LYMPHADENOPATHY Dr. Manjit Singh Saren Pathologist, MAHSA University College.
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Transcript of LYMPHADENOPATHY Dr. Manjit Singh Saren Pathologist, MAHSA University College.
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