Anatomical Pathology - Leukaemia, Spleen And Lymph Nodes Flashcards by Michael Nel

Defn hypersplenism

Peripheral blood pancytopaenia and splenomegaly (primary or secondary)

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Congenital abnormalities of spleen

Accessory spleens/ splenunculi
Asplenia
Polysplenia

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Causes of splenomegaly

Congestion
Infection
Immune disorders
RBC abnormalities
1ry or metastatic neoplasms
Storage disorders
Amyloidosis

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Causes of congestive splenomegaly

Pre-hepatic = extrahepatic portal/splenic vein thrombosis
Hepatic = cirrhosis 
Post-hepatic = raised IVC pressure (RHF, pulmonary/tricuspid disease)

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Where does pathology mainly occur in congestive splenomegaly

Red pulp

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Cut surface of congestive spleen

Beefy red with little white pulp

Some firm brown nodules (areas of healed infarction - gamma gandy bodies)

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Types of infection causing splenomegaly

Systemic infection
Bacterial 
Viral
Chronic malarial
Granulomatous inflammation

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What are gamma gandy bodies composed of?

Fibrinous and elastic tissue
Abundant haemosiderin
Dystrophic calcification

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What organisms cause granulomatous inflammation of spleen

Bacterial: Tuberculosis
Fungi: histoplasmosis, cryptococcus
Protozoan: toxoplasmosis

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Extreme bacterial splenomegaly

Acute septic splenitis

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What causes splenomegaly in bacterial infection

Accumulation of neutrophils in sinuses and medullary cords

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Why bacterial splenomegaly soft?

Proteolytic enzyme action

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Immune causes of splenomegaly

Felty’s syndrome - RA and splenomegaly

SLE

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RBC abnormalities causing splenomegaly

Sickle cell anemia

Hereditary spherocytosis

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Neoplasms that cause splenomegaly

Hemangioma
Acute/chronic leukaemia
Myeloproliferative disorders
Hodgkin’s/ Non-Hodgkin’s lymphoma

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Storage disorders that cause splenomegaly

Niemann Pick disease
Gaucher’s disease
Mucopolysaccaridoses

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What is seen macroscopically in storage disorders

Red pulp expansion by macrophages (filled with abnormal storage product)

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Causes of splenic rupture

Usually blunt abdo trauma (emergency splenectomy)

Spontaneous rupture - infectious mononucleosis

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Causes of splenic infarction

Splenic artery occlusion due to:
Emboli
Local thrombosis (sickle cell, myeloproliferative disorders, malignant infiltrates)

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Causes of splenic atrophy

Sickle cell (infarcts)
Malabsorption disease (eg coeliac disease)

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Slate grey spleen?

Malarial infection

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Causes of infective granulomatous lymphadenitis

Toxoplasma

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Infective causes of necrotising lymphadenitis

Lymphogranuloma venereum

Cat scratch disease

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Histological feature of necrotising lymphadenitis (infective)

Stellate abscesses in lymph node surrounded by palisades histiocytes

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Cause of infective follicular hyperplasia

Syphilis

Causes of infective para cortical hyperplasia

Infectious mononucleosis (EBV)

Causes of non infective granulomatous lymphadenitis

Sarcoidosis Crohn's Reaction to tumor Ag Foreign body

Causes of non infectious necrotising lymphadenitis

Kikuchi's disease | SLE

Non infectious causes of follicular hyperplasia

Non infectious causes of para cortical hyperplasia

Dermatopathic lymphadenopathy Eg. Eczema, psoriasis Cutaneous T cell lymphoma

No infectious causes of sinus histiocytosis

SHML/ Rosia-Dorfman syndrome | Langerhan's cell histiocytosis

Defn persistent generalized lymphadenopathy syndrome

Persistent extrainguinal LN in two or more contiguous sites. Greater than three months. Unknown aetiology besides HIV.

Distinguishing features of Hodgkin's Disease

Rarely involves tonsillar area, skin, stomach, ileum. | Reed-Steenberg cells

Reed-Steenberg cell morphology

Large, bi-/multi-lobulated nuclei Large eosinophilic nucleoli Slightly acidophilic cytoplasm

WHO classification of non Hodgkin's based on..

Type/ number of neoplastic cells Pattern of fibrosis Proportion of reactive lymphs to neoplastic cells

Two main types of Hodgkin's Disease

Nodular lymphocyte predominant HD | Classic HD

Four main type of classic HD

Lymphocyte rich HD Nodular sclerosing HD Mixed cellularity HD Lymphocyte depleted HD

Spread of HD (?pattern)

Generally via lymphatics. Mostly, contiguous groups of LN are involved

Clinical outcome of HD influenced by

Stage ''B'' constitutional symptoms Disease bulk Extent of splenic involvement

Complications of HD

Infection (NB) [T cell immunity defect, splenectomy, opportunistic infections] Cachexia Massive organ infiltration Complications of Rx [corticosteroids=immunosuppression, endocrine dysfunction (hypothyroid,hypogonadism), pulmonary inflammation and fibrosis, pericardial fibrosis] Secondary malignancies

Risk factors for NHL

Viruses - EBV, HTLV1 | Immunodeficiency - 1ry or 2ndry

''B'' symptoms of lymphoma

Fever Weight loss Night sweats

System used to stage lymphoma

Ann-Arbor system

Stage 1 lymphoma

Single LN region or structure

Stage 2 lymphoma

2 or more LN region on same side of diaphragm

Stage 3 lymphoma

LN regions on both sides of diaphragm

Stage 4 lymphoma

LN region with non-contiguous extra nodal involvement

Complications of NHL

Immunodeficiency (disease/ Rx) Infection Neutropenia, thrombocytopenia, anemia (replacement of normal bone elements by NHL, marrow damage during Rx, involvement of spleen by NHL = hypersplenism)

Common site of extra nodal NHL

GIT Thyroid, salivary glands *no site exempt

Extra nodal NHL may arise following

``` H. Pylori gastritis Autoimmune thyroiditis (Hashimoto's) Autoimmune inflamm of salivary/lacrimal glands (Sjogren's) ``` Known as MALT lymphomas

Presentation of NHL

Involves any LN group in body, haphazard distribution. May involve lymphoreticular tissue (spleen, BM, liver, tonsils) or extra nodal tissue. May even involve nonlymphoid tissue such as skin, brain, thyroid. Usually painless rubbery enlarge LNs. Symptoms may occur as a result of tissue infiltration. Fish-flesh. Loss of nodal architecture.

Common forms of mature B cell NHL

Follicular Diffuse small lymphocytic Diffuse large cell Burkitt's lymphoma

Histology of Burkitt's lymphoma

Starry-sky = sheets of primitive medium sized blastic lymphoid cells and many histiocytes

Types of Burkitt's lymphoma

Endemic Non-endemic AIDS associated

Types of mature T cell NHL

Anaplastic large cell lymphoma | Mycosis fungoides and sezary syndrome (cutaneous)

Endemic Burkitt's presents with

Enlarged jaw or ovaries. Nodal involvement not characteristic. Children 4-8yrs.

Presentation of non-endemic Burkitt's

Intestinal involvement common (ileum) with mesenteric LNs. | Older children.

Causes of massive splenomegaly

``` Chronic malaria Gaucher's disease CML Myelofibrosis Kala-azar Infectious mononucleosis ```

Three complications of splenomegaly

Anaemia Thrombocytopenia Neutropenia

Microscopic features of granulomatous lymphadenitis

Cluster of epitheliod histiocytes w/wout necrosis. | Giant cells

Anatomical Pathology - Leukaemia, Spleen And Lymph Nodes Flashcards

(60 cards)