LYMPHADENOPATHY

Dr. Manjit Singh SarenPathologist,MAHSA University College.

HISTOLOGYHISTOLOGY

HISTOLOGY

LYMPHADENOPATHY

DEFINITION: Disease of lymph nodes

Associated with underlying pathology. i) Involvement in variety of systemic diseases. ii) Primary lymphoid malignancies iii) Metastatic lymphoid lesions iv) Localized infections v) Localized injuries

LYMPHADENOPATHYTypes:

1. REACTIVE LYMPHADENITIS Inflammation of lymph nodes

2. REACTIVE LYMPHADENOPATHYPrimary immune reactions

REACTIVE LYMPHADENITISNON- SPECIFIC RESPONSE1.Acute lymphadenitis2.Chronic lymphadenitis

1) Acute lymphadenitis: draining inflamed area. >Bacterial infections >Foreign bodies in woundsNodes: Enlarged and tenderUntreated : Chronic adenitis, necrosis and abscess

2) Chronic Lymphadenitis:

A). With follicular B cell hyperplasia i.Non- specific lymphadenitis: Commonest lesionii. Specific lymphadenitis: Rheumatoid arthritis Toxoplasmosis Syphilis AIDS

B) With para-follicular T cell hyperplasia - Microbiological agents - Drugs (Dilantin) - Virus (Inf. Mononucleosis) -Post vaccinial

C) With sinus hyperplasia with histiocytosis: Cancer draining sites. Micro: Phagocytes within dilated sinuses.

LYMPHADENOPATHY1.Primary: Lymphoid malignancies. Amyloidosis2. Secondary: i. Infections: TB Sarcoidosis Syphilis Castleman’s Disease Dermatolymadenopathy Filariasis ii. Metastatic diseases

CAUSES OF LYMPADENOPATHY:

1.HIV related2.Opportunistc infections: TB, CMV, Toxoplasmosis, Norcardia.3.Fungal: Histoplasmosis, cryptococcusis.4.Reactive: Pyogenic infections/bacteria. 5.Venereal: (STD)- Syphilis, Chancroid, Lympho- Granuloma Venereum6.Malignancies: i. Primary: Lymphomas ii. Secondary: Metastasis

CYTO MEGALIC VIRUS

CYTO MEGALIC VIRUS

Toxoplasma gondii

TUBERCULOUS LYMPHADENOPATHY

Poor socio-economic background.Over-crowdingPresentation:Night sweatsCough with hemoptysisLoss of weightFamily history

Diagnosis

HistoryESRSputum examination for AFBTB CultureChest X-raysCT ScanMRIBIOPSY

SARCOIDOSISEtiology: Unknown. Cell mediated immune reactionAffects: Lung and lymph nodesMicro: 1. Langhans cells, Foreign body giant cells 2. Asteroid bodies, Schaumann bodies.3. Non-caseating granuloma4. Epitheloid cells and fibrosisDiagnosis: Kviem’s Test: Intra-dermal test

FILARIAL LYMPHADENOPATHY

Etiology: Wuchereia Bancrofti Brugia malayiAdult worm in: lymphatics, Lymph nodes, testis and epididymisAcute: Fever, lymphangitis, epididymo-orchitis and microfilaria.Chronic: Lymphadenopathy, hydrocele and elephantiasis.Complications: Chylous ascitis & chyluria

AL AMYLOIDOSIS

Associated with plasma cell dyscrasias.Secrete Immunoglobulin light chains.Can be associated with lymphadenoparthy

Diagnosis: Congo red: 1.Light

microscopy Eosinophilic

amorphous 2.Polarised

light: Apple green

birefringence

PART IPART I

LYMPHADENOPATHYLYMPHADENOPATHY

CASTLEMAN’S DISEASE

Definition:Single solid growth within lymphatic tissueSites: Chest, stomach or neck .Abnormal enlargement of lymph nodes.

CASTLEMAN’S DISEASE

Etiology:UnknownRare disorderTypes:1. Hyaline type 90%2. Plasma type: prevalent in young

DERMOTOPATHIC LYMPHADENOPATHY

Definition:Reactive lymph node hyperplasia.Etiology:Secondary to eczema and dermatitisMicro: Intra-dermal macrophages containing fat and melanin

CAT SCRATCH DISEASE

Children 80%Self limiting Gm-ve bacterial infectionLocalized lymphadenopathySarcoid-like granulomasStellate abscess

LYMPHANGIITIS

Inflammation of lymphatic vesselsi. Acute Lymphangiitis: Bacterial infections: B-Strep % & Staph.Micro: inflammatory exudate and clotted lymph

ii. Chronic Lymphangitis:TB, Actinomyces, syphilis, radiation,& parasitesMicro: Fibrosis and chronic lymphedema

KIKUCHI’S DISEASEPresentation:Fever and Tender Adenitis Micro:Necrosis and stellate abscessesNeutrophils and nuclear dustHistiocytes but rarely any eosinophils

KIMURA’S DISEASE

Introduction:Chronic inflammatory disorder

Clinical Features:Age: 20-40 yrs and malesPainless swelling of parotidCervical lymphadenopathy

KIMURA’S DISEASE

Micro: Lymph node biopsy:Eosinoplilia Proliferation of vascular endothelium. Focal eosinophilic abscessHyperplasia of lymphoid follicles:Well vascularised Warthin-Finkeldey polykaryocytes

KIKUCHI’S DISEASE

Common in childrenCervical lymphadenopathyAlso :Necrotizing histiocytic lymphadenitisEtiology:CMVEBVHerpes virus

KIMURA’S DISEASE

PATHOPHYSIOLOGYAllergic reaction: -Parasites, viral, arthropod bites and candidiasis.Auto-immune reaction :IgE –mediated Type I hypersensitive reaction.Cytokines:Interleukin 4 and 5 produces:- > Eosinophiltrophic cytokines & IgE20% with nephrotic syndrome

KAWASAKI’S DISEASE

Age: <5yrsCause: UnknownLymphadenopathyClinically: Fever (>39C) red eyes Red and cracked lipsRash on chest and genitals Swollen tongue and enlarged lymph nodesComplications: Affects heart: Arrhythmias

C)Multicentric or Generalized Type CASTLEMAN’S DISEASE

Multiple sitesSymptoms:Same as plasma typeHepato-splenomegaly‘POEMS SyndromeComplications : POEMS SYNDROME Kaposi’s Sarcoma Non Hodgkin’s

Lymphoma

LANGERHANS CELL HISTIOCYTOSIS

Histiocytosis : Proliferative disorder of histiocytes or macrophages.Auto-immune disease & genetically related

Types:1. Benign: Histiocytic proliferation in lymph nodes.2. Malignant: Histiocytic lymphoma3. Intermediate: Langerhans cell Histiocytosis

LANGHERAN CELLS: ORIGIN

Derived from dendritic cells of skin.Proliferating Langerhans cells are LEUKOCYTE ANTIGEN DR (HLA-DR) positive and express CD1 antigen. Cells contain Berkeck’s granules. EM Micro: Vacuolated cytoplasm resembling tissue histiocytes and hence called Langerhans Cell Histiocytosis

HISTIOCYTOSIS X

1. LITTERER SEWE DISEASEAge: 2 yrs and lessPresentation:Cutaneous lesionsHepato-splenomegalyPulmonary lesions (stiffening)Destructive osteolytic bone lesions&fracturesInfiltrates bone marrow causing:anaemia and thrombocytopeniaPredisposing: to infections.Rapidly fatalChemo:50% 5 year survival

2: EOSINOPHILIC GRANULOMA

Langerhans cells in bone medullary cavities Micro:Histiocytes and eosinophils along with plasma cells and lymphocytes.Lesions:Unifocal: Pain and pathological #Treatment:Local excision and radiation.May heal spontaneously

2. MULTIFOCAL LESIONS Affects childrenClinical Presentation:Fever and diffuse eruptions on scalpOtitis mediaURTIGeneralized LymphadenopathyHepato-splenomegalyDiabetes Insipidus (post pituitary stalk involved)

3. HAND SCHULLER CHRISTIAN DISEASE

Presentation:Involvement of calvarial boneDiabetes InsipidusExophthalmos

Treatment:Spontaneous regressionChemotherapy

HAND SCHULLER CHRISTIAN DISEASE

Presentation:Involvement of calvarial boneDiabetes InsipidusExophthalmos

Treatment:Spontaneous regressionChemotherapy