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Reactive lymphatic tissue disease

MBCHB III

Lymphoreticular system
Lymph nodes Spleen Mucosa associated lymphatic system (Peyer patches) Thymus Bone marrow Tonsills, adenoids

Primary and Secondary Lymphoid Tissue


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The Lymphatic System

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Benign reactive lymph node, high power

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Cells of the lymphatic system


Lymphocytes T-lymphocytes
CD4+ cells CD8+ cells Natural killer cells

Macrophages / monocytes B-lymphocytes Dendritic cells (interdigitating) Follicular dendritic cells Langerhans cells

Identification of lymphatic cells


Morphology Immunohistochemistry
B-cells T-cells Natural killer cells

Moleculargenetic methods
Immunoglobulin rearrangements T-cell receptor rearrangements

T-cell associated antigens


Antigen CD1 CD2 CD3 CD4 CD5 CD7 CD8 Detection Cortical thymocytes and Langerhans cells All T-cells Thymocytes, peripheral T-cells, NK cells T helper cells T-cells and small subset of B-cells T-cells and myeloid precursors Cytotoxic peripheral T-cells

B-cell associated antigens


Antigen CD10 CD19 CD20 CD21 CD22 CD23 Detection Marrow pre-B cells and follicular center B cells ( CALLA) Marrow pre- B cells and mature B cells Marrow pre- B cells and mature B cells Mature B cells, foll. dendr. retic. cells Mature B cells, Mature activated B cells

Monocyte and macrophage associated antigens


Antigen CD13 CD14 CD15 CD33 Detection Immature and mature monocytes and granulocytes Monocytes Granuocytes, Reed-Sternberg cells Myeloid progenitors and monocytes

NK cell associated antigens


Antigen CD16 CD56 Detection All NK cells and granulocytes NK cells and subset of T-cells

Stem cell and Progenitor cell associated antigens


Antigen CD34 Detection Pluripotent haematopoetic stem cells and progentior cells of many lineages

Activation markers
Antigen CD30 Ki67 Detection Activated B-cells, T-cells and monocytes, Reed-Sternberg cells Proliferative phase of cell cycle

Leukocyte marker
Antigen CD45 Detection Present on all leukocytes, Leukocyte common antigen

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Response of lymphoid tissue to injurious stimuli Predominantly B-lymphocyte immune response:


Follicular hyperplasia and plasmacytosis Paracortical hyperplasia Reactive sinus histiocytosis (monocytoid B-cell reaction) Sinus histiocytosis with massiv lymphadenopathy (Rosai Dorfmann-disease) Dermatopathic lymphadenitis

Predominantly T-cell immune response:


Macrophage response:

Epitheloid cell transformation and granuloma fomation

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Enlargement of different compartments in response to various stimuli

A Follicular B Paracortical C Normal D Medullary E Sinusoidal

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Benign reactive lymph node, low power

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Benign reactive lymph node, high power

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Benign reactive lymph node, high power

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Progressive transformation of germinal centre

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Progressive transformation of germinal centre

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Dermatopathic lymphadenopathy

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Dermatopathic lymphadenopathy

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Malignant lymphoma, diffuse small lymphocytic type, lymph node, low power

Types of lymphadenitis
Acute lymphadenitis:
Bacterial infections

Chronic lymphadenitis
Yersinia Tuberculosis Fungal diseases Lympogranuloma venerum (Chlamydia) Cat-scratch disease (small gram-negative bacillae, Bartonella henselae) Syphilis Toxoplasomosis Leishmanioisis

Types of lymphadenitis
Infectious mononucleosis Others:
Drugs, foreign body material

Autoimmune lymphadenitis
Rheumatoid arthritis Lupus erytematodes

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Cat scratch disease

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Cat scratch disease: Numerous Bartonellae

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Mycobacterial lymphadenitis

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Epitheloid histiocytes and Langhans-type giant cells

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Mycobacteria

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Cytomegalovirus lymphadenitis. Florid follicular hyperplasia

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Endothelial cells with large inclusions

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Cryptococcal lymphadenitis, silver stain

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Rheumatoid arthritis: Florid follicular hyperplasia

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Follicular lysis in rheumatoid arthritis

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LN sarcoidosis

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LN sarcoidosis

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LN sarcoidosis

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Sarcoidosis

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LN sarcoidosis

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Carbonpartikels from Tattoo

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Carbonpartikels from Tattoo

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Anthracosis

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AIDS
Persistent generalised lymphadenpathy
Follicular hyperplasia Follicular involution with regressively transformed germinal centers Lymphocyte depletion

Subdivision of HIV-related lymphadenopathy into phases


Histopathological criteria

Phase I IRREGULAR FOLLICULAR HYPERPLASIA (IFH)


Follicle - Follicles increased and enlarged - Bizzare follicle shapes - Centroblasts dominant - Multiple starry sky cells - Regular fibre structure - Mantle zone intact - High mitosis rate Interfollicular space - Hypercellularity - Predominant cell types - Lymphocytes, macrophages - Individual epithelioid - (Warthin-Finkeldey type) - Lymphoblasts, immunoblasts - Nests of interdigitating ret. cells

Phase II
FOLLICULAR TRANSFORMATION WITH DESTRUCTION/ BEGINNING OF FOLLICULAR DESTRUCTION (BFD) Follicle - Large irregularly formed follicles - Reticular cells (FDCs) and starry sky cells - Irregular formed and broken mantle zone with -The occurrence of monocytoid B lymphocytes - Incipient dissolution of the reticular fibre structure Interfollicular space - Reduction of cell density - Small groups of epitheliod cells - Monocytoid B lymphocytes - Reduction of lymphoblasts and immunoblasts - Nests of interdigitating reticulum cells (IRCs) - angioneogenesis

Phase III
PROGRESSIVE FOLLICULAR DESTRUCTION (PFD) Follicle - Large indistinctly demarcated, fading (exploding) and /or shrinking follicles - Loss of mantle zone - Depletion of monocytoid B lymphocytes - Marked reduction of lymphatic germinal centre cells and starry sky macrophages - Marked increase in lymphocytes - Incipient vascularisation of large fading follicles Interfollicular space - Increased angioneogenesis

- Reduction of lymphocytes and IRCs - Increased macrophages

- Depletion of monocytoid B lymphocytes

Phase IV FOLLICULAR INVOLUTION AND ATROPHY (FI/FA)


Follicle - Hyalinisation of shrinking follicles - Vascularisation of fading follicles - Follicles occupied almost exclusively by lymphocytes Interfollicular space - Marked increase in angioneogenesis - Further reduction of lymphocytes and IRCs - Marked increase in macrophages and plasma cells

Phase V
COMPLETE LOSS OF LYMPHNODE STRUCTURE (CLLNS)

- naked connective tissue structure - Diffuse distribution of macrophages, plasma cells and scattered lymphocytes - Hyaline plaques and foci of vascular proliferation as follicle remnants - Occasionally extreme angioneogenesis

The spleen
Normal function: Filtration of blood Secondary organ of the immune system Source of lymphoreticular cells Reserve and storage side

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Normal spleen and accessory spleen

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Normal spleen, low power

Splenomegaly
Infections Congestion related to portal hypertension Lymphohaematogenous disorders Immunologic-inflammatory conditions Storage diseases Miscellanous

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Splenomegaly from portal hypertension

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Splenomegaly with myeloproliferative disorder

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Splenic infarcts

Thymus

Developmental disorders
Thymic hypoplasia DiGeorge syndrome Thymic cysts

Thymic hyperplasia
Thymic follicular hyperplasia Linked to myasthenia gravis in 70% of cases

Thymomas
Benign thymoma Malignant thymoma

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