3. Chronic lymphadenitis
Follicular Hyperplasia
• Secondary follicles with germinal centers
• Parafollicular areas – plasma cells,
histiocytes.
• Eg: Rhematoid arthritis, Toxoplasmosis, HIV
infection
• DD: Follicular lymphoma
– Preservation of architecture
– Marked variation in size & shape of lymphoid
follicles
– Frequent mitosis, TBM
4. Chronic lymphadenitis
Paracortical (Interfollicular) Hyperplasia
•Reactive changes in T cell regions
•Infectious mononucleosis
• Other Viral infection
•Immunological reaction against drugs
•Dermatopathic lymphadenitis
6. Chronic lymphadenitis
Granulomatous inflammation
– Infections – Tuberculosis, leprosy, syphilis,
fungus, sarcoidosis, brucellosis, LGV
– Foreign body reaction
– LN draining carcinomas
– Hodgkin’s lymphoma
•Presence & type of necrosis
•Langerhans giant cells – size & number
•Size, shape & distribution of granulomas
•Associated changes in intervening tissue
7.
8.
9.
10. Sarcoidosis
• Sarcoidosis is an unexplained derangement of
the immune system
• Distinctive granulomas form in lymph nodes and
other locations such as lungs, spleen, liver et.c.
• Low CD4 counts and >ACE levels
• Epithelioid granulomas Schaumann's or asteroid
bodies
13. AIDS Related
lymphadenopathy
• Mycobacterial & other opportunistic
infections
• Kaposis sarcoma
• Malignant lymphoma
• Florid reactive hyperplasia
– Follicle lysis – Invagination of mantle
lymphocytes into germinal centres
– polykaryocytes
14. INFECTIOUS MONONUCLEOSIS
• EBV
• Effacement of architecture
• Marked proliferation of immunoblasts,
immature plasma cells
• RS like cells – Basophilic nucleoli.
Paranuclear hof
15. METASTATIC DEPOSITS
• Usually carcinomas metastasize to LNs
• Produce firm, painless enlargement of the lymph nodes,
similar to lymphomas.
• Far more common than lymphomas
• Initially subcapsular deposits
• Deposits in medullary region are indicative of blood spread
• Sarcomas that may spread thru lymphatics include:
-- Synovial sarcoma
-- Lymphomas
-- RMS
• Virchow’s lymphnode
16. Seen here are sections across very enlarged nodes that contain
metastases. Metastatic tumor can produce a firm, homogenous white
appearance in nodes up to 1 to 2 cm. The cut surface is variegated.
17. Seen here are neoplastic glandular configurations representing metastatic
adenocarcinoma. The nodes draining from the primary site of a carcinoma are
most commonly involved, but distal nodal groups may be involved as well.
24. This is a markedly enlarged spleen (the ruler is 15 cm long). Such massive
splenomegaly is usually indicative of some myeloproliferative disease such as chronic
myelogenous leukemia or myelofibrosis. There are subcapsular yellow-tan infarcts.
Congestive splenomegaly (as with portal hypertension in cirrhosis of the liver)
is unlikely to increase the size of the spleen over 800 gm. A spleen >1000 gm
suggests a myeloproliferative, lymphoproliferative, or hematopoietic disorder.
25. At high power are large pale pink macrophages. Numerous clusters of these
macrophages are present in an enlarged spleen of a child. This appearance is typical for
a storage disease. In this case, the patient had Gaucher disease.