Lymphatic system (1)

By
Dr/ Nagwa Abd El-Sadek Ahmed
Lecturer of Pathology
 Anatomy of Lymph Node
• Lymph node is capsulated lymphoid ts composed of
cortex and medulla
• Cortex is divided into outer and inner cortex
 Outer cortex is composed of follicles of B cells
 Inner cortex is composed of T cells
 Sites of Lymphoid Tissue
The lymphoid tissue exists in:
 Bone marrow
 Thymus
 Lymph nodes
 Spleen
 Lymphoid tissue in the nasopharynx, tonsils,
Peyer’spatches of the terminal ileum, appendix
and bronchus associated lymphoid tissue.
 The lymphoid tissue exists also in: yolk sac, fetal
liver of the embryo.
 Lymphadenitis
 It is an inflammation of the lymph nodes, resulting in
lymph node swelling and tenderness.

 The lymph nodes are part of the lymphatic system.

The lymphatic system is part of the immune system.
 Classification of lymphadenitis
1.Acute lymphadenitis:
A. Acute bacterial lymphadenitis
B. Acute viral lymphadenitis

2. Chronic lymphadenitis:
A. Chronic non-specific lymphadenitis
B. Chronic specific lymphadenitis
1.Acute bacterial lymphadenitis:
 It usually occurs in L.Ns. draining acutely inflamed
focus e.g. acute suppurative tonsillitis or abscess.

 It leads to nodal acute inflammatory reaction, rich in

neutrophils.

 The affected lymph nodes are enlarged, soft, and

tender, may be the seat of abscess formation.
2. Viral lymphadenitis
Infectious mononucleosis:
• It is a rare viral disease
• Usually caused by Epstein-Barr virus (EBV)
• Cause generalized lymphadenopathy, splenomegaly,
mild fever, and sore throat.
• Microscopic picture: There is partial loss of nodal
architecture with marked diffuse paracortical
proliferation of atypical B cell forms. This picture
may be confused with malignant lymphoma.
• Diagnosis:
1. Lymphocytosis with atypical lymphocytes in
peripheral blood.
2. Positive monospot test.
3. A rising titer of specific EBV antibodies.
3.Chronic non specific lymphadenitis:
• Lymphoid hyperplasia: Is proliferation of normal
lymphocytic cells. May occur with bacterial or viral
infections
 The condition assume one of three patterns
depending on the causative agent:

A. Reactive follicular hyperplasia

B. Paracortical hyperplasia

C. Sinus histocytosis
A. Reactive follicular hyperplasia
 Is a stimulation of B cells compartment
 Enlarged lymphoid follicles varying in size and
shape
 The lymphoid follicles are prominent with
enlargement of their germinal centers.
 It is associated with inflammatory processes that
activate B cells, as rheumatoid arthritis,
toxoplasmosis, and HIV.
 Numerous tingible body macrophages are
characteristic feature
• Tingible body macrophages: is a type of macrophages predominantly found in
germinal centers containing many phagocytized apoptotic cells in various states of
degeneration & contain condensed chromatin fragments
• Tangible = stainable
Microscopic picture
• Lymph node showing preserved normal nodal
architecture (The normal lymphoid follicles are
arranged in the cortex and the sinusoids contained
lymph fluid at the center).
• The lymph node is enlarged and the lymphoid follicles
are enlarged, with central paler areas (germinal
centers). There are numerous tangible body
macrophages in the germinal center.
• The nodal sinusoids are dilated and increased in
number.
• DD. between lymphoma and reactive nodal hyperplasia
?
B. Paracortical hyperplasia
 Is preferential stimulation of T cell compartment
 It is due to activation of the parafollicular T cells ,
expansion of interfollicular zones
 It is accompanied by vascular proliferation
 As in viral infection, follows vaccination, or application of
certain drugs as phenytoin.

C. Sinus histocytosis
 Is preferential stimulation of the histocytes compartment
 The medullary sinuses are loaded with histiocytes.
 It is often encountered in nodes draining cancer (represent
immune reaction to the tumor or its products).
4.Chronic specific lymphadenitis; Granulomatous
lymphadenitis:

A. Tuberculosis
B. Sarcoidosis
C. Toxoplasmosis
D. Crohn’s disease
E. Cat scratch disease
A. Tuberculosis

Gross picture:
 Early: The L.Ns. are enlarged firm and not adherent
together with grayish white cut surface.

 Late lesions: The L.Ns. become adherent to each other

(matted together) due to periadenitis. The cut surface
show cheesy-like yellowish material (caseous necrosis)
Microscopic picture:
 Early tuberculous lymphadenitis: There is multiple
infiltration by multiple small pale tubercle formed of
aggregates of epithelioid cells, few Langhan’s giant
cells and lymphocytes with absent or minimal
caseation.

 Caseating tuberculous lymphadenitis: Most of nodal

tissue is replaced by areas of caseous necrosis with
multiple small tubercles at the periphery.
Complications and effects:
 TB cervical lymphadenitis: Cold abscess with multiple
sinuses discharging caseous material. TB of the skin
around these sinuses.

 TB medistinal lymphadenitis: Pressure manifestation

(mediastinal syndrome). Spread of infection to the lung.

 TB mesentric lymphadenitis: Rupture of caseous L.Ns.

Leading to TB peritonitis.

 In addition to the following complications:

Pathological calcification.
Hematogenous dissemination.
Secondary amyloidosis.
B. Sarcoidosis:
• It is a disease forming non-caseating epithelioid cell
granuloma.
• The granulomas are typically “naked” with few
surrounding lymphocytes and a rim of mild fibrosis.
• Schaumann bodies & asteroid bodies, While
frequently seen, these findings are not specific to
sarcoidosis.
• Schaumann bodies (calcium inclusions inside giant
cells basophilic, laminated , rounded structures)
• Asteroid bodies (small, intracytoplasmic , eosinophilic
star shaped inclusions)
• The disease usually begins in the lungs, skin, or lymph
nodes.
Schaumann bodies
asteroid bodies
C.Toxoplasmosis:
• Is infection caused by microscopic parasites
called (toxoplasma gondii)
• These microscopic parasites live inside the cells
of human and animals (cats & farm animals)
• presented by muscle aches and tender.
• It forms non caseating epithelioid cell
mirogranuloma.

D. Crohn’s disease:
• One of the inflammatory bowel disease of the
intestine that forms non caseating epithelioid cell
granuloma in the GIT wall.
E. Cat scratch disease:
• Is infection caused by the bacterium Bartonella
henselae
• It is transmitted to man through skin scratches or bites
of cats or rabbits.
• Axillary group of L.Ns. are usually affected.
• Microscopic : it is characterized by nodal formation of
microabscesses having central stellate shaped areas of
necrosis with neutrophiles surrounded by palisading
of histiocytes i.e., stellate necrotizing granuloma.
 Tumors of lymphoid tissue
• Tumors of L.Ns. are either primary or secondary.
Primary tumors:
 All are malignant and are called lymphomas.
 They arise from nodal or extranodal lymphoid
tissue.
 Lymphoma is divided into two main categories:
A. Hodgkin's Lymphoma (HL).
B. Non-Hodgkin's Lymphoma (NHL).
Secondary tumors:
 These are the metastatic tumors which occur in L.Ns.
draining primary site of malignancy. occurs in L.Ns.
draining carcinoma.
 They are more frequent than the primary group.
 The L.Ns. are enlarged firm fixed. The cut surface is
grayish white.
Infectious mononucleosis is a……………..
A. Viral disease
B. Parasitic disease
C. Bacterial disease
D. Autoimmune disease

The following type of lymphadenitis may be

misdiagnosed as lymphoma
A. T.B lymphadenitis
B. Sarcoidosis
C. Infectious mononucleosis
D. Toxoplasmosis