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Path - benign lymphoid proliferations (ii) (investigating an enlarged node…
Path - benign lymphoid proliferations (ii)
Patterns in a benign reactive lymph node
architecture maintained
cortex follicular hyperplasia (mainly B cells, with macrophages in centre)
non-specific immune stimulation
usually due to infection
sinus histiocytosis
dilated sinus due to infiltration of histiocytes, lymphocytes + APCs
Paracortical hyperplasia (T cells)
granulomatous reaction
giant cells
e.g. TB, sarcoid, Crohn's, foreign bodies, syphilis, certain connective tissue disorders
Causes of benign reactive node
infections
granulomas
brucellosis
infectious mononucleosis
deposits (e.g. amyloid)
immune reactions (RA, SLE)
storage disorders (enzyme deficiencies)
e.g. Gaucher's disease
deposition of glucocerebroside in histiocytes + macrophages
Reactive lymphadenitis
Acute
e.g. strep throat - cervical nodes enlarged + tender
histological features
architecture preserved
follicular hyperplasia
neutrophilic infiltration
abscess formation
lymphadenopathy secondary to infection in an area drained by those nodes
Chronic
in response to chronic antigen exposure
e.g. collagen vasc disease
RA (generalised follicular hyperplasia)
Sjogren's syndrome
dry eyes + mouth
follicular hyperplasia
increased lymphoma risk
SLE (cervical follicular hyperplasia)
Dx Qs
benign or malignant?
if benign is there an identifiable cause?
strep throat?
ear infection?
acne?
if malignant is it carcinoma/melanoma/sarcoma/lymphoma?
if mets where is the primary site?
gastric + bronchogenic carcinoma spread to supraclav node
breast carcinoma spreads to axillary nodes
melanoma of skin of leg spreads to inguinal nodes
nasopharyngeal/oropharyngeal/head + neck carcinoma spreads to cervical nodes
prostate cancer spreads to para-aortic nodes
squamous/basal cell carcinoma rarely spread
investigating an enlarged node
proper Hx
recent infection
evidence of malignancy in draining site
localising symptoms
weight loss
night sweats (esp in lymphoma)
duration of lymphadenopathy
soreness/tenderness
FBC (indicates anaemia)
CRP
LDH (increased in increased cell turnover)
viral screen
chest/abdo imaging
for staging/finding primary
tissue Dx NB
FNA
trucut Bx (best to assess architecture)
if inconclusive do whole node excision (open removal)
incisional/open Bx
BM trephine (if +ve late stage lymphoma/leukaemia)
clinical exam
tumour emboli
obstruct blood supply to node
necrosis
keratin - squamous cell carcinoma
mucin + tubules - adenocarcinoma
gland = lumen surrounded by secreting epithelium
melanoma primary sites
skin
anus
retina
tumour markers
useful for poorly differentiated tumours
cytokeratin = epithelial (carcinoma)
vimentin = mesenchymal (sarcoma)
CD45 = common leukocyte antigen = lymphoid
S100P + HMB45 = melanoma
IHC (dyed Igs)