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Flashcards in Lymph Nodes Deck (343)
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30

HIV-related lymphadenopathy: Immunohistochemistry (3).

Reactive germinal centers: Many CD8-positive lymphocytes.

Interfollicular area: Fewer CD-positive lymphocytes; many S100-positive IDCs.

Advanced disease: Absence of CD21- and CD23-positive FDCs.

31

Kimura's disease: Classic patient.

East Asian male with painless subcutaneous masses and lymphadenopathy of head and neck.

32

Kimura's disease: Internal site.

Salivary gland (in 40% of patients).

33

Kimura's disease: Laboratory findings (2).

Eosinophilia.

Elevated serum IgE.

34

Kimura's disease: Histology (4).

Reactive follicular hyperplasia.

Many eosinophils.

Hypervascularity.

Eosinophilic proteinaceous deposits (IgE) in the germinal centers.

35

Kimura's disease vs. drug-related lymphadenopathy (2).

Drug-related lymphadenopathy:

- Paracortical proliferation of immunoblasts.
- There may or may not be follicular hyperplasia.

36

Kimura's disease vs. angiofollicular hyperplasia with eosinophilia (2).

Angiofollicular hyperplasia with eosinophilia:

- Typically affects middle-aged white women.
- Eosinophilic microabscesses are unusual.

37

Causes of increase in IgG4-positive lymphocytes (4).

IgG4-related disease.

Carcinoma.

Lymphoma.

Others.

38

IgG4-related lymphadenopathy: Classic presentation.

Autoimmune pancreatitis.

39

IgG4-related lymphadenopathy: Other frequently involved organs (5).

Kidney.

Lung.

Liver.

Gallbladder.

Ocular adnexa.

40

IgG4-related lymphadenopathy: Types.

I: Multicentric Castleman's disease-like.

II: Follicular hyperplasia.

III: Paracortical expansion.

IV: Progressive transformation of germinal centers.

V: Inflammatory pseudotumor-like.

41

IgG4-related lymphadenopathy: Histology of type I (3).

Hyperplastic and atrophic follicles.

Interfollicular vascular proliferation.

Eosinophilia.

42

IgG4-related lymphadenopathy: Histology of type II (2).

Interfollicular and paracortical plasmacytosis.

Eosinophilia.

43

IgG4-related lymphadenopathy: Histology of type III (2).

Prominent high-endothelial venules.

Expansion of paracortex by various lymphocytes and eosinophils.

44

IgG4-related lymphadenopathy: Histology of type IV (2).

Enlarged follicles with expanded mantle zones.

Scattered interfollicular plasma cells.

45

IgG4-related lymphadenopathy: Clonality.

Stains for kappa and lambda light chains demonstrate polytypic plasma cells.

46

IgG4-related lymphadenopathy: Quantification (2).

Ratio of IgG4 to IgG is more than 40%.

Thee must be more than 100 IgG4-positive plasma cells in at least 3 hpf.

47

IgG4-related lymphadenopathy: Laboratory findings (3).

High serum IgG4.

Normal IL-6.

Normal CRP.

48

IgG4-related lymphadenopathy vs. inflammatory pseudotumor.

Inflammatory pseudotumor: No increase in IgG4-positive plasma cells.

49

IgG4-related lymphadenopathy: Putative causes.

Chronic infection.

Autoimmune disease.

50

IgG4-related lymphadenopathy: Treatment.

Patients respond well to steroids.

51

IgG4-related lymphadenopathy: Main histologic feature in non-lymphoid organs.

Sclerosis.

52

IgG4-related lymphadenopathy: Histology of type V.

Lymph node is focally replaced by fibrous tissue containing plasma cells and lymphocytes.

53

Progressive transformation of germinal centers: Typical patient.

Child or young adult with a single enlarged lymph node.

54

Progressive transformation of germinal centers: Histology

Massively expanded mantle zone with loss or fragmentation of the germinal center.

Typically follicular hyperplasia in the background.

55

Progressive transformation of germinal centers: Immunohistochemistry.

Mantle zones are reactive for Bcl-2 and IgD.

Germinal centers contain increased CD57+ cells.

56

Progressive transformation of germinal centers: Flow cytometry.

CD4+/CD8+ T lymphocytes may be detected.

57

Progressive transformation of germinal centers: Relation to NLP-HD.

PTGC may rarely precede, follow, or coexist with NLP-HD.

58

Infectious mononucleosis: Pattern of reactive hyperplasia.

Paracortical.

59

Infectious mononucleosis: Histology.

Expansion of paracortex by small, medium-sized, and large immunoblasts.

Increased mitotic activity.

Necrosis sometimes.