Lymph Node Pathology
Normal Lymphatic System
Anatomy
- Cortex: 1o and 2o Follicles; B-cells
- Medulla: Lymph sinuses; Vessels; Some B-cells
- Paracortex: Mobile pool of T-cells
Lymphadenopathy
Causes
- Viral: EBV; Hepatitis; HIB; Measles; Rubella
- Bacterial: Streptococci; Brucella; TB; Syphilis
- Fungal: Histoplasmosis; Cryptococcosis
- Chlamydia: Lymphogranuloma venerum
- Parasitic: Toxoplasmosis
- Rickettsial: Scrub typhus
- AID: RA; SLE; PBC; GVHD; Drug hypersensitivity
Infectious Mononucleosis
Pathophysiology
- Path: Follicular + Sinus hyperplasia; ↑ Plasma cell
Presentation
- Sx: Fever; Pharyngitis; ↑ Lymph; Splenomegaly
Sarcoidosis
Epidemiology
- Ethnicity: Scandinavian; African-Americans
Investigations
- Serology: ↑ ACE; ↑ Calcium
- Biopsy: non-caseating granulomata
Non-Hodgkin Lymphoma (NHL)
Classifications
- Behaviour: Clinically aggressive or indolent
- Lineage: T-cell or B-cell
- Growth: Follicular or Diffuse
Cell Sizes
- Small: Small lymphocytic; Follicular; Mantle cell
- Intermediate: Burkitt’s
- Large: Diffuse large B-cell
Types of NHL
- Lymphocytic: Indolent; B-cell
- Follicular: Indolent; B-cell
- Lymphoblastic: Aggressive; B-cell or T-cell
- Burkitt’s: Aggressive; B-cell
- Diffuse Large B-cell: Aggressive; B-cell
- Mantle cell: Aggressive; B-cell
T-cell Lymphomas
- Sx: ↑ Lymph; Pruritis; ↓ Weight; Fever
- Cytology: Mycosis fungoides; CD3; CD2
- Prognosis: Generally worse than B-cell NHL
Small Lymphocytic Lymphoma
- Epidemiology: M:F 2:1; Median AOO 60 YO
- Cytology: Small lymphocytes; Prolymphocytes; CD5
- Associations: Trisomy 12
- Prognosis: Median survival 4-6 yrs
Lymphatic Cells
- B-cells: Centroblasts; Centrocytes; Humoral
- T-cells: Cell-mediated
- Other: Macrophages; Dendritic cells
Non-Neoplastic Conditions
- Hyperplasia: E.g. Cat Scratch Fever
- Lymphadenitis: E.g. Staph; Typhoid; Plague
- Granulomatous: Sarcoid; TB; Fungi; Hodgkin’s
Investigations
- Serology: EBV; CMV; HIV; ANA; Anti-dsDNA
- Imaging: CXR; CT; USS; MRI; PET
- Biopsy: Fine needle aspiration cytology
Investigations
- Monospot Test: Anti-EBV antibodies
- Peripheral: Atypical lymphocytes
- Biopsy: If atypical presentation
Pathophysiology
- Systemic: Can involve any organ; Commonly
Lungs
- Granuloma: Non-caseating granulomata
- Cells: Langhan’s giant cells; Lymphocytes
- Bodies: Asteroid bodies; Schaeumann bodies
Follicular Lymphoma
- Epidemiology: 45 % of adult lymphomas
- Cytology: Centroblasts; Centrocytes; CD10
- Associations: t(14:18)  bcl2 overexpression
- Prognosis: Median survival 10 yrs; BM infiltration
Mantle Cell Lymphoma
- Epidemiology: 3-9 % of all NHLs
- Cytology: Monotonous ↑ in small lymphoid cells
- Associations: t(11:14)
- Prognosis: Poor prognosis; BM + PB infiltration
Burkitt’s Lymphoma
- Epidemiology: Children and young adults
- Sx: Jawbone mass (Africa); Ileocaecal mass
(other)
- Cytology: Starry sky appearance; Diffuse growth
- Associations: t(8:14); EBV associated in Africa
- Prognosis: High dose Chemo cures many
Diffuse Large B-cell Lymphoma
- Epidemiology: No age or sex distribution
- Cytology: Large cells; Diffuse growth pattern
- Association: t(14:18) in 30 %; Bcl6 gene; AIDS
- Prognosis; 50-60 % remission
Hodgkin Lymphoma (HL)
Classifications
- Nodular Sclerosis: Lacunar cells; Sclerotic bands
- Mixed Cell: Cellular infiltrate; Reed-Sternberg cells
- Lymphocytic: L&H cells (popcorn cells)
- Lymphocyte Depleted: High stage disease
Epidemiology
- Nodular Sclerosis: Excellent Px; Young women
- Mixed Cell: Good Px
- Lymphocytic: Excellent Px
- Lymphocyte Depleted: Poor Px; Older men
Ann Arbor Staging
- Stage I: Single lymph node
- Stage II: ≥2 nodes on same side of diaphragm
- Stage III: Nodes on different sides of diaphragm
- Stage IV: Spread beyond lymph nodes
- A Subtype: No systemic sx other than pruritis
- B Subtype: weight loss > 10%; ↑To; Night sweats

Splenomegaly
Pathophysiology
- Hyperfunction: Haemoglobinopathies - ↑ Splenic Blood Flow: Portal HTN
- Immune Hyperplasia: Infections - Infiltration: Amyloid; Lipid storage disease
- Disordered Immunity: RA; SLE; AIHA - Infiltration: Haematological malignancies
- Extramedullary Haemopoiesis: CML; Myelofibrosis