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LYMPHADENOPATHY/LYMPHADENITIS

pathology
supplement to the main document. LYMPHADENOPATHY refers to enlarged lymph nodes,
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Student will be able to:
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Hodgkin lymphomas.
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morphological
features of Hodgkin's and non-
Hodgkin

• lymphoma and correlate with

clinical course

• Causes of splenomegaly
 Causes of lymph node enlargement/lymphadenopathy

Define generalized
lymphadenopathy

What is Virchow's node?

How can you differentiate lymph

nodes of tuberculosis and
lymphoma?

Morphology of chronic NON SPECIFIC lymphadenitis

Follicular hyperplasia

• is caused by stimuli that activate humoral immune responses

• B-cell mediated antigenic response

• Causes of follicular hyperplasia include rheumatoid arthritis,

toxoplasmosis, and early stages of infection with HIV

Paracortical hyperplasia

• is caused by stimuli that trigger T-cell–mediated immune responses, such

as acute viral infections (e.g., infectious mononucleosis)

Sinus histiocytosis

• benign histiocytic response in lymph nodes draining a tumor

Mention the oncogenic microbes
causing lymphoma?

Lymphoid Neoplasms

Leukemia is used for neoplasms that present with widespread involvement of

the bone marrow and (usually, but not always) the peripheral blood.
Lymphoma is used for proliferations that arise as discrete tissue masses.

Aetiology:

• Chromosomal Translocations and Other Acquired Mutations.

• Viruses. Three lymphotropic viruses—human T-cell leukemia virus-1

(HTLV-1), Epstein-Barr virus (EBV), and Kaposi sarcoma herpesvirus/human
herpesvirus-8 (KSHV/HHV-8)—have been implicated as causative agents in
particular lymphomas

• Chronic Inflammation: H pylori infection causing gastric lymphoma

• Iatrogenic Factors: Radiation, chemotherapy

• Smoking
 Clinical presentations of lymphoma

• Lymphadenopathy: painless(often > 2 cm), rubbery, generalized

A 58-year-old
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Biopsy orthese
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• weight loss, sweats, and itching
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Immunohistochemical staining
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• Account for ∼60% of adult lymphomas
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(B) Chronic lymphoid leukemia • Greater than 70% are of B-cell origin and derive from the germinal
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plasmacytoma • Median age in adults is 50 years old
(D) Hairy cell leukemia
• Approximately one-third arise from extranodal sites
(E) Mycosis fungoides
• Extranodal sites include the stomach (most common site), Peyer
patches, and centralnervous system

What are the

immunohistochemical markers Follicular lymphoma
of B lymphocytes?
• Neoplastic proliferation of small B cells (CD20) that form follicle-like
nodules
What are the
immunohistochemical markers • Clinically presents in late adulthood with painless lymphadenopathy
of T lymphocytes?
• Driven by t (14; 18) translocation

• Treatment is reserved lot patients who are symptomatic and involves low-
dose chemotherapy or rituximab (anti-CD20 antibody).
Menntion five important non
Hodgkin lymphoma

Mention the peculiarity of

MALToma?

A 55-year-old man presents with

recurrent epigastric pain. Upper
GI endoscopy and gastric biopsy
reveal a neoplastic, lymphocytic
infi ltrate invading glandular
tissue. Giemsa staining is
positive for Helicobacter pylori.
Which of the following is the
most likely diagnosis?

(A) Burkitt lymphoma

(B) Follicular lymphoma

(C) Hodgkin lymphoma

(D) Mantle cell lymphoma

(E) Marginal zone lymphoma

Burkitt lymphoma

• Neoplastic proliferation of intermediate-sized B cells associated with EBV

• Classically presents as an extranodal mass in a child or young adult

• African form usually involves the jaw Sporadic form usually involves the
abdomen.

• Driven by translocations of c-myc gene

• Characterized by high mitotic index and 'starry-sky' appearance on

 microscopy

Hodgkin lymphoma
The Ann Arbor Staging System
is the basis for most Hodgkin • Accounts for ∼40% of adult lymphomas
Lymphoma staging
• Slightly more common in men than women

• More common in adults than children

Which subtypes of Hodgkin
lymphoma having best • 3. Bimodal age distribution
prognosis?
• First large peak is 15 to 34 years old

In which subtypes RS cells are • Second smaller peak is >50 years old
most abundant?
• Occurs in a younger age bracket than NHL

• Most common site of initial involvement is the neck region

What is B symptoms?
• EBV has been identified in certain types of HL

A 23-year-old woman presents Subtypes of Hodgkin Lymphoma

with cervical and mediastinal
lymphadenopathy. Biopsy of a
cervical lymph node reveals a
nodular appearance with fibrous
bands, effacement of the lymph
node architecture, and
numerous lacunar cells. Which
of the following is characteristic
of this disorder?

(A) Benign neoplasm

(B) Frequent association with

EBV infection

(C) Most often a complication of

human immunodeficiency virus
infection Reed Sternberg cell

(D) Peak incidence in early • Diagnostic Reed-Sternberg cells are large cells with multiple nuclei or a
childhood single nucleus with multiple nuclear lobes, each with a large inclusion-like
(E) Relatively favorable clinical nucleolus
course
• Large B cells (CD 15 and CD 30 +ve) with multilobed nuclei and prominent
nucleoli that looks like Owl eye. They produce cytokines which attract
inflammatory cells and cause fibrosis
The classical Hodgkin
lymphomas (nodular sclerosis,
mixed cellularity,
lymphocyterich, lymphocyte-
depleted) share the
immunophenotype CD45-,
CD15+, CD30+.

Is exact categorization of
lymphoma is done by
histopathological examination?

Differences between Hodgkin and Non-Hodgkin Lymphomas

Spleenomegaly
Mention the subtypes of RS cell?

The spleen may be enlarged due to

•Whatinvolvement by lymphoproliferative
is popcorn cell?
disease

• Extramedullary haematopoiesis in
myeloproliferative disease

• enhanced reticulo-endothelial activity in

autoimmune haemolysis

• expansion of the lymphoid tissue in

response to infections

• vascular congestion as a result of portal

hypertension
Variants of RS cell

Lab diagnosis of lymphoma

• CBC and ESR

• Serum LDH level

• Radiology: Chest x ray, CT scan

• FNAC (Not confirmatory)

• Lymph node biopsy

• Immunohistochemistry

• Flowcytometry

• Cytogenetic study: FISH

Atlas & Quiz (For those who wants to be a specialist doctor, NOT MBBS ONLY)
Quiz A

A 30-year-old man with a 2-month history of dyspnea describes intermittent chest pain with alcohol
consumption. Biopsy of the lesion shown on the chest CT scan reveals bands of fibrosis and lacunar
cells marking for CD15 and CD30.

1. What is your diagnosis?

2. What is the stage of this patients disease?

3. What is the prognosis?

Ans

1. In the subcarinal region between the right and left main bronchi is a mass ( ▸) of enlarged lymph
nodes. The chest pain symptoms are a curious paraneoplastic finding of Hodgkin lymphoma (HL). The
pathology description suggests HL, nodular sclerosis type .

2. If this is the only region involved, then the patient has stage I disease. If another lymph node region
or contiguous spread to adjacent tissue is involved, then the patient has stage II disease.

3. The prognosis of patients with HL, nodular sclerosis type, is excellent.

Quiz B

A 35-year-old Bangladeshi woman presents to her general practitioner for low grade fever and neck
mass for one month. General examination reveal multiple lymph nodes are enlarged in cervical and
axillary region. A CBC reports shows features of anemia of chronic disease, lymphocytosis and ESR is
75. A cervical lymph node biopsy is planned.

◆ what is the most likely diagnosis?

◆ What type of cells most likely would be seen on the biopsy specimen?

◆ what is the usual clinical course in patients with this condition?

Ans:

Most likely diagnosis: Pulmonary tuberculosis.

◆ Cells likely to be seen on biopsy: Epithelioid cells and Langhans-type giant cells typically surround
the tuberculous granuloma (tubercle) with a central area of caseous necrosis.

◆ Usual clinical course: Initial pulmonary involvement with granuloma formation and later
reactivation during times of stress or immunocompromise.