q

The Adaptive immune system is made up of what cells?

A

B cell –> Antibodies
T cell –> CD4+ T cell, CD8+ T cell

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3
Q

What cells overlap between the Adaptive and innate immune system?

A

T-Cell
Natural Killer T cell

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4
Q

The lymphoreticular system is made up of…

A

thymus, spleen, LN’s, Mucosa-associated lymphoid tissue (MALT), tonsils, bone marrow

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5
Q

What cells are present within the outer cortex of the thymus?

A

Immature T-cells migrate to thymus for proliferation & maturation

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6
Q

What cells are present within the inner medulla of the thymus?

A

Defective mature T-cells move to blood

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7
Q

What age of life is the thymus important in the lymphoreticular system?

A

Foetal life

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8
Q

The thymus is associated w/ what type of immunity and lymphocytes?

A

Cell-mediated immunity
Production of helper (Th 1&2) and T-regulatory lymphocytes

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9
Q

What pathologies affect the thymus?

A

Thymic mass (thymic lymphoma, thymoma, other epithelial tumours)
Benign thymic hyperplasia
Cyst
haemorrhage - acute
thymic atrophy

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10
Q

What clinical signs may be present if there is a thymus pathology?

A

Resp signs due to pleural effusion
Myasthenia gravis (canine thymoma)
Hypercalcemia & assoc’d signs (lethargy, PU/PD)

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11
Q

How would you approach thymus pathologies diagnostically?

A

Good clin Hx, Physical exam
General blood panel (hematology, biochemistry, urinalysis)
Imaging (chest rads, chest ultrasound, thx CT)
Sampling (cytology, Bx)

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12
Q

Lymphomas can arise in the thymus through

A

malignant transformation of lymphocytes

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13
Q

Thymomas arise from…

A

neoplastic epithelium

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14
Q

Describe thymomas on cytology

A

Monomorphic population of small lymphocytes or mixed lymphoid cell population
Small amt of mast cells interspersed among lymphocytes

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15
Q

What cells are not typically seen with lymphoma?

A

Mast cells & melanocytes

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16
Q

Why is it difficult to distinguish between thymoma and LSA on FNA?

A

Thymic epithelial cells do not readily exfoliate & rare to see on FNA

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17
Q

How should you differentiate from Thymoma and LSA?

A

PARR - PCR for antigen receptor rearrangements
Flow cytometry
Histopath +/- Immunohistochem

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18
Q

Describe the structure of the spleen.

A

Capsule - subject to action of the ANS
Red Pulp - RBC component
White Pulp - immune regulation

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19
Q

Describe the functions of the spleen.

A
  • Assoc’d w/ humoral-mediated immunity –> production of B-lymphocytes & antibodies
  • macrophages filter blood for removal of infectious agents
  • Removal of old/abnormal RBC’s w/ inclusions or coated w/ antibody & complement
  • Storage of RBCs, platelets, Fe
  • Extramedullary haematopoiesis (EMH) in presence of anemia
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20
Q

What vascular pathology(ies) might occur?

A

Thrombus

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21
Q

What inflammatory/infection splenic pathologies might occur?

A
  • splenitis
  • splenic abscess
  • splenic granuloma
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22
Q

What traumatic splenic pathologies may occur?

A
  • Haematoma
  • Splenic torsion
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23
Q

What anomaly in the spleen may occur?

A

Splenic cyst

24
Q

What metabolic pathologies can occur in the spleen?

A

Splenic congestion

Due to CHF, PSS, Drugs, Portal hypertension

25
Q

Are there any idiopathic pathologies of the spleen?

A

No

26
Q

What neoplastic pathologies of the spleen can occur?

A
  • Hematopoietic tumors
  • sarcoma (HSA)
  • metastasis
27
Q

What degenerative pathologies of the spleen may occur?

A
  • Myelolipomas
  • Nodular lymphocytic hyperplasia
28
Q

What are some things you might look for on a physical exam for splenic pathologies?

A
  • Abdominal effusion
  • VPCs
  • Pain
29
Q

What are you looking for on abdominal palpation that may indicate a splenic pathology?

A
  • Splenomegaly
  • Altered shape, irregular margins
  • altered consistency
30
Q

What is the general location of the spleen?

A

Located Left cranial abdomen and is associated with greater curvature of the stomach

31
Q

What is the normal shape of the spleen?

A

Smooth outer capsule, soft parenchyma

32
Q

When would a spleen cause regenerative anemia?

A

Splenic rupture or hemoabdomen

33
Q

What might you see on blood smear if there is a pathology in the spleen?

A

Schistocytes

34
Q

Coagulopathies are seen on bloods and are related to the spleen when what pathologies may be occurring?

A

DIC
Hypercoagulopathic State

35
Q

What imaging might you use for looking at the spleen?

A

Rads, Ultrasound, CT

36
Q

When might you do splenic aspirates under ultrasound?

A

Hyperechoic nodules &/or mixed echogenicity

37
Q

How might you take a biopsy of the spleen?

A

Surgical of laparoscopic excisional biopsy (+/- impression smear from sample)

38
Q

What additional tests might be used to diagnose splenic pathologies?

A
  • PARR, immuncytochemistry
  • +/- culture & susceptibility if suspect cystic lesion or abscess
39
Q

What is the most common canine splenic neoplasm?

A

Splenic hemangiosarcoma

40
Q

What canine breeds are predisposed to canine splenic HSAs?

A

GSD
Golden retrievers

41
Q

Canine Splenic HSAs are associated with…

A
  • Coagulopathies (DIC)
  • Arrhythmias (VPCs)
  • Sudden collapse due to rupture - hemoabdomen
  • Concurrent RHS atrial mass tumor
42
Q

What essential pre-operative stabilisation must occur if there is a canine splenic HSA?

A

if hemoabdomen is present, give fluids &/or transfusions

43
Q

Can you determine HSA being benign or malignant on ultrasound appearance ?

A

No

44
Q

Describe the structure and function of lymph nodes

A
  • Outer cortex - Lymphoid follicles; inner germinal centre is the site for B-cell proliferation; outer edge has more T-cells
  • Inner medulla - cords of lymphocytes, macrophages, plasma cells; has activated B-cells
45
Q

What peripheral LN’s are important to know and feel on physical exam?

A
  • Submandibular
  • Prescapular
  • Popliteal
  • Inguinal & axillary (if enlarged)
46
Q

What are you looking for when asking about Hx or doing a physical exam?

A
  • Travel Hx
  • Concurrent systemic clinical signs
  • painful around area
  • recent trauma, Sx, bite, wound
  • other lesions?
  • signle or multiple LN’s involved?
  • Measure & record LN size/consistency
47
Q

Lymphadenopathy can be…

A

Non-neoplastic or neoplastic

48
Q

What are forms of non-neoplastic lymphadenopathy?

A
  • Lymphoid Hyperplasia
  • Inflammation - Lymphadenitis
49
Q

What neoplastic lymphadenopathies may occur?

A
  • Primary - Lymphoma
  • Secondary - Metastatic Dz
50
Q

Compare and contrast FNA and Excisional/Tru-cut Bx

A

FNA
* Easy to perform, quick, conscious or sedated, eval cell morphology, may not be representative, low cellularity & higher risk blood contamination, less complications, cheap
Bx
* Req’s experience, GA/deep sedation, eval morpholgoy & structure, larger tissue sample, infection, wound dehiscence, peripheral oedema, more costly

51
Q

Lymphoid hyperplasia is what kind of process?

A

Reactive

52
Q

If you did an FNA on a lymph node with hyperplasia, what might you see?

A

Predominantly small cell lymphocytes
<20% med to large lymphocytes
Plasma cells 5-20%

53
Q

If you did an FNA on a patient with lymphadenitis, what might you see?

A
  • 90% well-differentiated small cell lymphocytes
  • Up to 10% med to large lymphocytes
  • Occasional plasma cells, histiocytes, neutrophils, mast cells
54
Q

What is the main differential for lymphoma?

A

Generalised lymphadenopathy

55
Q

High-grade LSA will look like what on cytology?

A

> 50% med to large lymphocytes

56
Q

What are the 2 main types of lymphoma?

A

Diffuse large B-cell LSA
Small cell T-zone lymphoma

57
Q

What tests are required to differentiate between lymphoid hyperplasia and low-grade LSA?

A
  • Histopath (excisional vs incisional wedge Bx/Tru-cut)
  • immunophenotyping (immunocyto- or histochem)
  • PARR
  • flow cytometry (expression of specific cell markers)

Hemolymphatics (21 decks)

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