Flashcards in Lymph Nodes Deck (343)
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.
Kimura's disease: Classic patient.
East Asian male with painless subcutaneous masses and lymphadenopathy of head and neck.
Kimura's disease: Internal site.
Salivary gland (in 40% of patients).
Kimura's disease: Laboratory findings (2).
Elevated serum IgE.
Kimura's disease: Histology (4).
Reactive follicular hyperplasia.
Eosinophilic proteinaceous deposits (IgE) in the germinal centers.
Kimura's disease vs. drug-related lymphadenopathy (2).
- Paracortical proliferation of immunoblasts.
- There may or may not be follicular hyperplasia.
Kimura's disease vs. angiofollicular hyperplasia with eosinophilia (2).
Angiofollicular hyperplasia with eosinophilia:
- Typically affects middle-aged white women.
- Eosinophilic microabscesses are unusual.
Causes of increase in IgG4-positive lymphocytes (4).
IgG4-related lymphadenopathy: Classic presentation.
IgG4-related lymphadenopathy: Other frequently involved organs (5).
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.
IgG4-related lymphadenopathy: Histology of type I (3).
Hyperplastic and atrophic follicles.
Interfollicular vascular proliferation.
IgG4-related lymphadenopathy: Histology of type II (2).
Interfollicular and paracortical plasmacytosis.
IgG4-related lymphadenopathy: Histology of type III (2).
Prominent high-endothelial venules.
Expansion of paracortex by various lymphocytes and eosinophils.
IgG4-related lymphadenopathy: Histology of type IV (2).
Enlarged follicles with expanded mantle zones.
Scattered interfollicular plasma cells.
IgG4-related lymphadenopathy: Clonality.
Stains for kappa and lambda light chains demonstrate polytypic plasma cells.
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.
IgG4-related lymphadenopathy: Laboratory findings (3).
High serum IgG4.
IgG4-related lymphadenopathy vs. inflammatory pseudotumor.
Inflammatory pseudotumor: No increase in IgG4-positive plasma cells.
IgG4-related lymphadenopathy: Putative causes.
IgG4-related lymphadenopathy: Treatment.
Patients respond well to steroids.
IgG4-related lymphadenopathy: Main histologic feature in non-lymphoid organs.
IgG4-related lymphadenopathy: Histology of type V.
Lymph node is focally replaced by fibrous tissue containing plasma cells and lymphocytes.
Progressive transformation of germinal centers: Typical patient.
Child or young adult with a single enlarged lymph node.
Progressive transformation of germinal centers: Histology
Massively expanded mantle zone with loss or fragmentation of the germinal center.
Typically follicular hyperplasia in the background.
Progressive transformation of germinal centers: Immunohistochemistry.
Mantle zones are reactive for Bcl-2 and IgD.
Germinal centers contain increased CD57+ cells.
Progressive transformation of germinal centers: Flow cytometry.
CD4+/CD8+ T lymphocytes may be detected.
Progressive transformation of germinal centers: Relation to NLP-HD.
PTGC may rarely precede, follow, or coexist with NLP-HD.
Infectious mononucleosis: Pattern of reactive hyperplasia.