Notes on Lymphoid Tissue Disorders

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Lymphadenopathy:

• Nodal enlargement; benign in younger than 30; malignant in older than 30.

• Caused by reactive lymphadenitis.

• Infiltrative.

• Painful lymph nodes; localized in infection; generalized in systemic disease.

• Painless = malignant; eg., Hodgkin's lymphoma.

Nodes involved in primary/metastatic cancer:

Submental:

• Squamous cell carcinoma in mouth.

Cervical:

• Hodgkin's lymphoma.

Left-sided supraclavicular (Virchow's nodes):

• Gastric or pancreatic cancer.

Right-sided supraclavicular:

• Lung or esophageal cancers; Hodgkin's lymphoma.

Axillary:

• Breast cancer.

Hilar:

• Lung cancer.

Mediastinal:

• Lung cancer, Hodgkin's lymphoma, T-cell lymphoblastic lymphoma.

Para-aortic:

• Testicular cancer.

Inguinal:

• Vulvar and penis cancers.

Types of Reactive Lymphadenitis:

Follicular hyperplasia:

• B-cell response; seen in HIV infection, RA and SLE.

Paracortical hyperplasia:

• T-cell response; caused by phenytoin, viral infections.

Mixed T/B cell hyperplasia:

• Cat-scratch disease by Bartonella henselae.

Sinus histiocytosis:

• Seen in axillary nodes in breast cancer.

Non-Hodgkin's lymphoma:

• 80% are B-cell origin.

• Caused by: Viruses (EBV), HTLV-1.

• H. pylori.

• Sjogren's syndrome; Hashimoto's thyroiditis.

• AIDS, Bloom syndrome.

• Recipients of organ transplants.

• Radiation.

• Blocked development of B/T-cells.

• These are T/B-cell lymphomas.

Hodgkin's Lymphoma:

• EBV association.

• Defects in cellular immunity.

• Reed-Sternberg cells; CD15/CD30 positive; two mirror image nuclei.

• Reactive cells: eosinophils, plasma cells, histiocytes.

• Fever, weight loss, night sweats.

• Pel-Ebstein fever.

• Anemia.

• Painless enlargement of single group of lymph nodes; cervical, supraclavicular, anterior mediastinal.

Langerhans Cell Histiocytosis (Histiocytosis X):

• Histiocyte = macrophage present in connective tissue.

• CD1 positive.

• Birbeck granules; tennis-racket appearance with electron microscopy.

• Children and young adults.

Letterer-Siwe disease:

• Malignant histiocytosis.

• Younger than 2 years old.

• Rash, multiple organs involved, defective skull, pelvis, long bones; fatal.

Hand-Schuller-Christian disease:

• Malignant histiocytosis.

• Mainly children.

• Fever, rash on scalp and ear canals.

• Defective skull; diabetes insipidus; exophthalmos.

Eosinophilic granulomas:

• Benign.

• Adolescents and young adults.

• Lesions in bone; pain.

Mast cell disorders:

• Release of histamine: pruritus and swelling.

Urticaria pigmentosum:

• Skin lesions.

• Darier's sign from scratching.

• Dermatographism.

• Positive skin culture with toluidine blue and Giemsa stain.

• Pruritus and flushing triggered by alcohol, foods, drugs.

Plasma cell dyscrasias:

• B-cell disorder.

• Increased IgG.

• Bence Jones protein in urine.

Multiple myeloma:

• Blacks.

• Radiation exposure.

• M-spike on urine test.

• Bone pain; punched-out lesions.

• Hypercalcemia.

• Renal failure.

• Bence Jones protein in urine.

• Anemia; increased erythrocyte sedimentation rate; increased bleeding time.

Spleen disorders:

• Function is blood filtration, antigen trapping, platelet storage, RBC production.

Splenomegaly:

• White pulp hyperplasia.

Caused by:

• Autoimmune: eg., SLE, thrombocytopenia.

• Infectious mononucleosis.

• Parasitic infections.

• Defective lysosomal storage: Gaucher disease; Niemann-Pick disease.

• Left upper quadrant pain.

Portal hypertension:

• Sugar-coated spleen.

• Ca and Fe concretions: Gamna-Gandy bodies in collagen.

Hypersplenism:

• Exaggeration of normal spleen function.

• More RBCs, WBCs, platelets destroyed.

• Portal hypertension.

• Splenomegaly, blood cytopenias.

Splenic dysfunction and splenectomy:

• Dysfunction: Howell-Jolly bodies; predisposition to infection; decreased IgM/C3b.

• Splenectomy: increased risk for infections.

Additional Reading:

Basic Pathology

1. Cell Injury
2. Inflammation and Repair
3. Immunopathology
4. Water, Electrolyte, Acid-Base, Hemodynamic Disorders
5. Genetic and Developmental Disorders
6. Environmental Pathology
7. Nutritional Disorders
8. Neoplasia
9. Vascular Disorders
10. Heart Disorders
11. Red Blood Cell Disorders
12. White Blood Cell Disorders
13. Lymphoid Tissue Disorders
14. Hemostasis Disorders
15. Blood Banking and Transfusion Disorders
16. Upper and Lower Respiratory Disorders
17. Gastrointestinal Disorders
18. Hepatobiliary and Pancreatic Disorders
19. Kidney Disorders
20. Lower Urinary Tract and Male Reproductive Disorders
21. Female Reproductive and Breast Disorders
22. Endocrine Disorders
23. Musculoskeletal Disorders
24. Skin Disorders
25. Nervous System Disorders
26. Notes on Tissue Regeneration
27. A Table of Bleeding Disorders
28. FAQ on Structure and Function of Red Blood Cells
29. FAQ on Components of Blood
30. Notes on Hemostatic Mechanisms
31. What is Fever?
32. What is Edema?
33. FAQ on Blood Pressure
34. FAQ on principles of fluid and flow dynamics of Blood
35. Causes of Thrombocytopenia
36. Squamous cell carcinoma of head and neck mucosa
37. Four tumors which never metastasize to the brain
38. What is caustic injury?
39. What causes Peripheral Edema?

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