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S3B5 Pathology > Non-Lymphoma Lymph Nodes, Spleen & Thymus > Flashcards

Non-Lymphoma Lymph Nodes, Spleen & Thymus Flashcards

1
Q

What is the name for swelling of the lymph nodes for any cause?

A

lymphadenopathy

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2
Q

What is the term for infection of the lymph nodes (acute or chronic)?

A

lymphadenitis

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3
Q

What is the term for reactive increase in lymphocytes from any cause?

A

lymphoid hyperplasias

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4
Q

What is the clinical picture of acute lymphadenitis?

A
  • affected region- redness, swelling, tenderness
  • may be abscessed & drain to skin surface
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5
Q

Wha is the clinical picture of chronic lymphadenitis?

A
  • nontender lymph node
  • enlarge over time
  • common in inguinal & axillary lymph nodes
    • drain to extremities
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6
Q

What are the 3 non-neoplastic lymph reactive changes?

A

Follicular pattern

Paracortical pattern

Sinus pattern

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7
Q

What is the most common reactive lymphoid hyperplasia in children?

A

follicular (most common in all but especially children)

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8
Q

What is the morphology seen in follicular pattern reactive lymphoid hyperplasia?

A
  • variably sized follicles
    • large, oblong germinal centers
      • dark zone: centroblasts
      • lighter zone: centrocytes
      • scattered antigen-presenting dendritic cells & tingible body macrophages
    • mantle (around germinal center)
      • small B-lymphocytes with scant cytoplasm
      • asymmetric
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9
Q

What lymph node pathology is shown in the provided image?

A

GOTCHA! (or hopefully I didn’t)

Normal lymph node

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10
Q

Identify the types of lymph node pathology shown in the provided diagram

A
  • Follicular
    • usually seen with humoral response (autoimmune & bacterial infections)
  • Diffuse Hyperplasia
    • usually viral
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11
Q

What pattern of reactive lymphoid hyperplasia is shown in the provided image?

A

Follicular

  • variably sized follicles
    • large, oblong germinal centers
      • dark zone: centroblasts
      • lighter zone: centrocytes
      • scattered antigen-presenting dendritic cells & tingible body macrophages
    • mantle (around germinal center)
      • small B-lymphocytes with scant cytoplasm
      • asymmetric
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12
Q

What is the cause of follicular patter reactive lymphoid hyperplasia?

A

activated humoral immune response

(bacterial infections, RA, some viral infections, etc)

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13
Q

What pattern of reactive lymphoid hyperplasia is shown in the provided image?

A

common in cancer patients - because draining an organ that has tumor in it, so you get these antigens & get reactive sinus hyperplasia/histiocytosis

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14
Q

What pattern of reactive lymphoid hyperplasia is shown in the provided image?

A
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15
Q

What is the cause of paracortical pattern reactive lymphoid hyperplasia?

A

activated T-cell-mediated immune response

(acute viral infections & some medications)

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16
Q

What is the morphology seen in follicular pattern reactive lymphoid hyperplasia?

A
  • diffuse expansion T-lymphocytes in interfollicular region
    • scattered immunoblasts (3-4x size resting lymphocytes)
      • round nuclei, open chromatin, prominent nucleoli, moderate amount pale cytoplasm
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17
Q

What are centroblasts?

A

proliferating blast-like B lymphocytes (large nucleus so cause a darker appearance)

(seen in Follicular pattern reactive lymphoid hyperplasia)

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18
Q

What are centrocytes?

A

zone with mainly B cells with irregular or cleaved nuclear contours

(seen in follicular pattern reactive lymphoid hyperplasia)

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19
Q

What is the cause of sinus pattern reactive lymphoid hyperplasia?

A

increase in number & size of cells lining the lymphatic sinusoids with numerous histiocytes

(lymph nodes draining tumors, Whipple disease, etc)

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20
Q

Rosai-Dorfman Disease displays what pattern of reactive lymphoid hyperplasia?

It most commonly affects what demographic?

Clinical presentation?

A
  • Sinus pattern
    • massive dilation of sinuses
    • numerous, large, intrasinusoidal histiocytes with intracytoplasmic lymphocytes
    • plasma cells, neutrophils & RBC
  • children/young adults
  • Clinical picture
    • massive lymphadenopathy
      • bilateral cervical lymphadenopathy (& others)
      • fever, night sweats, weight loss, anemia, etc
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21
Q

What lymph node pathology is shown in the provided slides?

A

Rosai-Dorfman Disease

  • Sinus pattern
    • massive dilation of sinuses
    • numerous, large, intrasinusoidal histiocytes with intracytoplasmic lymphocytes
    • plasma cells, neutrophils & RBC
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22
Q

Granulomatous lymphadenopathy is due to what 3 main inciting factors?

A
  1. Infection
  2. Foreign bodies
  3. Malignancy
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23
Q

What are the 2 main morphologic types of granulomas?

A

Necrotizing granulomas

Non-nectorizing granulomas

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24
Q

TB, histoplasmosis, cat scratch disease & tularemia cause what type of granulomas?

A

necrotizing granulomas

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25
Q

Non-necrotizing granulomas can be cause by what conditions?

A

numerous infections

sarcoidosis (diagnosis of exclusion)

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26
Q

How do metastatic tumors infiltrate the lymph nodes?

A

First: marginal sinus

Then: medullary sinus, medulla, & cortex

  • pink = capsule
  • dark purple = non-neoplastic lymph node (no germinal centers)
  • tube = afferent lymphatics - notice clusters of tumor cells migrating into the lymph node
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27
Q

What type of granuloma seen in the provided image?

A

Necrotizing

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28
Q

What type of granuloma is seen in the provided image?

A

Non-necrotizing

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29
Q

What is the most common congenital abnormality of the spleen?

A

accessory spleen

20-35% normal persons

histology & function are normal

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30
Q

What is the major significance of having an accessory spleen?

A

may be found anywhere in the abdomen

if there is a hematologic disorder where a splenectomy is indicated & the accessory spleen is overlooked, the benefit of the splenectomy may be reduced/lost

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31
Q

What are the 4 major functions of the spleen?

A
  • phagocytosis of blood cell & particulate matter
  • antibody production
  • hematopoiesis
  • sequestration of formed blood elements
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32
Q

What organ is seen in the provide image?

A

Spleen

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33
Q

Why do we we see nonspecific acute splenitis in situation of blood-borne infections? What is the major histology feature seen in this condition?

A

reaction caused by organisms themselves & cytokines released by immune system

congestion of red pulp, neutrophils & plasma cells seen throughout, white pulp follicles may be necrotic

34
Q

What splenic condition is seen in the provided slide? What is it commonly caused by?

A

granulomas

certain infections (esp fungal)

sarcoidosis

hodgkin lymphoma

some non-hodgkin lymphomas

35
Q

What is perisplenitis? What is it caused by?

A

inflammation of the peritoneal covering of the spleen

due to multiple rounds of inflammation of the splenic capsule & peritoneal covering

36
Q

What condition is seen in the provided image?

A

Perisplenitis

thick white fibrous nodules & plaques coat the spleen surface

37
Q

What are the causes of splenic insufficiency?

A

surgical splenectomy

auto-spenectomy (repeated infarction ie. sickle cell)

38
Q

Splenic insufficiency results in increased susceptibility to what 3 specific encapsulated organisms?

What precaution should individuals with splenic insufficiency take to protect against these organisms?

A
  • Streptococcus pneumoniae*
  • Haemophilus influenza*
  • Neisseria meningitides*

vaccination for all of these organisms

39
Q

What are the 8 causes of splenomegaly?

A
  1. Hematogenous disorder
  2. Autoimmune diseases
  3. Storage disorders
  4. Primary splenic neoplasms
  5. Metastatic tumor
  6. Infections
  7. Congestive states
  8. Hemophagocytic lymphohistiocytosis
40
Q

What splenic condition is seen in the provided images?

A

Splenic Amyloid

  • Top: Waxy pink appearance on H&E
  • Bottom: Apple green birefrengence on Congo Red stain
41
Q

Why does splenomegaly develop in the instance of congestive states?

A

direct consequence of venous outflow obstruction

  • intrahepatic: impede portal venous drainage
    • cirrhosis
  • extrahepatic: directly impinge portal or splenic veins
    • thrombosis of hepatic, portal or splenic veins
    • congestive heart failure
42
Q

What condition is shown in the provided image of the gross sample?

A

Congestive Splenomegaly

moderately enlarged

homogeneous, beefy red & focally hemorrhagic

capsule is thick & fibrous

43
Q

How does the the red pulp or the spleen change through the course of congestive splenomegaly?

A

initially congested but becomes increasing fibrotic & cellular over time

44
Q

Chronically enlarged spleen can result in what complications?

A

may removed excessive numbers of blood cells - anemia, leukocytopenia, or thrombocytopenia

45
Q

What are the causes of hypersplenism?

A
  • autoimmune diseases
  • congestive splenomegaly
  • gaucher disease
  • hematolymphoid neoplasms
  • hereditary spherocytosis & other hemolytic anemias
  • many infections
46
Q

What is the cause of hemophagocytic lymphohistiocytosis?

A

systemic activation of macrophages & CD8+ cytotoxic T cells

47
Q

What is the clinical manifestation of hemophagocytic lymphohistiocytosis?

A

peripheral cytopenias & signs/symptoms of systemic inflammation due to macrophage activation

if untreated may progress to DIC, shock, multiorgan failure & death

48
Q

What is the most common trigger of hemophagocytic lymphohistiocytosis?

A

infection - specifically EBV & HIV

also triggered by malignancy, autoimmune diseases, immunosuppression, medications & metabolic disorders

49
Q

What condition is seen in the provided image?

A

acquired hemophagocyic lymphiohistiocytosis

macrophages within sinuses with phagocytosis of lymphocytes & RBC

systemic inflammatory condition

50
Q

What are the 3 most common causes of splenic infarct?

A

embolism to the splenic artery/branches (endocarditis or severe artherosclerosis)

massive splenomegaly

thrombosis of splenic vein

51
Q

What condition is shown in the image of the provided gross sample?

A

splenic infarct

wedge-shaped, pale & subcapsular

52
Q

What are the most common causes of splenic rupture?

A

trauma & surgical intervention

spontaneous rupture happens only in abnormal spleens

53
Q

Splenic rupture can lead to what complications?

A

life-threatening intraperitoneal hemorrhage & requires prompt splenectomy

splenic implants

54
Q

What condition is shown in the provided image of the gross sample?

A

Splenic rupture

55
Q

What is the most common primary tumor of the spleen?

A

hemangioma

56
Q

What type of splenic tumor is seen in the provided images?

A

Hemangioma

usually <2cm

may involve entire spleen

usually cavernous type

57
Q

How is a lymphangioma different from a hemangioma?

A

channels contain lymph, not blood

otherwise very similar

58
Q

What type of splenic tumor is shown in the provided image?

A

Lymphangioma

may be focal but may involved the entire organ

subcapsular, multicystic, lumina contains proteinaceous material (not red blood cells), endothelium may form small papillary projections

59
Q

What demographic is most commonly affected by splenic lymphangiomas?

A

children

sometimes in association with lymphogiomas in other organs

60
Q

What is the most common malignant primary nonlymphoid tumor of the spleen?

A

angiosarcoma

61
Q

What type of splenic tumor is seen in the provided images?

A

Angiosarcoma

may present as a nodule or diffusely involves the spleen

62
Q

Angiosarcoma of the spleen can lead to what complication?

A

spontaneous rupture

63
Q

Metastasis to the spleen are most commonly originate from what sites?

A

melanoma

lung

breast

gastric

pancreas

liver

colon

64
Q

What type of splenic tumor is seen in the provided image?

A

Metastasis

65
Q

Which thymus sample is from and adult & which is from a child?

A

left child

right adult (much fattier)

66
Q

What is acute Thymic Involution?

A

response to severe disease & metabolic stress associated with

pregnancy, lactation, infection, surgery, malnutrition, malignancy, etc.

characterized by lymphocyte death & is (prob) mediated by high levels corticosteroids

67
Q

Thymic Involution most commonly affects what demographics?

A

premature infants or ill term infants exposed to chronic stress in utero

68
Q

What condition is seen in the provided histological slide?

A

Thymic Involution

complete loss of the cortex

Hassall corpuscle (arrows) are prominent

69
Q

What is the most common ectopic tissue to be found in the thymus?

A

parathyroid

70
Q

Thymic hypoplasia is commonly seen in what condition?

A

DiGeorge syndrome

severe defects in cell-mediated immunity

71
Q

Thymic Hyperplasia is seen in what conditions?

A

chronic inflammatory/immunologic states (particularly myasthenia gravis)

72
Q

What is the definition of thymic hyperplasia?

A

presence of lymphoid follicles in the thymus regardless of thymic size (usually normal sized thymus)

73
Q

What condition is seen in the provided histological slide?

A

Thymic hyperplasia

74
Q

What is the most common primary anterior mediastinal neoplasm?

A

Benign thymoma

75
Q

What is the origin of a benign thymoma?

A

primary tumor of thymic epithelial cells

NOT lymphoid cells

76
Q

What demographics are most commonly affected by benign thymomas?

M v F?

age?

A

M = F

usually middle age

may be associated with paraneoplastic syndrome (MG)

77
Q

What condition is seen in the provided image?

A

Benign Thymoma

lobulated, usually encapsulated mass

large, tan/gray with sharp lobulations due to fibrous bands with some nodules having pointed ends

cystic degeneration is common

78
Q

What is the histology type of benign thymoma shown in the provided histological examples?

A
  • Upper left: Spindle Type
  • Upper Right: Epitheliod type
  • Bottom: Mixed

background non-neoplastic small lymphocytes

usually no well-formed Hassall corpuscles

79
Q

What are the two diagnostic patterns of malignant thymoma?

A
  • Invasive Thymoma
  • Thymic Carcinoma
80
Q

What type of thymoma is shown in the provided histological slide?

A

Malignant thymoma - Invasive thymoma

  • benign cytologic features
  • locally aggressive architectural features
    • invasion through capsule
    • Pleural/pericardial implants
    • distant metastases
81
Q

What type of thymoma is shown in the provided histological slide?

A

Malignant thymoma- Thymic carcinoma

  • cytologic & architectural features are malignant (this one resembles poorly differentiated SSC)
  • often morphologically similar to squamous cell carcinoma
  • typically NOT associated with myasthenia gravis
  • ~5% all thymomas
82
Q

What are the most common primary sites of tumors that metastasize to the thymus?

A

esophagus

lung/pleura

breast

thyroid

melanoma

S3B5 Pathology (13 decks)

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