Lecture 88

Front 1

Back 1

Enlargement of lymph nodes by hyperplasia of follicular (germinal) centers.

In FOLLICULAR HYPERPLASIA (increase in cell number), the hyperplastic germinal center contains a normal mixture of varibly sized lymphocytes, plasma cells, and macrophages, as well as a few dendritic reticular cells. No one lymphocyte type predominates as in lymphoma.

FOLLICULAR

* rheumatoid arthritis
* giant lymph node hyperplasia (Castleman's disease)
* AIDS (persistent generalized lymphadenopathy)*
* idiopathic (most common)

Front 2

Back 2

In SINUS HYPERPLASIA the sinuses become distended and filled with histiocyte/macrophages and some plasma cells.

1. **Rosai-Dorfman :

2. Kimura’s Disease:

3.** Whipple Disease:

4. Virus-Associated hemorrhagic syndrome

5. Dermatopathic lymphadenitis:

6. Autoimmune lymphproliferative syndrome:

7 . Mucocutaneous lymph node syndrome: Kawasaki’s

Front 3

Back 3

In DIFFUSE HYPERPLASIA the lymph node architecture is diffusely effaced by sheets of small lymphocytes, and a few scattered immunoblasts and macrophages.

Front 4

Back 4

Non specific follicular hyperplasia

**children and adolescents

malignant NON-tender/unilateral

infectious is bilateral and tender

Different sizes

Regular circumscribed shape

Mantle zone = lymphocyte surrounding border

TINGIBLE BODY MACROPHAGES

Front 5

Back 5

1. Tingible Body Macrophages: engulfed cell portions; pale cells in background

(this is a special kind of macrophage seen in follicular hyperplasia)

Front 6

Back 6

Paracortical Hyperplasia

-caused by viral lymphadenitis

1. Post capillary venules 2. Karyolysis and karyorrhxis

Front 7

Back 7

Necrotizing Lymphadenitis

-expansion of follicles, some with necrotic dead cells at center

-Necrosis in the subcapsular area (look for this as a good hint on the exam)

-karyorrhexis and karyolysis on higher mag

Front 8

Back 8

Necrotizing Lymphadenitis- TB

-Caseating necrosis

Front 9

Back 9

Necrotizing Lymphadenitis- Toxoplasmosis Lymphadenitis

1. NON-caseating necrosis

2. epitheloid histiocytes clusters

3. "monocytoid" cells that are actually B cells. 4. Toxoplasma cyst

5. in subscapsular and trabecular sinuses

Front 10

Back 10

monocytoid B cell hyperplasia (subtype of b cells)

(toxoplasmosis)

Front 11

Back 11

Toxoplasma cyst

Front 12

Back 12

Follicular hyperplasia – syphilis

*****plasmatic and lymphocytic infiltrate

-Has periarteritis: b.v proliferation causing arthritis
- epithelial histocytes
- thick capsule

- spirochetes in wall of b.v
- solitary inguinal lymphadenopathy

Front 13

Back 13

1. Plasmacytic and lymphocytic infiltrate*** 2. Periarteritis, spirochetesm inflammation and fibrosis

Front 14

Granulomatous Lymphadenitis

Back 14

1. Kikuchi

2. Cat scratch

3. Lymphogranuloma verereum

4. Sarcoidosis

Front 15

Young women

Back 15

1. Kikuchi Disease

***Young women

- C-shaped nuclei (maCrophages) in necrosis

- fever

- changes similar to SLE

Front 16

Back 16

2. Sarcoidosis

(Pulmonary typically

1. Asteroid bodies

2. NON-caseating

dx of exclusions

3. more prominent in African Americans

4. Have discrete, well circumscribed epitheliod granulomas,

5. Schaumen bodies, Calcium oxalate crystals

Front 17

Back 17

Asteroid Body

Front 18

Back 18

3. Cat Scratch Disease:

1. Stellate accesses with palisading macrophages

2. *Bartonella henselae: seen in early stages.

The same organism but different population of infection:

*Bacillary angiomatosis caused by same

orgamism but in IMMUNOCOMPROMISED

HOSTS**

- may look like Kaposi’s sarcoma.

Front 19

Back 19

Lymphogranuloma vereum

NECROTIZING granuloma

1. similar to cat scratch

2. negative silver stain

3. presence of Chlamydia

Front 20

a

Back 20

HIV-related hyperplasia

-geographical follicles (not round very irregular)

-Extravasation o RBC in germinal centers is unique to HIV

-Thinning of mantel zone

-Wartthin-Finkledey - cells with multiple eosinophilic intranuclear inclusions

-p24

Front 21

Back 21

Infectious mononucleosis

-Immunoblasts (second picture) look like Reed Sternberg Cells: prominent nucleoli, mem intact, minimal cytoplasm, ring around.

-splenomegaly

Front 22

Back 22

Post Vaccinial Lymphadenitis:

used to be seen with smallpox, resembles mono, mottled vascular mixed cell infiltrate

Front 23

Allergic-like reaction

Back 23

Dilantin Hypersensitivity

fever, erythematous rash, eosinophilia (THINK ALLERGIC RXN TYPE I); Immunoblasts, plasma cells

Front 24

Russel Bodies

Back 24

*Follicular Hyperplasia RA

-Interfollicular plasmacytosis (similar to syphilis)

-Russell Bodies

-precurser lymphoma

Front 25

Back 25

SLE: Lupus

accumulation of basophilic staining

Front 26

Back 26

Castleman Disease*

-giant lymph nodes

-1. Hyaline vascularization= 'Onion skin' around germinal center represents lymphocytes

-2. plasma cells = herpes 8 also linked to Kaposi’s Sarcoma (plasma cells are often asymptomatic)

Front 27

Sinus

Back 27

Sinus : non-specific pattern

1. **Rosai-Dorfman :

3.** Whipple Disease:

Front 28

What disease is associated with macrophages with emperipolesis?*

Back 28

Rosai-Dorfman

(macrophage ingested entire cell)

Front 29

Back 29

1. **Rosai-Dorfman :

**first two decades of life

-Bilateral nontender cervical nodes

-Dilated sinusitis histiocytes

-S100 (stain) m

-macrophages with emperipolesis: macrophage ingested entire cell.

-Fevers, neutros, elevated ESR

-Nodes matted together from fibrosis.

Front 30

Back 30

2. Kimura’s Disease:****

eosinophils*** (very pink area)

-salivary glands

Kimora Lee Simmons, hello kitty

Front 31

MIDDLE AGED MALES

CNS: psych, neuro, deficits

Back 31

3.** Whipple Disease:

-foamy macrophages with bacillary organism

-Tropheryma whippeli

-malabsorption, sickle-shaped

foamy whipped cream dirty old men

Front 32

Younger children with pancytopenia

Back 32

4. Virus-Associated hemorrhagic syndrome

Younger children with pancytopenia (low WBC, platelets)

-constitutional symptoms.

-bland macrophages

hemorrhagic, de=panted vampire sucks your blood and makes you pale

Front 33

Skin disease

Back 33

5. Dermatopathic lymphadenitis:

associated with skin diseases especially exfoliative dermatitis; skin sloughs off; paracortical/interfollicular expansion of large cells.

-Mimics lymphoma: mycosis fungoides

-pigmented macrophages

Front 34

ALPS

Back 34

6. Autoimmune lymphproliferative syndrome: (ALPS)

-caspase 10

-SPLENOMEGALY.

-Hypergammaglobinemia.

Front 35

Conjunctivitis, coronary artery involvement, KIDS

(K's: kids, konjunctivitis, koronary artery involvement)

Back 35

7 . Mucocutaneous lymph node syndrome: Kawasaki’s

Lymphoid depletion and absence of follicles.

Foci necrosis and thrombi in vessels

Front 36

Wartthin-Finkledey

Back 36

HIV hyperplasia: cells with multiple eoisinophilic intranuclear inclusions.

Front 37

plasmacytic and lymphocytic infiltrate

Back 37

follicular hyperplasia- syphilis

Front 38

What age group is non-specific follicular hyperplasia common in?

Back 38

adolescents and children

Front 39

What is a key sign of follicular hyperplasia - syphilis?

Back 39

Plasmacytic and lymphocytic infiltrate

Front 40

What is a common disease in young women?

Back 40

Kikuchi Disease

-C-shaped nuclei (maCrophages)

-fever and looks similar to SLE

Front 41

What can be seen in immunocompromised people with Cat Scratch Fever?

Back 41

-Bartonella henselae is normal host and

-BACILLIARY ANGIOMATOSIS is in immune compromised

Front 42

Herpes virus 8 is associated with....

Back 42

1. Bacillary angiomatosis

2. Kaposi Sarcoma

3. Plasma cell: Castleman disease

Front 43

Is what checked in the serum in the first few weeks after a possible HIV exposure?

Back 43

p24

-HIV-core protein in germinal centers

-useful for diagnosing very early infection when antibody levels are still low.

Front 44

1. Caseating vs 2. Non Caseating granulomas

Back 44

1. TB and 2. Toxoplasmosis

Front 45

Wartthin-Finkledey cell

Back 45

HIV- related hyperplasia, cells with multiple eosinophilic intranuclear inclusions

Front 46

Reed Sternburg Cells

Back 46

Prominent nucleoli, mem intact, minimal cytoplasm, ring around.

HL, mimics in mono

Front 47

People 20 and under

Back 47

Rosai-Dorfman syndrome

Front 48

What disease are plasma cells asymptomatic?

Back 48

Castleman's disease

Front 49

What disease do eosinophils have extensive infiltration?*

Back 49

Kimura disease

Front 50

What disease is associated with foamy macrophages?

Back 50

Whipple disease

Front 51

What mimics lymphoma, specifically mycosis fungoides?

Back 51

dermatophatic lymphadenitic

Front 52

What are Russell bodies associated with?

Back 52

RA

Front 53

What regulatory gene does HIV need to progress to AIDS?

Back 53

nef - which down regualtes cell surface expression of CD4 and MHC 1

Front 54

what protein undergoes conformational change to fuse with CRC-5?

Back 54

gp41

Front 55

NNRTI

Back 55

do not bind to active site

do not need to be phosphorylated

Front 56

NRTIs

Back 56

nuceoside analgoues incorporated into genome

need to be phosphorylated

resistance: reverse transcriptase mutation (pol gene)