LYMPHADENOPATHY
Dr. Manjit Singh Saren
Pathologist,
MAHSA University College.
HISTOLOGY
HISTOLOGY
LYMPHADENOPATHY
DEFINITION: Disease of lymph nodes
Associated with underlying pathology.
i) Involvement in variety of systemic diseases.
ii) Primary lymphoid malignancies
iii) Metastatic lymphoid lesions
iv) Localized infections
v) Localized injuries
LYMPHADENOPATHY
Types:
1. REACTIVE LYMPHADENITIS
Inflammation of lymph nodes
2. REACTIVE LYMPHADENOPATHY
Primary immune reactions
REACTIVE LYMPHADENITIS
NON- SPECIFIC RESPONSE
1.Acute lymphadenitis
2.Chronic lymphadenitis
1) Acute lymphadenitis: draining inflamed area.
>Bacterial infections
>Foreign bodies in wounds
Nodes:
Enlarged and tender
Untreated : Chronic adenitis, necrosis and abscess
2)
Chronic Lymphadenitis:
A). With follicular B cell hyperplasia
i. Non- specific lymphadenitis:
Commonest lesion
ii. Specific lymphadenitis:
Rheumatoid arthritis
Toxoplasmosis
Syphilis
AIDS
B) With para-follicular T cell hyperplasia
- Microbiological agents
- Drugs (Dilantin)
- Virus (Inf. Mononucleosis)
-Post vaccinial
C) With sinus hyperplasia with histiocytosis:
Cancer draining sites.
Micro:
Phagocytes within dilated sinuses.
LYMPHADENOPATHY
1. Primary: Lymphoid malignancies.
Amyloidosis
2. Secondary:
i. Infections:
TB
Sarcoidosis
Syphilis
Castleman’s Disease
Dermatolymadenopathy
Filariasis
ii. Metastatic diseases
CAUSES OF LYMPADENOPATHY:
1.HIV related
2.Opportunistc infections: TB, CMV,
Toxoplasmosis, Norcardia.
3.Fungal:
Histoplasmosis, cryptococcusis.
4.Reactive: Pyogenic infections/bacteria.
5.Venereal: (STD)- Syphilis, Chancroid,
Lympho- Granuloma Venereum
6.Malignancies:
i. Primary: Lymphomas
ii. Secondary: Metastasis
CYTO MEGALIC VIRUS
CYTO MEGALIC VIRUS
Toxoplasma gondii
TUBERCULOUS LYMPHADENOPATHY
Poor socio-economic background.
Over-crowding
Presentation:
Night sweats
Cough with hemoptysis
Loss of weight
Family history
Diagnosis
History
ESR
Sputum examination for AFB
TB Culture
Chest X-rays
CT Scan
MRI
BIOPSY
SARCOIDOSIS
Etiology: Unknown.
Cell mediated immune reaction
Affects: Lung and lymph nodes
Micro:
1. Langhans cells, Foreign body giant cells
2. Asteroid bodies, Schaumann bodies.
3. Non-caseating granuloma
4. Epitheloid cells and fibrosis
Diagnosis: Kviem’s Test: Intra-dermal test
FILARIAL LYMPHADENOPATHY
Etiology: Wuchereia Bancrofti
Brugia malayi
Adult worm in: lymphatics, Lymph nodes,
testis and epididymis
Acute: Fever, lymphangitis, epididymo-orchitis
and microfilaria.
Chronic: Lymphadenopathy, hydrocele and
elephantiasis.
Complications: Chylous ascitis & chyluria
AL AMYLOIDOSIS
Associated with plasma cell dyscrasias.
Secrete Immunoglobulin light chains.
Can be associated with lymphadenoparthy
Diagnosis:
Congo red: 1.Light microscopy
Eosinophilic amorphous
2.Polarised light:
Apple green birefringence
PART I
LYMPHADENOPATHY
CASTLEMAN’S DISEASE
Definition:
Single solid growth within lymphatic tissue
Sites: Chest, stomach or neck .
Abnormal enlargement of lymph nodes.
CASTLEMAN’S DISEASE
Etiology:
Unknown
Rare disorder
Types:
1. Hyaline type 90%
2. Plasma type: prevalent in young
DERMOTOPATHIC LYMPHADENOPATHY
Definition:
Reactive lymph node hyperplasia.
Etiology:
Secondary to eczema and dermatitis
Micro:
Intra-dermal macrophages containing fat and melanin
CAT SCRATCH DISEASE
Children 80%
Self limiting Gm-ve bacterial infection
Localized lymphadenopathy
Sarcoid-like granulomas
Stellate abscess
LYMPHANGIITIS
Inflammation of lymphatic vessels
i. Acute Lymphangiitis:
Bacterial infections: B-Strep % & Staph.
Micro: inflammatory exudate and clotted lymph
ii. Chronic Lymphangitis:
TB, Actinomyces, syphilis, radiation,& parasites
Micro: Fibrosis and chronic lymphedema
KIKUCHI’S DISEASE
Presentation:
Fever and Tender Adenitis
Micro:
Necrosis and stellate abscesses
Neutrophils and nuclear dust
Histiocytes but rarely any eosinophils
KIMURA’S DISEASE
Introduction:
Chronic inflammatory disorder
Clinical Features:
Age: 20-40 yrs and males
Painless swelling of parotid
Cervical lymphadenopathy
KIMURA’S DISEASE
Micro:
Lymph node biopsy:
Eosinoplilia
Proliferation of vascular endothelium.
Focal eosinophilic abscess
Hyperplasia of lymphoid follicles:
Well vascularised
Warthin-Finkeldey polykaryocytes
KIKUCHI’S DISEASE
Common in children
Cervical lymphadenopathy
Also :
Necrotizing histiocytic lymphadenitis
Etiology:
CMV
EBV
Herpes virus
KIMURA’S DISEASE
PATHOPHYSIOLOGY
Allergic reaction: -Parasites, viral, arthropod bites and
candidiasis.
Auto-immune reaction :
IgE –mediated Type I hypersensitive reaction.
Cytokines:
Interleukin 4 and 5 produces:-
> Eosinophiltrophic cytokines & IgE
20% with nephrotic syndrome
KAWASAKI’S DISEASE
Age: <5yrs
Cause: Unknown
Lymphadenopathy
Clinically:
Fever (>39C) red eyes
Red and cracked lips
Rash on chest and genitals
Swollen tongue and enlarged lymph nodes
Complications: Affects heart: Arrhythmias
C)Multicentric or Generalized Type
CASTLEMAN’S DISEASE
Multiple sites
Symptoms:
Same as plasma type
Hepato-splenomegaly
‘POEMS Syndrome
Complications : POEMS SYNDROME
Kaposi’s Sarcoma
Non Hodgkin’s
Lymphoma
LANGERHANS CELL HISTIOCYTOSIS
Histiocytosis : Proliferative disorder of histiocytes
or macrophages.
Auto-immune disease & genetically related
Types:
1. Benign: Histiocytic proliferation in lymph nodes.
2. Malignant: Histiocytic lymphoma
3. Intermediate: Langerhans cell Histiocytosis
LANGHERAN CELLS: ORIGIN
Derived from dendritic cells of skin.
Proliferating Langerhans cells are LEUKOCYTE
ANTIGEN DR (HLA-DR) positive and express
CD1 antigen.
Cells contain Berkeck’s granules. EM
Micro: Vacuolated cytoplasm resembling tissue
histiocytes and hence called Langerhans Cell
Histiocytosis
HISTIOCYTOSIS X
1. LITTERER SEWE DISEASE
Age: 2 yrs and less
Presentation:Cutaneous lesions
Hepato-splenomegaly
Pulmonary lesions (stiffening)
Destructive osteolytic bone lesions&fractures
Infiltrates bone marrow causing:
anaemia and thrombocytopenia
Predisposing: to infections.
Rapidly fatal
Chemo:50% 5 year survival
2: EOSINOPHILIC GRANULOMA
Langerhans cells in bone medullary cavities
Micro:
Histiocytes and eosinophils along with
plasma cells and lymphocytes.
Lesions:
Unifocal: Pain and pathological #
Treatment:
Local excision and radiation.
May heal spontaneously
2. MULTIFOCAL LESIONS
Affects children
Clinical Presentation:
Fever and diffuse eruptions on scalp
Otitis media
URTI
Generalized Lymphadenopathy
Hepato-splenomegaly
Diabetes Insipidus
(post pituitary stalk involved)
3. HAND SCHULLER CHRISTIAN DISEASE
Presentation:
Involvement of calvarial bone
Diabetes Insipidus
Exophthalmos
Treatment:
Spontaneous regression
Chemotherapy
HAND SCHULLER CHRISTIAN DISEASE
Presentation:
Involvement of calvarial bone
Diabetes Insipidus
Exophthalmos
Treatment:
Spontaneous regression
Chemotherapy