Lymphadenopathy

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LYMPHADENOPATHY Dr. Manjit Singh
Saren Pathologist, MAHSA University College.
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HISTOLOGY
HISTOLOGY
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LYMPHADENOPATHY DEFINITION Disease of lymph
nodes Associated with underlying pathology.
i) Involvement in variety of systemic diseases.
ii) Primary lymphoid malignancies iii)
Metastatic lymphoid lesions iv) Localized
infections v) Localized injuries
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LYMPHADENOPATHY Types 1. REACTIVE
LYMPHADENITIS Inflammation of lymph nodes 2.
REACTIVE LYMPHADENOPATHYPrimary immune reactions
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REACTIVE LYMPHADENITIS NON- SPECIFIC
RESPONSE 1.Acute lymphadenitis 2.Chronic
lymphadenitis 1) Acute lymphadenitis draining
inflamed area. gtBacterial infections
gtForeign bodies in wounds Nodes Enlarged
and tender Untreated Chronic adenitis, necrosis
and abscess
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• 2) Chronic Lymphadenitis
• A). With follicular B cell hyperplasia
• Non- specific lymphadenitis
• Commonest
  lesion
• ii. Specific lymphadenitis
• 
  Rheumatoid arthritis
• 
  Toxoplasmosis
• Syphilis
• AIDS

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B) With para-follicular T cell hyperplasia
- Microbiological agents -
Drugs (Dilantin) - Virus (Inf.
Mononucleosis) -Post vaccinial
C) With sinus hyperplasia with histiocytosis
Cancer draining sites. Micro
Phagocytes within dilated sinuses.
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• LYMPHADENOPATHY
• Primary Lymphoid malignancies.
• Amyloidosis
• 2. Secondary
• i. Infections
• TB
• Sarcoidosis
• Syphilis
• Castlemans Disease
• Dermatolymadenopathy
• Filariasis
• ii. Metastatic diseases

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CAUSES OF LYMPADENOPATHY 1.HIV
related 2.Opportunistc infections TB, CMV,
Toxoplasmosis, Norcardia. 3.Fungal
Histoplasmosis, cryptococcusis. 4.Reactive
Pyogenic infections/bacteria. 5.Venereal
(STD)- Syphilis, Chancroid,
Lympho- Granuloma Venereum 6.Malignancies
i. Primary Lymphomas
ii. Secondary Metastasis

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CYTO MEGALIC VIRUS
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CYTO MEGALIC VIRUS
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Toxoplasma gondii
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TUBERCULOUS LYMPHADENOPATHY Poor socio-economic
background. Over-crowding Presentation Night
sweats Cough with hemoptysis Loss of
weight Family history
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Diagnosis History ESR Sputum examination for
AFB TB Culture Chest X-rays CT Scan MRI BIOPSY
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SARCOIDOSIS Etiology Unknown. Cell mediated
immune reaction Affects Lung and lymph
nodes Micro 1. Langhans cells, Foreign body
giant cells 2. Asteroid bodies, Schaumann
bodies. 3. Non-caseating granuloma 4.
Epitheloid cells and fibrosis Diagnosis Kviems
Test Intra-dermal test
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FILARIAL LYMPHADENOPATHYEtiology Wuchereia
Bancrofti Brugia malayiAdult
worm in lymphatics, Lymph nodes, testis and
epididymisAcute Fever, lymphangitis,
epididymo-orchitis and microfilaria.Chronic
Lymphadenopathy, hydrocele and elephantiasis.Comp
lications Chylous ascitis chyluria
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AL AMYLOIDOSISAssociated with plasma cell
dyscrasias.Secrete Immunoglobulin light
chains.Can be associated with lymphadenoparthy
Diagnosis Congo red
1.Light microscopy
Eosinophilic amorphous
2.Polarised light
Apple green
birefringence
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• PART I
• LYMPHADENOPATHY

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CASTLEMANS DISEASE Definition Single solid
growth within lymphatic tissue Sites Chest,
stomach or neck . Abnormal enlargement of lymph
nodes.
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CASTLEMANS DISEASE Etiology Unknown Rare
disorder Types 1. Hyaline type 90 2. Plasma
type prevalent in young
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DERMOTOPATHIC LYMPHADENOPATHY DefinitionReactiv
e lymph node hyperplasia.EtiologySecondary to
eczema and dermatitisMicro Intra-dermal
macrophages containing fat and melanin
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CAT SCRATCH DISEASE Children 80 Self limiting
Gm-ve bacterial infection Localized
lymphadenopathy Sarcoid-like granulomas Stellate
abscess
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LYMPHANGIITISInflammation
of lymphatic vesselsi. Acute Lymphangiitis
Bacterial infections B-Strep Staph. Micro
inflammatory exudate and clotted lymph ii.
Chronic LymphangitisTB, Actinomyces, syphilis,
radiation, parasitesMicro Fibrosis and chronic
lymphedema
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KIKUCHIS DISEASE Presentation Fever and Tender
Adenitis Micro Necrosis and stellate
abscesses Neutrophils and nuclear
dust Histiocytes but rarely any eosinophils
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KIMURAS DISEASE Introduction Chronic
inflammatory disorder Clinical Features Age
20-40 yrs and males Painless swelling of
parotid Cervical lymphadenopathy
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KIMURAS DISEASE Micro Lymph node
biopsy Eosinoplilia Proliferation of vascular
endothelium. Focal eosinophilic
abscess Hyperplasia of lymphoid follicles Well
vascularised Warthin-Finkeldey polykaryocytes
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KIKUCHIS DISEASE Common in children Cervical
lymphadenopathy Also Necrotizing histiocytic
lymphadenitis Etiology CMV EBV Herpes virus
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KIMURAS DISEASE PATHOPHYSIOLOGY Allergic
reaction -Parasites, viral, arthropod bites and
candidiasis. Auto-immune reaction IgE mediated
Type I hypersensitive reaction. Cytokines Interl
eukin 4 and 5 produces-? gt
Eosinophiltrophic cytokines IgE 20 with
nephrotic syndrome
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KAWASAKIS DISEASEAge lt5yrsCause
UnknownLymphadenopathyClinically Fever (gt39C)
red eyes Red and cracked lipsRash on chest and
genitals Swollen tongue and enlarged lymph
nodesComplications Affects heart Arrhythmias
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• Multicentric or Generalized Type CASTLEMANS
  DISEASE
• Multiple sites
• Symptoms
• Same as plasma type
• Hepato-splenomegaly
• POEMS Syndrome
• Complications POEMS SYNDROME
• Kaposis Sarcoma
• Non Hodgkins
  Lymphoma

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LANGERHANS CELL HISTIOCYTOSISHistiocytosis
Proliferative disorder of histiocytes or
macrophages.Auto-immune disease genetically
relatedTypes1. Benign Histiocytic
proliferation in lymph nodes.2. Malignant
Histiocytic lymphoma3. Intermediate Langerhans
cell Histiocytosis
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LANGHERAN CELLS ORIGIN Derived from dendritic
cells of skin.Proliferating Langerhans cells
are LEUKOCYTE ANTIGEN DR (HLA-DR) positive and
express CD1 antigen. Cells contain Berkecks
granules. EM Micro Vacuolated cytoplasm
resembling tissue histiocytes and hence called
Langerhans Cell Histiocytosis
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HISTIOCYTOSIS X1. LITTERER SEWE DISEASEAge 2
yrs and lessPresentationCutaneous
lesionsHepato-splenomegalyPulmonary lesions
(stiffening)Destructive osteolytic bone
lesionsfractures Infiltrates bone marrow
causinganaemia and thrombocytopeniaPredisposing
to infections.Rapidly fatalChemo50 5 year
survival
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2 EOSINOPHILIC GRANULOMALangerhans cells in
bone medullary cavities MicroHistiocytes and
eosinophils along with plasma cells and
lymphocytes.LesionsUnifocal Pain and
pathological TreatmentLocal excision and
radiation.May heal spontaneously
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2. MULTIFOCAL LESIONS Affects childrenClinical
PresentationFever and diffuse eruptions on
scalpOtitis mediaURTIGeneralized
LymphadenopathyHepato-splenomegalyDiabetes
Insipidus (post pituitary stalk involved)
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3. HAND SCHULLER CHRISTIAN DISEASEPresentation
Involvement of calvarial boneDiabetes
InsipidusExophthalmosTreatmentSpontaneous
regressionChemotherapy
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HAND SCHULLER CHRISTIAN DISEASEPresentationInv
olvement of calvarial boneDiabetes
InsipidusExophthalmosTreatmentSpontaneous
regressionChemotherapy