Flashcards in Lymph Nodes Deck (343)
Cat-scratch disease: Prognosis in the immunocompetent.
Resolution in 2 to 6 months.
Cat-scratch disease: Prognosis in the immunocompromised (3).
Can lead to
- Widespread granulomatous inflammation.
- Bacillary angiomatosis.
- Bacillary peliosis.
Cat-scratch disease: Other bacteria that may cause histologically similar lymphadenitis (4).
Sarcoidal lymphadenitis: Frequency.
Occurs in 40% of patients with sarcoidosis.
Sarcoidal lymphadenitis: Necrosis.
Not typical, but small foci of fibrinoid necrosis can be seen.
Sarcoidal lymphadenitis: Lymphoma that must be excluded.
Classic Hodgkin's lymphoma: Granulomas may be seen in affected nodes and in benign ones.
A. Histology of lymphadenitis.
B. Diagnosis (2).
A. May mimic tuberculous or sarcoidal lymphadenitis.
B. Culture, serology.
Castleman's disease: Types.
Hyaline-vascular: Most common.
Castleman's disease, hyaline-vascular type:
A. Typical patient.
B. Typical presentation.
C. Typical site.
A. Young adult.
B. Incidental finding.
C. Mediastinal lymph node.
Castleman's disease, plasma-cell type: Presentation.
Half of patients have
- Increased ESR.
- Increased gamma globulins in the serum.
- Increased plasma cells in the bone marrow.
Castleman's disease, multicentric type: Typical patient.
Middle-aged or older adult.
Castleman's disease, multicentric type: Presentation (4).
Generalized peripheral lymphadenopathy.
Castleman's disease, multicentric type: Associated malignancies (3).
Castleman's disease, multicentric type: Additional association.
Castleman's disease, hyaline-vascular type, histology:
A. Mantle zones (2).
C. Interfollicular area.
A. "Onion-skin" pattern; one mantle zone may surround two or more germinal centers.
Castleman's disease, plasma-cell type, histology:
A. Germinal centers.
C. Interfollicular area.
A. Some are atrophic, some hyperplastic.
B. May be patent.
C. Hypervascular; sheets of plasma cells.
Castleman's disease, multicentric type, histology.
Similar to that of plasma-cell type, but occurring in many lymph nodes.
Castleman's disease, plasmablastic type.
Type of multicentric Castleman's disease in which plasmablast-like cells occupy germinal centers and the interfollicular area.
Castleman's disease: Monoclonality (3).
Plasma-cell type: Plasma cells may be restricted to IgG-lambda or IgA-lambda.
Plasmablastic type: Plasmablasts are restricted to IgM-lambda.
No clonality of rearrangement of IgH.
Castleman's disease: Immunohistochemistry (2).
Regressed follicles: CD21 and CD23.
Multicentric type (up to 40%): HHV8.
Castleman's disease: Laboratory abnormality.
Increased IL-6 in the serum.
Castleman's disease vs. B-cell lymphoma: Molecular test.
B-cell lymphoma: IgH is clonality rearranged.
Castleman's disease vs. HIV-associated lymphadenopathy (3).
- Attenuated mantle zones.
- No "onion-skin" pattern.
- No "lollipop" follicles.
Castleman's disease vs. angioimmunoblastic T-cell lymphoma.
AITCL: Atypical small to medium-sized lymphocytes with clear cytoplasm.
Castleman's disease vs. thymoma.
Thymoma: Epithelial cells (confirmable by IHC).
Castleman's disease vs. autoimmune lymphadenopathy.
Autoimmune lymphadenopathy can also show sheets of plasma cells.
Distinction requires clinical correlation.
Castleman's disease vs. plasma-cell neoplasm.
Plasma-cell neoplasm lacks the typical follicular changes of Castleman's disease.
SLL/CLL: Components of the proliferation centers (3).
SLL/CLL: Flow cytometry (2,2,1).
Positive: CD5, CD23.
Dim: CD20, sIg.