Lymph Node Flashcards
(151 cards)
1
Q
What is contained in the cortex of the lymph node?
A
primary and secondary folliclesB-cells
2
Q
What is contained in the medulla of lymph nodes?
A
lymph sinuses
blood vessels
small B-cell component
3
Q
What is contained in the paracortex of lymph nodes?
A
mobile T lymphocyte pool
4
Q
What is the function of lymphocytes?
A
long term constant defence by recognising self from non-self
5
Q
How does lymph travel through the node?
A
through afferent vessels in the cortex, through the sinuses and exits through efferent vessels in medulla
6
Q
How does lymph travel through the node?
A
through afferent vessels in the cortex, through the sinuses and exits through efferent vessels in medulla
7
Q
What does lymph carry?
A
antigens
8
Q
What do follicles or germinal centres contain?
A
large B cells (centroblasts) which mature into smaller B cells (centrocytes)
9
Q
What causes B cells to divide and mature in follicles?
A
encountering antigens
10
Q
What happens mature B cells
A
differentiate into plasma cells outside the follicles
11
Q
What do plasma cells do?
A
produce antibodies
12
Q
How do T cells work?
A
help B cells organise an antibody responsehave receptors that cause cell damage to the affected organs
13
Q
Where are T cells found in the node?
A
between follicles and medulla (paracortex)
14
Q
Where are macrophages in the node?
A
between sinuses and follicles
15
Q
What stain is used to asses the lymph arcitecture?
A
H&E
16
Q
What is immunochemistry?
A
use commercially available antibodies to detects antigens expressed on cell surfaces, cytoplasm or nucleus
17
Q
What antibodies are on B cells?
A
CD19, 20 and 79asurface immunoglobulin
18
Q
What antibodies are on T cells?
A
CD3, 4 and 8
19
Q
Causes of lymphadenopathy
A
viralbacterialfungalchlamydiaparasiticrickettsialimmunologicmalignancy
20
Q
Viral causes of lymphadenopathy
A
infectious mononucleosishepatitisHIVmeaslesrubella
21
Q
Bacterial causes of lymphadenopathy
A
streptococcibucellosisTBsyphilis
22
Q
Fungal causes of lymphadenopathy
A
histoplasmosiscryptococcosis
23
Q
Chlamydia cause of lympohadenopathy
A
lymphogranuloma venereum
24
Q
Parasitic cause of lymohadenopathy
A
toxoplasmosis
25
Rickettsial cause of lymophadenopathy
scrub typhus
26
Immunologic causes of lymphadenopathy
rheumatoid arthritisSLEprimary biliary cirrhosisdrug hypersensitivitygraft verseus host disease
27
Malignant causes of lymohadenopathy
haematologicalmetastases from other sites
28
Other causes of lymphadenopathy
sarcoidosisdermatopathic lymphadenitis
29
Investigations in lymphadenopathy
general and ENT examinationFBPserologychest X rayUSSCTMRIPET*FNA and biopsy*
30
Name the structures
largest cells: centroblastssmallest cells with dark nucleus and minimal cytoplasm: mature lymphocytes white arrow: centrocyte
31
What kinds of lymph hyperplasia are there?
follicularparacorticalsinuscombination
32
What happens in follicular hyperplasia?
follicular pattern accentuates
33
What happens in paracortical hyperplasia?
expansion of lymph node medulla
34
What happens in sinus histiocytosis?
infiltration of sinuses by histocytes
35
How do lymph nodes become perulent?
pus-filled nodes are seen after bacterial infection due to infiltration of neutrophils
36
What is a granuloma?
discrete collection of macrophages
37
When are granulomas seen in lymph nodes?
TBsarcoidosis
38
Who is mainly affected by infectious mononucleosis?
children and young adults
39
Clinical features of infectious mononucleosis
```
fever
sore throat
lymphadenopathy
splenomegaly
```
40
Monospot test for infectious mononucleosis? (Serology findings)
anti EBV antibodies
41
What is seen in peripheral blood in infectious mononucleosis?
atypical lymphocytes
42
When is infectious mononucleosis biopsied?
when clinical features are atypical
| when malignancy is quieried
43
What type of hyperplasia is seen in infectious mononucleosis?
follicular and sinus hyperplasia
44
What cells are involved in follicular and sinus hyperplasia in infectious mononucleosis?
plasma cells and immunoblasts
45
What lymphopathology is seen in the picture?
```
infectious mononucleosis
large blast-like cells
some small lymphocytes
plasma cells
blood vessels
```
46
Where does sarcoidosis commonly affect?
lungs
eyes
skin
lymph nodes
47
Who is commonly affected by sarcoidosis?
african americans
| scandinavians
48
What is seen in histological diagnosis for sarcoidosis?
non-caseating or non-necrotic granulomata
49
What makes up the non-caseating granulomata in sarcoidosis?
epithelioid histocytes
Langerhans giant cells
sometimes calcified structures called asteroid bodies or Schaumann bodies
50
What laboratory abnormalities are seen in Sarcoidosis?
raised ACE levels
| raised calcium levels
51
What diagnosis is seen in the picture?
sarcoidosis
| single granulomata with ark central asteroid body
52
What condition is seen in the picture?
sarcoidosis
| multiple pale discrete granulomas replacing normal lymph node
53
What is a lymphoma?
solid tumour of lymph nodes
| tumour nodules]localised masses initially
54
What is a leukaemia?
liquid tumour
primarily based in bone marrow but can include lymph nodes
systemic and diffuse at outset
55
What are the 2 mai classes of lymphomas?
Hodgkin's and Non-Hodgkins
56
What is the Reed-Sternberg (RS) cell?
distinctive neoplastic cell in Hodgkin's lymphoma
57
What is Hodgkin's lymphoma further divided into?
nodular lymphocyte predominant Hodgkin lymphoma and classical Hodgkin lymphoma
58
Morphological variants of Hodgkin lymphoma?
nodular sclerosing
lymphocyte rich
lymphocyte depleted
mixed cellularity
59
What is the behaviour of NH lymphoma?
clinically aggressive
| indolent (causing little or no pain)
60
Lineage of NH lymphoma
T and B cell
61
Growth pattern of NH lymohoma
follicular
| diffuse
62
What are the indolent NH lymphomas?
```
lymphocytic lymphoma (B)
follicular lymphoma (B)
```
63
What are the aggressive NH lymphomas?
lymphoblastic lymphoma (B or T)
Burkitt's lymphoma (B)
diffuse large B-cell lymphoma (B)
mantle cell lymphoma (B)
64
What are the small lymphoid cells in B-cell NH lymphoma?
small lymphocytic lymphoma
mantle cell lymphoma
follicular lymphoma
65
What is the lymphoma with intermediate cell size?
Burkitt's lymphoma
66
What is the large cell NH B lymphoma?
diffuse large B-cell lymphoma
67
What is the most common leukaemia?
chronic lymphocytic leukaemia (CLL) / small lymphocytic lymphoma
68
What is the absolute lymphocyte count in CLL?
>4000/mm^3
69
M:F ratio in CLL
2:1
70
What are symptoms like in CLL?
often asymptomatic
71
Physical examination findings in CLL?
lymphadenopathy
| splenomegaly
72
Haematological findings in CLL?
haemolytic anaemia
thrombocytopaenia
hypogammaglobulinaemia
73
Morphological findings in peripheral blood/lymph node in CLL?
small mature lymphoid cells seen with larger cells (pro-lymphocytes)
tumour cells stain positively with CD5 and B-cell antibodies
74
What is the frequently assoociated molecular abnormality seen?
trisomy 12
| deletion 13q
75
Median survival of CLL?
4-6 years
76
What can CLL transform into?
more aggressive large cell lymphoma
77
Follicular lymphoma frequency?
<45% adult lymphomas
78
How does follicular lymphoma present?
painless lymphadenopathy
79
What organs are involved in follicular lymphoma?
spleen
liver
bone marrow
80
What are the tumour B cells in follicular lymphoma?
centroblasts
| centrocytes
81
What is expressed on tumour B cells in follicular lymphoma?
CD10
BCL2
pan B-cell markers
82
What is the molecular abnormality in follicular lymphoma?
t(14:18)
83
What does the t(14:18) in follicular lymphoma cause?
overexpression of BCL2
84
What does overexpression of BCL2 cause in follicular lymphoma?
blocks apoptosis and causes increased cell survival
85
What is the prognosis for follicular lymphoma?
non-curable disease
median survival 10 years
transformation to diffuse large B-cell lymphoma in 30-50%
86
What kind of lymphoma is mantle cell lymohoma?
small cell agressive
87
What is involved in mantle cell lymphoma?
peripheral blood
bone marrow
lymph nodes
spleen
88
What is it called when the GI tract is involved in mantle cell lymphoma?
lymphomatoid polyposis (polyps)
89
What is the molecular feature of mantle cell lymphoma?
t(11:14)
90
What do the small lymphoid cells express in mantle cell lymphoma?
pan B
CD5
cyclin D1
91
What does the t(11:14) cause in mantle cell lymphoma?
over-expression of cylcin D1
92
What kind of lymphoma is Burkitt's lymphoma?
intermediate cell size
| aggressive but potentially curable
93
How does Burkitt's lymphoma present?
leukaemia or lymphoma
| predominantly nordal or extra nodal (abdominal disease)
94
Where is Burkitt's lymphoma endemic
areas of Africa seen in children
95
What part of the body is involved in Burkitt's lymphoma in children?
jaw bone
96
What virus is Burkitt's lymphoma associated with in African areas?
Epstein-Barr virus
97
What is the viral cause of Burkitt's lymphoma in the west?
HIV
98
How does Burkitt's lymphoma usually present?
ileocecal masses
99
What causes the starry sky appearance in Burkitt's lymphoma?
large turnover of intermediate-sized B cells recruits macrophages
100
What is the translocation associated with Burkitt's lymphoma?
t(8:14)
101
What gene is characteristic of Burkitt's lymphoma?
c-myc
102
What is involved in diffuse large B-cell lymphoma?
lymph nodes
| visceral organs
103
What are teh translocations associated with diffuse large B-cell lymphoma?
t(14:18)]BCL6 abnormalities
104
What are symptoms associated with T-cell lymphomas?
pruritic/itchy skin rashes
weight loss
fever
lymphadenopathy
105
What is expressed on the tumour T cells in T-cell lymphomas?
pan T
CD3
CD2
106
What happens on a molecular level in T-cell lymphoma?
T-cell receptor rearrangement
107
What are 3 common T-cell lymphomas?
microcyst fungoides
peripheral T-cell lymphoma
enteropathy-associated T-cell lymphoma (following long-standing coeliac disease)
108
What is this NH lymphoma?
CLL with pro-lymphocytes
109
What is this NH lymphoma?
follicular lymphoma
110
What is this NH lymphoma?
mantle cell lymphoma (cyclin D1 expression)
111
WHat is this NH lymphoma?
Burkitt's lymphoma (starry sky appearance)
112
What is this NH lymphoma?
diffuse large B-cell lymphoma
113
What is this NH lymphoma?
mycosis fungoides
114
Where does Hodgkin's lymphoma usually affect?
single or multiple lymph nodes
115
Where can Hodgkin's lymphoma rarely affect?
```
lymph nodes of:
gut
skin
mesenteric
Waldeyer's ring
```
116
What is the neoplastic cell in Hodgkin's lymphoma?
Reed-Sternberg
117
What are the 2 types of Hodgkin's lymphoma
classisal
| nodular lymphocyte predominant
118
What cells are Hodgkin's lymphomas derived from?
B-cells (not all will express B-cell markers)
119
What do the RS cells in HL stain with?
antibodies CD15 and 30
120
What are the 4 morphological variants sof HL?
nodular sclerosis
mixed cellularity
lymphocyte rich
lymphocyte depleted
121
Who is most affected by nodular scelrosis HL?
young adults and women
122
Which nodes are commonly involved in nodular sclerosis HL?
lower cervical
supraclavicular
mediastinal
123
What are the RS cells in nodular sclerosis HL like?
lacunar with sclerotic bands
124
WhatRS cells are in mixed cellularity HL?
classic binuclear
125
How does lymphocyte rich HL usually present?
isolated cervical or axillary lymphadenopathy
126
What are the RS cells in lymphocyte rich HL?
lymphohistiocytic (LNH)
127
How does lymphocyte depleted HL usually present?
high stage disease in older men
128
What are the prognoses of HL like?
nodular sclerosis - excellent
mixed cellularity - good
lymphocyte rich - excellent
lymphocyte depleted - poor
129
What do Hodgkin cells of nodular lymphocyte-predominant HL stain with?
CD20 and B-cell markers
130
What is the name of the system to stage HL?
Ann Arbor
131
What is stage I in Ann Arbor?
single lymph node/region/extralymphatic site/organ
132
Stage II Ann Arbor
2 or more LN regions on same side of diaphragm
133
Stage III Ann Arbor
both sides of diaphragm +/- spleeen or contiguous extralymphatic organ
134
Stage IV Ann Arbor
disseminated disease and bone marrow development
135
What do the A annd B stand for in Ann Arbor?
A: absence of constitutional symptoms
B: presence of constitutional symptoms (fever, night sweats, unexplained weight loss)
136
Where do leukaemias arise?
bone marrow
137
How is leukaemia classified?
myeloid/lymphoid
| acute (blast)/chronic (cyte)
138
What are the 4 types of leukaemia?
AML acute myeloid leukaemia
ALL acute lymphoid leukaemia
CML chronic myeloid leukaemia
CLL chronic lymphoid leukaemia
139
What is the chromosome in CML?
philadelphia gene chromosomes 9 and 22
140
When does ALL tyoically occur?
children and young adults
141
What happens in pre-B ALL?
marrow filled with primitive blassts spill out into peripheral blood
142
How does pre-B ALL present?
marrow failure and bone pain
143
How does pre-T ALL present?
adolescent boys with mediastinal masses
144
What is the morphology seen in ALL?
undifferentiated blassts
145
What are the surface immunophenotypes in B-ALL
CD79a
CD 10
Tdt
146
What are the surface ummuniphenotypes in T-ALL?
CD7
CD3
Tdt
147
How does myeoloma usually present?
pathological fractures
pain
hypercalcaemia
148
Haematologically what is seen in myeloma after marrow replacement by plasma cells and why?
thrombocytopenia
leukopenia
anaemia
plasma cells suppress normal haemopoiesis
149
What can happen as a result of excess production and aggregation of IgGs produced by the plasma cells in myeloma treatment?
hyperviscosity
renal failure
amyloidosis
150
What proteins are associated with myeloma?
Urine Bence-Jones preoteins
151
What is the commonest cause of death in myeloma?
infections
| renal failure
