Lymph node pathology - Revision history

Michael: /* Reactive follicular hyperplasia */ split out

2021-02-16T15:16:20Z

Reactive follicular hyperplasia: split out

← Older revision		Revision as of 15:16, 16 February 2021
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	==Reactive follicular hyperplasia==		==Reactive follicular hyperplasia==
	~~===General===~~		{{Main\|Reactive follicular hyperplasia}}
	*Many causes - including: bacteria, viruses, chemicals, drugs, allergens.
	**In only approximately 10% can definitive cause be identified.<ref name=Ref_ILNP174>{{~~Ref_ILNP~~\|~~174~~}}~~</ref>~~

	~~===Microscopic===~~
	~~Features:<ref name=Ref_ILNP179>{{Ref_ILNP\|179}}</ref>~~
	*Enlarged follicles, follicle size variation - '''key feature''' with:
	**Large germinal centers (pale on H&E).
	***Mitoses common.
	***Variable lymphocyte morphology.
	***Tingible-body macrophage (large, pale cells with junk in the cytoplasm).
	***Germinal centers (GCs) have a crisp/sharp edge.
	***Normal dark/light variation of GCs; superficial aspect light, deeper aspect darker.
	**Rim of small (inactive) lymphocytes.

	~~DDx:~~
	*[[Hodgkin lymphoma]] - with rare Reed-Sternberg cells.
	*Non-Hodgkin [[lymphoma]].
	**T-cell/histiocyte-rich large B cell lymphoma.

	~~Image: [http://pleiad.umdnj.edu/hemepath/normal_node/normal_node.html Normal lymph node (umdnj.edu)].~~

	~~===IHC===~~
	~~Screening panel:~~
	*[[CD3]].
	*[[CD5]].
	*CD10.
	*[[CD20]].
	*CD30.
	*CD15.

	~~Others:~~
	*BCL2 -ve.

	==Diffuse paracortical hyperplasia==		==Diffuse paracortical hyperplasia==

Michael at 15:45, 5 March 2017

2017-03-05T15:45:18Z

← Older revision		Revision as of 15:45, 5 March 2017
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	===IHC===		===IHC===
	Screening panel:		Screening panel:
	*CD3.		*[[CD3]].
	*CD5.		*[[CD5]].
	*CD10.		*CD10.
	*CD20.		*[[CD20]].
	*CD30.		*CD30.
	*CD15.		*CD15.

Michael: touch

2016-02-06T16:56:03Z

touch

← Older revision		Revision as of 16:56, 6 February 2016
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	*Neoplastic - lymphoma, carcinoma.		*Neoplastic - lymphoma, carcinoma.
	*Endocrine - [[hyperthyroidism]].		*Endocrine - [[hyperthyroidism]].
	*Trauma.		*Trauma.
	*Autoimmune - [[SLE]], [[RA]], [[dermatomyositis]].		*Autoimmune - [[SLE]], [[RA]], [[dermatomyositis]].
	*Inflammatory - drugs (phenytoin).		*Inflammatory - drugs (phenytoin).

Michael at 16:00, 4 November 2015

2015-11-04T16:00:58Z

← Older revision		Revision as of 16:00, 4 November 2015
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	\| melanin-laden histiocytes		\| melanin-laden histiocytes
	\| [[histiocytosis]]		\| [[histiocytosis]]
	\| ~~S100~~+ve (interdigitating dendritic cells), CD1a+ve (Langerhans cells)		\| [[S-100]]+ve (interdigitating dendritic cells), CD1a+ve (Langerhans cells)
	\| [[cutaneous T-cell lymphoma]]		\| [[cutaneous T-cell lymphoma]]
	\| [[Image:Dermatopathic_lymphadenopathy_-_intermed_mag.jpg \|thumb\|center\|150px\| DL - intermed. mag.]]		\| [[Image:Dermatopathic_lymphadenopathy_-_intermed_mag.jpg \|thumb\|center\|150px\| DL - intermed. mag.]]
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	\| abundant histiocytes with reniform nuclei		\| abundant histiocytes with reniform nuclei
	\| often prominent eosinophilia		\| often prominent eosinophilia
	\| ~~S100~~+, CD1a+		\| [[S-100]]+, CD1a+
	\| [[Kimura disease]] (eosinophilia), [[Rosai-Dorfman disease]]		\| [[Kimura disease]] (eosinophilia), [[Rosai-Dorfman disease]]
	\| [[Image:Langerhans_cell_histiocytosis_-_very_high_mag.jpg\|thumb\|center\|150px\|LCH - very high mag.]]		\| [[Image:Langerhans_cell_histiocytosis_-_very_high_mag.jpg\|thumb\|center\|150px\|LCH - very high mag.]]
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	\| sinus histiocytosis		\| sinus histiocytosis
	\| emperipolesis (intact cell within a macrophage)		\| emperipolesis (intact cell within a macrophage)
	\| ~~S100~~+, CD1a-		\| [[S-100]]+, CD1a-
	\| Langerhans cell histiocytosis		\| Langerhans cell histiocytosis
	\| [[Image:Emperipolesis_-_very_high_mag.jpg \|thumb\|center\|150px \| RDD - very high mag.]]		\| [[Image:Emperipolesis_-_very_high_mag.jpg \|thumb\|center\|150px \| RDD - very high mag.]]

Michael: /* Overview in a table */

2015-10-31T02:59:21Z

Overview in a table

← Older revision		Revision as of 02:59, 31 October 2015
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	\| [[Kimura disease]]		\| [[Kimura disease]]
	\| eosinophils		\| eosinophils
	\| angiolymphoid proliferation (thick-walled blood vessels with hobnail endothelial cells)		\| angiolymphoid proliferation (thick-walled blood vessels with [[hobnail]] endothelial cells)
	\| IHC ?		\| IHC ?
	\| [[Langerhans cell histiocytosis]], drug reaction, [[angiolymphoid hyperplasia with eosinophilia]]		\| [[Langerhans cell histiocytosis]], drug reaction, [[angiolymphoid hyperplasia with eosinophilia]]

Michael: /* Systemic lupus erythematosus lymphadenopathy */ split out

2014-01-11T14:28:08Z

Systemic lupus erythematosus lymphadenopathy: split out

← Older revision		Revision as of 14:28, 11 January 2014
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	==Systemic lupus erythematosus lymphadenopathy==		==Systemic lupus erythematosus lymphadenopathy==
	~~===General===~~		{{Main\|Systemic lupus erythematosus lymphadenopathy}}
	*Lymphadenopathy associated with [[systemic lupus erythematosus]] (SLE).

	~~===Microscopic===~~
	~~Features:<ref name=pmid9406250>~~{{Cite journal \| last1 = Kojima \| first1 = M. \| last2 = Nakamura \| first2 = S. \| last3 = Itoh \| first3 = H. \| last4 = Yoshida \| first4 = K. \| last5 = Asano \| first5 = S. \| last6 = Yamane \| first6 = N. \| last7 = Komatsumoto \| first7 = S. \| last8 = Ban \| first8 = S. \| last9 = Joshita \| first9 = T. \| ~~title =~~ Systemic lupus erythematosus ~~(SLE)~~ lymphadenopathy presenting with histopathologic features of Castleman' disease: a clinicopathologic study of five cases. \| journal = Pathol Res Pract \| volume = 193 \| issue = 8 \| pages = 565-71 \| month = \| year = 1997 \| doi = \| PMID = 9406250 }}~~</ref>~~
	*Necrosis.
	*Hematoxylin bodies (in necrotic foci).
	**Dark blue irregular bodies on H&E.

	~~DDx:~~
	*[[Kikuchi disease]].

	~~====Images====~~
	~~<gallery>~~
	~~Image:Systemic_lupus_erythematosus_lymphadenopathy_-_high_mag.jpg \| SLE lymphadenopathy - high mag. (WC)~~
	~~Image:Systemic_lupus_erythematosus_lymphadenopathy_-_very_high_mag.jpg \| SLE lymphadenopathy - very high mag. (WC)~~
	~~</gallery>~~

	==Castleman disease==		==Castleman disease==

Michael: /* Lymph node metastasis */ split out

2014-01-10T03:08:49Z

Lymph node metastasis: split out

← Older revision		Revision as of 03:08, 10 January 2014
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	==Lymph node metastasis==		==Lymph node metastasis==
	~~===General===~~		{{Main\|Lymph node metastasis}}
	*Determination of ''lymph node status'' is one of the most common indications for the examination of lymph nodes.
	*It is a good idea to look at the tumour (if available) ...before looking at the LNs for mets.
	*Lymph node metastasis, in the absence of other metastases, often up-stage a cancer from [[cancer staging\|stage]] II to stage III.

	~~===Gross===~~
	*Outside:
	**"Large" - size varies by site.
	***Neck >10 mm.<ref name=pmid18337039>{{Cite journal \| last1 = Mack \| first1 = MG. \| last2 = Rieger \| first2 = J. \| last3 = Baghi \| first3 = M. \| last4 = Bisdas \| first4 = S. \| last5 = Vogl \| first5 = TJ. \| title = Cervical lymph nodes. \| journal = Eur J Radiol \| volume = 66 \| issue = 3 \| pages = 493-500 \| month = Jun \| year = 2008 \| doi = 10.1016/j.ejrad.2008.01.019 \| PMID = 18337039 }}</ref>
	**Shape - round more suspicious than oval.
	*Sectioned:
	**White firm lesion with irregular border - classic appearance.
	**Non-fatty hilum.<ref name=pmid18337039/>

	~~===Microscopic===~~
	~~Features:~~
	*Foreign cell population - '''key feature'''.
	**Classic location: subcapsular sinuses.
	*+/-Cells with cytologic features of malignancy.
	**Nuclear pleomorphism (variation in size, shape and staining).
	**Nuclear atypia:
	***Nuclear enlargement.
	***Irregular nuclear membrane.
	***Irregular chromatin pattern, esp. asymmetry.
	***Large or irregular nucleolus.
	**Abundant mitotic figures.
	*+/-Cells in architectural arrangements seen in malignancy; highly variable - dependent on tumour type and differentiation.
	**+/-Gland formation.
	**+/-Single cells.
	**+/-Small clusters of cells.

	~~Notes:~~
	~~#Cytologic features of malignancy may not be present; some tumours, e.g. gallbladder carcinoma, do not always have overt cytologic features of malignancy.~~
	~~#*The diagnosis is based on the fact that they are foreign to the lymph node ''and'' architecturally consistent with a well-differentiated malignancy.~~
	~~#[[Soft_tissue_lesions#Lymph_node_metastases_in_sarcomas\|Lymph node metastases in sarcomas]] are uncommon; they are seen in <3% of cases.<ref name=pmid8424704>~~{{~~Cite journal \| last1 = Fong \| first1 = Y. \| last2 = Coit \| first2 = DG. \| last3 = Woodruff \| first3 = JM. \| last4 = Brennan \| first4 = MF.~~ \| ~~title =~~ Lymph node metastasis from soft tissue sarcoma in adults. Analysis of data from a prospective database of 1772 sarcoma patients. \| journal = Ann Surg \| volume = 217 \| issue = 1 \| pages = 72-7 \| month = Jan \| year = 1993 \| doi = \| PMID = 8424704 \| PMC = 1242736}}</ref>
	#Fatty lymph nodes (esp. fatty hilus<ref name=pmid18337039>{{Cite journal \| last1 = Mack \| first1 = MG. \| last2 = Rieger \| first2 = J. \| last3 = Baghi \| first3 = M. \| last4 = Bisdas \| first4 = S. \| last5 = Vogl \| first5 = TJ. \| title = Cervical lymph nodes. \| journal = Eur J Radiol \| volume = 66 \| issue = 3 \| pages = 493-500 \| month = Jun \| year = 2008 \| doi = 10.1016/j.ejrad.2008.01.019 \| PMID = 18337039 }}</ref>) are less likely to harbor metastases.<ref name=pmid21972135>{{Cite journal \| last1 = Korteweg \| first1 = MA. \| last2 = Veldhuis \| first2 = WB. \| last3 = Mali \| first3 = WP. \| last4 = Diepstraten \| first4 = SC. \| last5 = Luijten \| first5 = PR. \| last6 = van den Bosch \| first6 = MA. \| last7 = Eijkemans \| first7 = RM. \| last8 = van Diest \| first8 = PJ. \| last9 = Klomp \| first9 = DW. \| title = Investigation of lipid composition of dissected sentinel lymph nodes of breast cancer patients by 7T proton MR spectroscopy. \| journal = J Magn Reson Imaging \| volume = 35 \| issue = 2 \| pages = 387-92 \| month = Feb \| year = 2012 \| doi = 10.1002/jmri.22820 \| PMID = 21972135 }}</ref>

	~~DDx - mimics of metastatic disease:~~
	*[[Endometriosis]].
	*Ectopic [[decidua]].<ref name=pmid15859655>{{Cite journal \| last1 = Wu \| first1 = DC. \| last2 = Hirschowitz \| first2 = S. \| last3 = Natarajan \| first3 = S. \| title = Ectopic decidua of pelvic lymph nodes: a potential diagnostic pitfall. \| journal = Arch Pathol Lab Med \| volume = 129 \| issue = 5 \| pages = e117-20 \| month = May \| year = 2005 \| doi = 10.1043/1543-2165(2005)129e117:EDOPLN2.0.CO;2 \| PMID = 15859655 }}</ref>
	*[[Endosalpingiosis]].<ref name=pmid20631604>{{Cite journal \| last1 = Corben \| first1 = AD. \| last2 = Nehhozina \| first2 = T. \| last3 = Garg \| first3 = K. \| last4 = Vallejo \| first4 = CE. \| last5 = Brogi \| first5 = E. \| title = Endosalpingiosis in axillary lymph nodes: a possible pitfall in the staging of patients with breast carcinoma. \| journal = Am J Surg Pathol \| volume = 34 \| issue = 8 \| pages = 1211-6 \| month = Aug \| year = 2010 \| doi = 10.1097/PAS.0b013e3181e5e03e \| PMID = 20631604 }}</ref>
	*Melanocytic nevus - intracapsular or within the trabeculae.<ref name=pmid12717252>{{Cite journal \| last1 = Biddle \| first1 = DA. \| last2 = Evans \| first2 = HL. \| last3 = Kemp \| first3 = BL. \| last4 = El-Naggar \| first4 = AK. \| last5 = Harvell \| first5 = JD. \| last6 = White \| first6 = WL. \| last7 = Iskandar \| first7 = SS. \| last8 = Prieto \| first8 = VG. \| title = Intraparenchymal nevus cell aggregates in lymph nodes: a possible diagnostic pitfall with malignant melanoma and carcinoma. \| journal = Am J Surg Pathol \| volume = 27 \| issue = 5 \| pages = 673-81 \| month = May \| year = 2003 \| doi = \| PMID = 12717252 }}</ref>
	*[[Dermatopathic lymphadenopathy]].{{fact}}
	*[[Sinus histiocytosis]] - especially for the junior resident.
	*[[Tumour deposit]] (discoutinuous extramural extension) - definition dependent on primary tumour (e.g. in the head & neck they are tumour replaced lymph nodes, in the colon they are considered separate and not counted as lymph nodes).

	~~====Images====~~
	~~<gallery>~~
	~~Image:Breast_carcinoma_in_a_lymph_node.jpg \| Breast carcinoma LN metastasis (WC)~~
	~~Image:Lymph_node_with_papillary_thyroid_carcinoma.jpg \| Thyroid carcinoma LN metastasis (WC)~~
	~~Image:Crc_met_to_node1.jpg \| Colorectal carcinoma LN metastasis (WC)~~
	~~Image:Lymph_node_with_metastatic_melanoma_-_by_Gabriel_Caponetti,_MD.jpg \| Melanoma in a lymph node. (WC)~~
	~~</gallery>~~
	~~=====Mimics=====~~
	~~<gallery>~~
	~~Image:Decidua_in_a_lymph_node_-_low_mag.jpg \| Decidua in a LN - low mag. (WC)~~
	~~Image:Decidua_in_a_lymph_node_-_high_mag.jpg \| Decidua in a LN - high mag. (WC)~~
	~~Image:Endometriosis_lymph_node_-_2_-_intermed_mag.jpg \| Endometriosis in a LN - intermed. mag. (WC)~~
	~~Image:Endosalpingiosis_in_lymph_node_-_intermed_mag.jpg \| Endosalpingiosis in a LN - intermed. mag. (WC)~~
	~~Image:Endosalpingiosis_in_lymph_node_-_very_high_mag.jpg \| Endosalpingiosis in a LN - very high mag. (WC)~~
	~~</gallery>~~

	==Kaposi sarcoma==		==Kaposi sarcoma==

Michael: /* Lymph node hyalinization */

2014-01-01T02:50:03Z

Lymph node hyalinization

← Older revision		Revision as of 02:50, 1 January 2014
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	*[[Amyloidosis]] - cotton candy-like appearance, usu. no calcifications.		*[[Amyloidosis]] - cotton candy-like appearance, usu. no calcifications.

	Images:		====Images====
			<gallery>
			Image: Hyalinized lymph node -- intermed mag.jpg \| Hyalinized LN - intermed. mag.
			Image: Hyalinized lymph node - alt -- intermed mag.jpg \| Hyalinized LN - intermed. mag.
			Image: Hyalinized lymph node -- high mag.jpg \| Hyalinized LN - high mag.
			Image: Hyalinized lymph node -- very high mag.jpg \| Hyalinized LN - very high mag.
			</gallery>
			www:
	*[http://www.flickriver.com/photos/euthman/sets/72157594513987154/ Lymph node with amyloidosis - several images (flickriver.com)].		*[http://www.flickriver.com/photos/euthman/sets/72157594513987154/ Lymph node with amyloidosis - several images (flickriver.com)].

			===Sign out===
			*Not reported.

	==See also==		==See also==

Michael: /* Castleman disease */ split out

2013-12-26T01:34:13Z

Castleman disease: split out

← Older revision		Revision as of 01:34, 26 December 2013
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	*[[AKA]] ''angiofollicular lymph node hyperplasia'', ''giant lymph node hyperplasia''.<ref>URL: [http://www.mayoclinic.com/health/castleman-disease/DS01000 http://www.mayoclinic.com/health/castleman-disease/DS01000]. Accessed on: 17 June 2010.</ref>		*[[AKA]] ''angiofollicular lymph node hyperplasia'', ''giant lymph node hyperplasia''.<ref>URL: [http://www.mayoclinic.com/health/castleman-disease/DS01000 http://www.mayoclinic.com/health/castleman-disease/DS01000]. Accessed on: 17 June 2010.</ref>
	*Abbreviated '''CD'''.		*Abbreviated '''CD'''.
	~~===General===~~		{{Main\|Castleman disease}}
	*Benign.
	*Hyaline vascular variant - a pathology of the follicular dendritic cells.<ref>{{~~Cite journal~~ \| last1 = Cokelaere \| first1 = K. \| last2 = Debiec-Rychter \| first2 = M. \| last3 = De Wolf-Peeters \| first3 = C. \| last4 = Hagemeijer \| first4 = A. \| last5 = Sciot \| first5 = R. \| title = Hyaline vascular Castleman's disease with HMGIC rearrangement in follicular dendritic cells: molecular evidence of mesenchymal tumorigenesis. \| journal = Am J Surg Pathol \| volume = 26 \| issue = 5 \| pages = 662-9 \| month = May \| year = 2002 \| doi = \| PMID = 11979097 }}</ref>

	~~===Classification===~~
	~~CD is grouped by histologic appearance:<ref name=Ref_ILNP228>{{Ref ILNP\|228}}</ref>~~
	~~#Hyaline vascular (HV) variant (described by Castleman).~~
	~~#*Usually unicentric.~~
	~~#*Typically mediastinal or axial.~~
	~~#*More common than plasma cell variant; represents 80-90% of CD cases.~~
	~~#*May be associated with [[follicular dendritic cell neoplasia]].<ref name=Ref_WMSP_596>{{Ref WMSP\|596}}</ref>~~
	~~#Plasma cell (PC) variant.~~
	~~#*Usually multicentric, may be unicentric.~~
	~~#*Abundant plasma cells.~~
	~~#*Associated with [[HHV-8]] infection (the same virus implicated in ''Kaposi's sarcoma'').~~

	~~Notes:~~
	*The subclassification of CD is in some flux. Some authors advocate splitting-out ''HHV-8'' and ''multicentric'' as separate subtypes.<ref name=pmid19546611>{{Cite journal \| last1 = Cronin \| first1 = DM. \| last2 = Warnke \| first2 = RA. \| title = Castleman disease: an update on classification and the spectrum of associated lesions. \| journal = Adv Anat Pathol \| volume = 16 \| issue = 4 \| pages = 236-46 \| month = Jul \| year = 2009 \| doi = 10.1097/PAP.0b013e3181a9d4d3 \| PMID = 19546611 }}</ref>

	~~===Microscopic===~~
	~~====Hyaline-vascular variant====~~
	Features:<ref>URL: [http://www.ispub.com/journal/the_internet_journal_of_otorhinolaryngology/volume_9_number_2_11/article/a_rare_case_of_castleman_s_disease_presenting_as_cervical_neck_mass.html http://www.ispub.com/journal/the_internet_journal_of_otorhinolaryngology/volume_9_number_2_11/article/a_rare_case_of_castleman_s_disease_presenting_as_cervical_neck_mass.html]. Accessed on: 15 June 2010.</ref><ref name=Ref_ILNP236>{{Ref ILNP\|236}}</ref>
	*Pale concentric (expanded) mantle zone lymphocytes - '''key feature'''.
	**"Regressed follicles" - germinal center (pale area) is small.
	*"Lollipops":
	**Germinal centers fed by prominent (radially penetrating sclerotic) vessels; lollipop-like appearance.
	*Two germinal centers in one follicle.
	*Hyaline material (pink acellular stuff on H&E) in germinal center.
	*Sinuses effaced (lost).
	*Mitoses absent.

	~~====Images====~~
	~~<gallery>~~
	~~Image:Castleman_disease_-_high_mag.jpg \| CD HVV - "lollipop" sign - high mag. (WC)~~
	~~Image:Castleman_disease_-_intermed_mag.jpg \| CD HVV - showing expanded mantle zone - intermed. mag. (WC)~~
	~~</gallery>~~
	~~www:~~
	*[http://path.upmc.edu/cases/case115.html CD HVV - case 1 - several images (upmc.edu)].
	*[http://path.upmc.edu/cases/case301.html CD HVV - case 2 - several images (upmc.edu)].

	~~====Plasma cell variant====~~
	~~Features:<ref name=Ref_ILNP236>{{Ref ILNP\|236~~}}~~</ref>~~
	*Interfollicular sheets of plasma cells - '''key feature'''.
	*Active germinal centers - mitoses present.
	*Sinus perserved.

	~~===IHC===~~
	~~Hyaline-vascular variant:~~
	*Stains to exclude [[mantle cell lymphoma]]:
	**Cyclin D1.

	~~Plasma cell variant:~~
	*HHV-8 +ve.

	==Cat-scratch disease==		==Cat-scratch disease==

Michael: /* Lymph node metastasis */

2013-12-20T15:16:28Z

Lymph node metastasis

← Older revision		Revision as of 15:16, 20 December 2013
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	*[[Dermatopathic lymphadenopathy]].{{fact}}		*[[Dermatopathic lymphadenopathy]].{{fact}}
	*[[Sinus histiocytosis]] - especially for the junior resident.		*[[Sinus histiocytosis]] - especially for the junior resident.
			*[[Tumour deposit]] (discoutinuous extramural extension) - definition dependent on primary tumour (e.g. in the head & neck they are tumour replaced lymph nodes, in the colon they are considered separate and not counted as lymph nodes).

	====Images====		====Images====