Lymph node pathology
Revision as of 17:18, 13 July 2010 by Michael (talk | contribs) (→Cat-scratch disease: replace ',' with '.')
This article deals with lymph node pathology. An introduction to the lymph node is in the lymph nodes article.
Progressive transformation of germinal centers
General
- Abbreviated as PTGC.
- Benign.
- Classically in younger patients.
- Associated with Hodgkin's lymphoma - non-classic type (nodular lymphocyte predominant Hodgkin's lymphoma).
Micrograph
Features:
- Large germinal centers - focally.
- No mass lesions.
Kikuchi disease
General
- AKA histiocytic necrotising lymphadenitis (HNL),[1] and Kikuchi-Fujimoto disease.
- Rare disease that may mimic cancer, esp. lymphoma.
- May cause fever & systemic symptoms.[2]
Epidemiology:[2]
- Usually <40 years old.
- Asian.
- Female:Male = 3:1.[3]
Treatment:
- Usually self-limited.[2]
- Oral corticosteroids.
DDx:
- Non-Hodgkin lymphoma.
- Systemic lupus erythematosus.
Micrograph
Features (the three main features - just as the name suggests):[4]
- Histiocytes.
- May be crescentic.
- Necrosis (due to apoptosis) - paracortical areas.[2]
- Necrosis without neutrophils - key feature.
- Lymphocytes (CD8 +ve).
- Plasmacytoid dendritic cells.
Notes:
- Dendritic cell - vaguely resembles a macrophage:[5]
- Long membrane projections - key feature.
- Abundant blue-grey cytoplasm, +/- ground-glass appearance.
- Nucleus: small, ovoid, usu. single nucleolous.
Images:
IHC
- CD68 +ve.
- CD8 +ve.
- CD4, CD20, CD3, and CD30 - mixed.
- Done to excluded lymphoma; should show a mixed population of lymphocytes.
Castleman disease
General
- AKA angiofollicular lymph node hyperplasia, giant lymph node hyperplasia.[6]
- Benign.
- Abbreviated CD.
Classification
CD is grouped by location/involvment:
- Hyaline vascular variant.
- Usually unicentric.
- Typically mediastinal or axial.
- Plasma cell variant.
- Usually multicentric.
- Abundant plasma cells.
- Associated with HHV-8 infection (the same virus implicated in Kaposi's sarcoma).
Discussed here: [7]
Microscopic
Features:[8]
- Pale concentric (expanded) mantle zone lymphocytes.
- "Regressed follicle". (???)
- "Lollipops" - germinal centers fed by prominent vessels; lollipop-like appearance.
- Two germinal centers in one follicle.
Cat-scratch disease
General
- AKA Cat-scratch fever.
- Infection caused by spirochete Bartonella henselae.[9]
- Treatment: antibiotics.
Micrograph
Features:
- Palisading granulomas with neutrophils in the center.
Stains:
- Warthin-Starry stain.
Image(s):
Dermatopathic lymphadenopathy
General
- Lymphadenopathy associated with a skin lesion. (???)
- May be benign of malignant (e.g. T-cell lymphoma).
Microscopic
- May see melanin pigment. (???)
See also
References
- ↑ Kaushik V, Malik TH, Bishop PW, Jones PH (June 2004). "Histiocytic necrotising lymphadenitis (Kikuchi's disease): a rare cause of cervical lymphadenopathy". Surgeon 2 (3): 179–82. PMID 15570824.
- ↑ 2.0 2.1 2.2 2.3 Hutchinson CB, Wang E (February 2010). "Kikuchi-Fujimoto disease". Arch. Pathol. Lab. Med. 134 (2): 289–93. PMID 20121621.
- ↑ URL: http://emedicine.medscape.com/article/210752-overview. Accessed on: 3 June 2010.
- ↑ URL: http://www.ispub.com/journal/the_internet_journal_of_head_and_neck_surgery/volume_1_number_1_30/article_printable/kikuchi_s_lymphadenitis_in_a_young_male.html. Accessed on: 1 June 2010.
- ↑ URL: http://www.healthsystem.virginia.edu/internet/hematology/hessedd/benignhematologicdisorders/normal-hematopoietic-cells/dendritic-cell.cfm?drid=214. Accessed on: 3 June 2010.
- ↑ URL: http://www.mayoclinic.com/health/castleman-disease/DS01000. Accessed on: 17 June 2010.
- ↑ PMID 19546611
- ↑ URL: http://www.ispub.com/journal/the_internet_journal_of_otorhinolaryngology/volume_9_number_2_11/article/a_rare_case_of_castleman_s_disease_presenting_as_cervical_neck_mass.html. Accessed on: 15 June 2010.
- ↑ Jerris, RC.; Regnery, RL. (1996). "Will the real agent of cat-scratch disease please stand up?". Annu Rev Microbiol 50: 707-25. doi:10.1146/annurev.micro.50.1.707. PMID 8905096.