Unit 3 - Formative 9 D4

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Triad of posterior auricular, cervical, and suboccipital lymphadenopathy; fever and rash

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Rubella

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Microscopically gland interstitum is edematous and infiltrated by macrophages, lymphocytes and plasma cells

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Mumps

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This organism is acquired from cat feces; ingestion of food/water ontaminated with oocysts

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Toxoplasmosis

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Most common AIDs defining illness; bilateral symmetrical interstitial infilatrates on chest x ray

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Pneumocystis Jiroveci Pneumonia

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Associated with pigeon droppings

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Cryptococcosis; yeast with halos

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Associated with bird or bat droppings; ubiquitous fungus; endemic in Central, South America, Ohio, Mississippi, Missouri River Valleys; diseminated dx in immunocompromised

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Histoplasmosis

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Progressively tired, sleeping more, sore throat, shotty anterior cervical and inguinal lymph nodes; spleen tip was palpable laterally

Downey cells in PB

Symptom triad: Fever, exudative pharyngitis, posterior cervical lymphadenopathy

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EBV infected B cells = Downey Cells

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BCRF-1

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Widespread polyclonal B cell activation; nonspecific antibody secretion (heterophile antibodies)

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Paul Bunnel Antigen

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On RBC; recognized by IgM secreted heterophiles due to polyclonal B cell activation by EBV via BCRF-1

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What diagnostic test is used for EBV?

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Heterophile Antibody (monospot test)

Presence of IgM antibody against the EBV capsid antigen indicates the infection is acute

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EBV Diagnosis

Atypical lymphocytes
Lymphocytosis
Heterophile antibodies
EBV Specific Antibodies

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EBV Diagnosis

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Oral Hairy Leukoplakia

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In HIV infected individuals (white plaques that contain EBV DNA) - often first presentation of HIV infection

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What receptor does EBV bind to infect B cells?

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CD21 = CR2

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A heterophile positive pt presents with fatigue, fever, sore throat, lymphadenopathy and splenomegaly

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EBV; infects B cells by binding CR2

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Heterophile antibodies that cross react with Paul Bunnell Antigen on sheep and bovine RBV

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EBV

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Complications of EBV infectoin

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Burkitt lymphoma, nasopharyngeal cancer, thymus carcinoma: EBNA found in all transformed B lymphoid cells

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Positive Monospot Test

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Heterophile antibodies detected by agglutination of sheep RBC

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CMV basophilic intranuclear inclusion body gives owl eye appearance; infected cells can be found in any tissue of the body

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A patient presents with heterophile negative mononucleosis

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CMV

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Pp65 Matrix Protein + owl eye histology

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CMV

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Blue Berry Muffin Baby - nom nom

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Congenital CMV; can range from asymptomatic to severe malformation

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CMV Retinitis; leads to blindness; most common form of CMV in AIDS patients as well as polyradiculopathy (most common CMV CNS infection in AIDS)

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Pyogenic Lymphandenitis blood agar shows beta hemolysis. The organism is also catalase and coagulase negative.

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Streptococcus pyogenes (GAS)

Gram positive, chains and pairs
BETA hemolytic
Catalase negative
Coagulase negative

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Stain shows gram positive bacteria in clusters.

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Gram positive, in clusters
Beta hemolytic, catalase positive, coagulase positive

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Pt with history of cat scratch

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Bartonellae Hensaelae
Cat scratches resulting in lymphadenopathy with stellate granulomas

Front 26

Pt from Missouri nicked his thumb while preparing rabbit meat. Resulted in ulceroglandular tularemia. Stain revealed gram negative coccobacillus

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F. tularensis; extremely hardy and cold tolerant encapsulated organisms.

Front 27

Pt presents with inguinal lymphadenopathy, as well as unexplained fever and systetmic manifestations of gram negative sepsis.

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Yersinia Pestis - Plague

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Trypansomal Chancre; occurs 7-14 days after bite by t. brucei; resolves in a few weeks.

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Winterbottom's Sign: enlargement of posterior cervical lymph nodes in T. brucei infection

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t. brucei; african sleeping sickness

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W. brancrofti; infective larvae deposited on skin upon bite; larvae enter lymph node and mature into adults that produce microfilariae

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Blood smear with W. brancrofti; causes elephantitis via lymphatic infection/edema

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River blindness

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Onchocercus; affects skin, eyes and lymph nodes

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Chronic Lymphoytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL)

Smudge cells are disrupted small lymphocytes

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Proliferation Centers containing larger activated cells and mitotically active cells

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CLL/SLL; lymph node architecture diffusely effacetd by small lymphocytes containing round to slightly irregular nuclei mixed with variable numbers of larger cells actively dividing; diving cells aggregate into proliferation centers = pathognomonic for CLL/SLL

In CLL all peripheral blood smears contain increased numbers of small disrupted lymphocytes = smudge cells

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Back 36

Benign reactive follicle vs follicular lymphoma


Not how normal lymph node architecture is obliterated by numerous nodules of uniform size and shape in FL

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Follicular Lymhoma; proliferation of lymph follicles; composed of centrocytes and centroblasts most common form of NHL in the US
BCL2 overexpression (so no apoptosis)


Not how normal lymph node architecture is obliterated by numerous nodules of uniform size and shape in FL

Front 38

Rapidly enlarging mass at a nodal or extranodal site

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Diffuse large B-cell lymphoma

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Diffuse Large B Cell Lymphoma

Large cells with vesicular nuclei; prminent nucleoli; irregular nuclear contours; high mitotic rate; margination of chromatin to nuclear membranes

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Starry Sky

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Starry sky appearance of burkitt lymphoma; large pale macrophages devour apoptotic cells

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Starry Sky

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Burkitt Lymphoma; high mitotic index; numerous apoptotic cells; multiple tingible body macrophages

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Cyclin D overpexpression, nuclear pattern

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Mantle Cell Lymphoma; often associated with lymphoid polyposis

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Back 43

Punched out lytic bone lesions characteristic of multiple myeloma; plasma cell neoplasm of older adults characterized by destructive bony lesions at multiple sites

MM CP: bone infiltration, reccurent bacterial infections, hyperviscosity syndrome, renal insufficiency, extensive marrow involvement

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Abnormal immunoglobin spike due to increase in light chain production from plasma cells; results in hypervisocity, renal insufficiency, and recurrent bacterial infections (from decreased normal production)

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Plasmacytomia of multiple myeloma; increased light chain secretion = recurrent bacterial infections, hyperviscosity, renal insuficiency

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Reouleaux agglutinations characteristic of multiple myeloma

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Reed Sternberg Cells characteristic of Hodkin Lymphoma; cells w/ multiple nuclei or a single nucleus with multiple nuclear lobes

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cells w/ multiple nuclei or a single nucleus with multiple nuclear lobes

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Lacunar Cell characteristic of Nodular Sclerosis Hodgkin Lymphoma

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Hodgkins Lymphoma Nodular sclerosis Type fibrous bands divide cellular areas into nodules

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Hodgkins Lymphoma Mixed Cellularity Type;

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Popcorn cell characteristic of hodgkin lymphoma lymphocyte predominance

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Cloverleaf cells characteristic of adult T-cell Leukemia; result of infection by human T-cell lymphotropi virus type 1