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Flashcards in Lymph Nodes Deck (343)
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60

Infectious mononucleosis: Immunohistochemistry (2,1,2).

Positive: CD20, Mum-1.

Variable: CD30.

Negative: CD10, CD15.

61

Infectious mononucleosis: Molecular study.

In-situ hybridization for EBV (EBER).

62

Infectious mononucleosis vs. CMV lymphadenitis (2).

CMV lymphadenitis:

- IHC demonstrates presence of CMV.
- EBER negative.

63

Herpes simplex lymphadenitis: Presentation (2).

Localized or generalized.

Usually painful.

64

Herpes simplex lymphadenitis: Histology (3).

Paracortical hyperplasia with many immunoblasts.

Multifocal necrosis with neutrophils.

Typical viral cytopathic effect.

65

Herpes simplex lymphadenitis vs. other necrotizing lymphadenitides.

HSV lymphadenitis: No granulomas associated with the necrosis.

66

Dermatopathic lymphadenitis: Histology (2).

Paracortical expansion, diffuse or nodular.

Many interdigitating dendritic cells, Langerhans' cells, and histiocytes that contain melanin.

67

Dermatopathic lymphadenitis vs. mycosis fungoides (2).

Mycosis fungoides:

- Atypical lymphocytes present singly, in clusters, or in large aggregates.
- PCR may be needed to exclude rearrangement of the T-cell receptor.

68

Dermatopathic lymphadenitis vs. Langerhans' cell histiocytosis.

LCH: Langerhans' cells fill the sinuses and are accompanied by eosinophils, neutrophils, plasma cells, and histiocytes.

69

Drug-related lymphadenopathy:

A. Timing.
B. Involved nodes.

A. Within 2 to 8 weeks after exposure to the drug.

B. Cervical lymph nodes or all nodes.

70

Drug-related lymphadenopathy: Causes (2).

Antiepileptics.

Allopurinol.

71

Drug-related lymphadenopathy: Histology.

Paracortical expansion with immunoblasts and eosinophilia.

Immunoblasts may form large aggregates.

72

Drug-related lymphadenopathy: Most powerful tool for diagnosis.

Clinical history of exposure to implicated drug.

73

Rosai-Dorfman disease: Typical patient.

Child or young adult with bilateral cervical lymphadenopathy.

74

Rosai-Dorfman disease: Other possible signs and symptoms

Fever.

Weight loss.

Leukocytosis.

Anemia.

Elevated ESR.

75

Rosai-Dorfman disease: Histology (2).

Histiocytes markedly expand the sinuses.

Small lymphocytes and abundant plasma cells accompany the histiocytes.

76

Rosai-Dorfman disease: Cytology

Histiocytes . . .

- Nucleus: Round, with single nucleolus.
- Cytoplasm: Abundant, eosinophilic.
- Emperipolesis, especially of lymphocytes.

77

Rosai-Dorfman disease: Immunohistochemistry (4,2).

Positive: S100, CD14, CD68, CD163.

Negative: CD1a, langerin.

78

Lymph nodes draining prosthetic implants: Histology.

Sinus histiocytes containing coarse refractive matter.

79

Whipple's disease: Initial presentation.

Migratory arthralgia.

80

Whipple's disease: Histology.

Histiocytes distend the sinuses.

Lipogranulomas.

Non-necrotizing granulomas sometimes.

81

Whipple's disease: Special stains (2).

Positive (histiocytes): PAS.

Negative: AFB.

82

Whipple's disease: Best site of biopsy.

Small intestine.

83

Whipple's disease: Ancillary studies (2).

Electron microscopy.

PCR of tissue, stool, or saliva.

84

Lymphadenopathy due to deposition of endogenous lipid material: Sites.

Nodes of porta hepatis.

Celiac lymph nodes.

85

Lymphadenopathy due to deposition of endogenous lipid material: Causes (5).

Mineral oil.

TPN.

Cholesterol.

Fat embolism.

Fat necrosis.

86

Lymphadenopathy due to deposition of endogenous lipid material: Histology (3).

Vacuolated sinus histiocytes.

Extracellular spaces.

Giant cells.

87

Lymphadenopathy due to deposition of endogenous lipid material: Special stain.

Negative: PAS.

88

Kikuchi's disease: Synonym.

Histiocytic necrotizing lymphadenitis.

89

Kikuchi's disease: Typical patient.

Young Asian woman.

However, the disease can affect either sex and any age or ethnic group.