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benign lymphadenopathy
cmbm exam V
36
Chemistry
Graduate
02/22/2010

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Term
what is the most common cause of reactive lymphadenopathy?
Definition
infection (benign)
Term
what is the best way to start looking at pathology under a microscope?
Definition
low power
Term
what are some general patterns of benign reactive lymphadenopathy?
Definition
several broad patterns, follicular, sinus infiltration, diffued, paracortical, and mixed
Term
what is a reactive lymph node condition that can mimic follicular malignant conditions? what is seen with these histologically?
Definition
nonspecific follicular hyperplasia; which varies in size, shape and number of follicles. it is often seen in children/adolescents. histologically, follicular hyperplasia is seen with tingible body macrophages (coming into clean up dead cells resulting from over-proliferation - similar to burkitt)
Term
what is seen in paracortical hyperplasia?
Definition
this is a benign hyperplasia of lymphocytes surrounding the cortex
Term
when can necrotizing lymphadenitis occur?
Definition
this is seen in children as a result of infection, sometimes inflammtory infiltrates can occude lymphocytes (plasma cells, neutrophils). caseating necrosis may be a sign of TB (includes PMN, eosinophils -> associated with massive lymph nodes typically in mediastinal/paratracheal/inguinal LN regions)
Term
is necrosis seen usually with lymphomas?
Definition
no
Term
what is toxoplasmosis lymphadenitis characterized by?
Definition
*unilateral posterior lymph nodes, reactive follicular hyperplasia, and small aggregates of epithelial histiocytes- which encroach on follicles (pink puffs). it is marked by a *monocytoid B cell hyperplasia seen in subscapular and trabecular sinuses. the toxoplasma cysts may be visible
Term
what is toxoplasmosis associated with?
Definition
HIV infections
Term
can syphilis produce a follicular lymph node hyperplasia?
Definition
yes, syphilis generally surrounds blood vessels (may cause periarteritis). **plasma cells are a trademark of syphillis. epithelial histiocytes, a thick capsule and solitary inguinal lymphadenopathy may be observed. spirochetes may also be visible in blood vessel walls
Term
what is granulomatous lymphadenitis seen in conjunction with?
Definition
kikuchi, cat-scratch disease, and lymphogranuloma venerum
Term
what is kikuchi disease?
Definition
this is seen more in young women, presenting with fever (similar to SLE). it features necrosis, aggregates of macrophages with C-shaped nuclei and CD8+ immunoblasts in interfollicular areas. the necrotic areas feature karyorrhectic debris and a *paucity of neutrophils. plasmacytoid monocytes w/round nuclei and eosinophilic cytoplasm - hybrid cells are also seen
Term
what is characteristic of sarcoidosis?
Definition
these are characterized by well-circumscribed epithelioid granulomas with asteroid bodies (stellate), schaumen bodies (circular laminar concretions), and **calcium oxalate crystals. it typically presents in the lungs, peritracheal lymph nodes, but can be anywhere. it is often seen in blacks and manifests as respiratory and possibly cardiovascular symptoms. **this is a dx of exclusion
Term
what is cat scratch fever characterized by?
Definition
supprative granulomas with **stellate (necrotic) absecesses, surrounded by pallisading macrophages/histiocytes; esp in germinal centers. follicular hyperplasia is commonly seen as well.
Term
what organsims is cat scratch fever associated with?
Definition
bartonella henslae, which can further cause bacillary angiomatosis in immunocompromised hosts (B. henselae wreaks havoc via dermal lesions, increased capillary formation, plump endothelial cells, and granular eosiniphilic material*)
Term
what is lymphogranuloma venereum?
Definition
this is similar to cat scratch diseae (not as much stellate hyperplasia), but includes chlamydia and is IDed via a negative silver stain
Term
what is HIV related hyperplasia?
Definition
this is related to extravasation of RBCs into germinal centers, thinning/elimination of mantle zones and **warhin-finkeldey cells which feature multiple nuclei and eosinophilic intranuclear inclusions. this may act as an HIV marker, so a stain for HIV core protein p24 should be done. as immunosuppression progresses the pattern changes from follicular hyperplasia (explosive, florid, and geographic) to follicular involution and finally lymphocyte depletion
Term
what are some reasons for diffuse lymphadenopathy?
Definition
infectious mononucleosis, postvaccinal lymphadenitis (adverse vaccine rxn), and dilantin hypersensitivity (anti-seizure meds). these may co-present with general symptoms such as malaise and fever (mimic leukemia)
Term
what can diffuse reactive lymphadenopathy to mono look like?
Definition
it may appear like a lymphoma, with interfollicular expansion of many immunoblasts/lymphocytes giving a mottled appearance. immunoblast cells may resemble reed sternberg cells. leukemia and lymphoma should be in the differential
Term
what is post-vaccinial lymphadentitis seen with?
Definition
smallpox. this can resemble infectious mono (rely on pt hx for dx). it also has a vascular mixe-cell infiltrate
Term
what characterizes dilantin hypersensitivity?
Definition
diffuse reactive lymphadenopathy, fever, erythematous rash and eosinophilia. the rash can develop into toxic epidermal necrolysis (one of the few dermatologic emergencies). immunoblasts, eosinophils, and plasma cells are seen w/this
Term
what is a common cause of benign lymphadenitis? how does it present?
Definition
viral. it presents with a large population of monocytes & lymphocytes w/interspersed macrophages
Term
can RA cause follicular hyperplasia?
Definition
yes, usually w/interfollicular plasmacytosis similar to syphilis. there may be russel bodies and an **increased risk of lymphoma
Term
can SLE cause lymphadenopathy?
Definition
yes - and necrotic debris can be present which may be painful/painless
Term
what are the three types of castleman's disease?
Definition
hyaline vascular, plasma cell type, multicentric
Term
what characterizes the hyaline vascular type of castleman's disease?
Definition
hyaline vascular is the more common form of castleman's and is characterized by mantle-zone **hyperplasia w/concentric layering of cells - "onion skin" which is then **penetrated by (sclerotic) vessels resembling a "lollipop". lymph nodes affected by this often have **2+ germinal centers.
Term
what characterizes the plasma cell type of castleman's disease?
Definition
this is composed of sheets of plasma cells, is often symptomatic
Term
what characterizes the multicentric type of castleman's disease?
Definition
multicentric castlemans is aggressive and linked to HHV-8
Term
what is the pattern of lymph node sinus infiltration?
Definition
rosai-dorfman syndrome, kimura's disease, and whipple's disease
Term
what is rosai-dorfman syndrome?
Definition
high level of sinus histiocytosis w/massive lymphadenopathy (cervical, nontender). this is common in people up to 20 yrs old and presents with matted lymphadenopathy, dialated sinuses, fever, neutrophilia and elevated ESR. histiocytes, S100+ (cell antigen protein stain)*, macrophages w/emperiopolesis (in vivo phenomenon in which one cell is completely engulfed into another)*
Term
what is kimura's disease?
Definition
lymph node sinus infiltration similar to rosai dorfman; proliferation/accumulation of lymphocytes surrounding the follicle, which ruptures node architecture
Term
what is whipple disease?
Definition
lymph node sinus infiltration marked by *foamy macrophages and sickle-shapped bacillary organisms (tropheryma whippelii). it is associated with *malabsorption in the GI, *hyperpigmentation and *CNS changes. (other changes: weight loss, anemia, tetani*, seizures, easy bruising due to lack of K+). this is seen more in males
Term
what is virus associated hemophagic syndrome?
Definition
this is characterized by *bland macrophages which ingest *RBC, neutrophils and platelets. it is seen in younger children with pancytopenia/neutropenia and constitutional symptoms. this can look like leukemia (if infiltrates the bone marrow)
Term
what is dermatopathic lymphadenitis?
Definition
this is similar to mycosis fungoides, featuring *pigment laden macrophages and *paracortical/interfollicular expansion of large cells. dermatopathic lymphadenitis is associated with skin diseases especially *exfoliative dermatitis
Term
what is autoimmune lymphoproliferative syndrome?
Definition
ALPs features lymphadenopathy, splenomegaly and *hypergammaglobulinemia. it has autoimmune features and is associated with the genetic type mutation of *FAS (CD95 as well as caspase 10) that generally activates apoptosis. paracortical follicular hyperplasia is seen w/transformation of germinal centers. *CD5+ B cells are seen in peripheral blood and there is an *increased risk of lymphoma
Term
what is kawasaki's disease?
Definition
mucocutaneous lymph node syndrome. pts may present w/ conjunctivitis, coronary artery involvement (in carotids). there is lymphoid depetion *(absence of follicles) and obliteration of nodal architecture. necrosis/thrombi is seen in vessels, (on differential for childhood MIs). -> “Kawasaki”, “Mucu-Kutaneous LN syndrome”, “Konjunctivitis”, “Koronary Artery Development”, “Ne-Krosis”, “absence of folli-Kles”, etc
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