PRACTICAL (I)

Diseases of Lymph nodes and spleen

BMS 201- FALL 2021
PROF. IMAN HEWEDI
iman.hewedi@gu.edu.eg
ILOs By the end of the practical lessons you will be able To
identify & Describe the gross and microscopic features of some
selected pathological processes in the lymph nodes and spleen
 List of lesions in BMS 201 in TWO Lab sessions
( those in orange are already described or similar lesion in BMS151 Foundation of Pathology)
Pathologic process Gross Microscopic

Chronic specific inflammation Tuberculous lymphadenitis/ tabes Tuberculous lymphadenitis

mesentrica
Chronic specific inflammation ----------- Sarcoidois in lymph node
Chronic specific inflammation Miliary TB in spleen ---------
Lab 1 Chronic specific inflammation Multiple tuberculomata in spleen ---------

Splenic infarction Recent splenic infarction

1ry malignant tumor in LN Hodgkin Lymphoma Hodgkin Lymphoma

1ry malignant tumor in LN Non Hodgkin Lymphoma- Burkitt

Lymphoma
Lab 2
Splenic congestion Congestive splenomegaly

Chronic myeloid leukemia (Spleen) Spleen with CML

2ry malignant tumor in the LN Metastatic deposit in the LN
Tuberculous Lymphadenitis
(gross)
Tuberculous Lymphadenitis Enlarged
(gross) Matted LNs
Caseating
Tuberculous Lymphadenitis (gross)

Enlarged
Matted LNs
Caseating (cheesy,
yellow-whitish areas)
 Tabes Mesenterica

Mesentery

Enlarged Large
Matted LNs Matted
Caseating Caseating

Opened small
intestinal loop
 Tuberculous Lymphadenitis

Enlarged
Non
caseating
LN

•Enlarged , Matted •Enlarged, ( 0.5- 3 cm) ,Matted

•Yellow white (caseation) •Yellow white (caseation)
Normal Lymph Node
Tuberculous Lymphadenitis (Microscopic)
Epithelioid granuloma
Clinical keynotes:
1- In course of primary or
secondary TB
2- May affect cervical, hilar
and mesenteric group of LNs
especially in the primary
type or complicating organ
involvement in regional LNs Nodal tissue
of affected site
3- Confirmation by Zeihl-
Neelsen Stain and
bacteriological studies
Nodal architecture is replaced by multiple epithelioid large
CONFLUENT CASEATING granulomas
Tuberculosis of the lymph node
Epithelioid
granuloma

Nodal architecture is replaced by multiple granulomas

Tuberculosis of the lymph node
Epithelioid granuloma

Nodal tissue

capsule

Caseation

Nature of this lesion: CHRONIC SPECIFIC INFLAMMATION of

bacterial etiology-Necrotizing granulomatous lymphadenitis
 Tuberculous Lymphadenitis
Langhan’s giant cell

Confluent granulomas

Caseation
Tuberculosis of the lymph node
capsule

granuloma

Extensive caseation
Tuberculous Lymphadenitis

Rim of lymphocytes
Epithelioid cells

Langhanz giant cell

Tuberculosis of the lymph node
Section in a lymph node showing:
Replacement of nodal architecture by multiple confluent (fused) epithelioid granulomas
formed of :
Epithelioid cells, multinucleated Langhan’s giant cells surrounded by a mantle of
lymphocytes and fibroblastic proliferation with central areas of pink homogenous
structureless caseous necrosis.

The epithelioid cells are oval or rounded with faint eosinophilic cytoplasm and central or
eccentric vesicular nuclei.
The langhan’s cells show peripheral horse shoe arrangement of the nuclei.
Sarcoidosis of lymph nodes

Capsule

Replacement of nodal architecture by multiple DISCRETE

epithelioid NON caseating granulomas
Sarcoidosis of lymph node

Multiple non caseating epithelioid granulomas (well

circumscribed, small discrete)
 Sarcoidosis of lymph nodes
Multiple
epithelioid
granulomas

Nature of this lesion: CHRONIC SPECIFIC INFLAMMATION of unknown

etiology-Non necrotizing granulomatous lymphadenitis
 Sarcoidosis of lymph nodes
Peripheral fibroblasts/fibrosis +
few lymphocytes if any (naked
granuloma)

Epithelioid cells

Langhan giant cells

Sarcoidosis of lymph node

Giant cell with Schaumann

body (laminated calcified Giant cell with Asteroid body
bodies) (intracellular inclusions)
Sarcoidosis of lymph node
Section in a lymph node showing:
Replacement of nodal architecture by multiple non caseating epithelioid
granulomas (well circumscribed, small discrete).
Granulomas are formed of :
Epithelioid cells, multinucleated Langhan’s giant cells surrounded by
fibroblastic proliferation ± lymphocytic rim.
Cytoplasm of giant cells may show:
Ø Schaumann bodies ( rounded calcified & laminated)
Ø Asteroid bodies (star shaped ).
• Miliary Tuberculosis
• Multiple Tuberculomata
Miliary TB of Spleen

DD: ?????? From the

Foundation of Pathology+ later
in BMS 201

Tubercles
§ On outer & cut surface
Cut Surface § Small
§ Rounded
§ Greyish white
Tubercles
§ On outer & Miliary TB of Spleen
cut surface
§ Small
§ Rounded
§ Greyish white

Cut Surface
Multiple tuberculomata of Spleen

Patches of Tuberculous reaction

Variable size ( > 0.5 cm) with
Yellow cheesy cut surface

Cut Surface
 Multiple tuberculomata of Spleen

Patches of
Tuberculous reaction
• On outer & cut
surface
• Variable size ( >0.5
cm)
• Variable shape

Cut Surface
Multiple tuberculomata of Spleen
Patches of
Tuberculous reaction
• On outer & cut
surface
• Variable size
• Variable shape
 Recent splenic infarction

Area of infarction
• Triangular
• Pale yellow
• solid
• Apex –hilum
• Base--capsule
 Recent splenic infarction

Area of infarction
• Triangular
• Pale yellow
• solid
• Apex –hilum
• Base--capsule
 Recent splenic infarction

Area of infarcNon
• Triangular
• Pale yellow
• solid
• Apex –hilum
• Base--capsule
 Recent splenic infarction

Area of infarction
• Triangular
• Pale yellow
• solid
• Apex –hilum
• Base--capsule
 Recent splenic infarction

Area of infarction
• Triangular ‘’’’
• Pale yellow
• solid
• Apex –hilum
• Base--capsule
 Virtual Pathology- Telepathology- scanned
slides
https://www.virtualpathology.leeds.ac.uk/slides/library/view.p
hp?path=%2FResearch_4%2FTeaching%2FEducation%2FUnder
graduate%2F1090.svs
 Virtual slides:
https://www.virtualpathology.leeds.ac.uk
THANK YOU