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Pathology Reactive Changes in Lymph Nodes Reactive Changes in Lymph

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Pathology Reactive Changes in Lymph Nodes Reactive Changes in Lymph 13.01.16 Pathology prof hab. n. med. Andrzej Marszałek LYMPH NODES reactive changes in lymph reactive changes nodes in lymph nodes causes • chronic • acute non-specific – hyperplasia of follicules (è B cells) – enlarged germinal centers • RA • toxo – neutrophils (in sisuses) • HIV (early phase) è bacterial – germinal centers necrosis (abscesses) • without disturbances in node structure • chronic • follicules of different size • different lymphocytes • macrophages (proliferating) reactive chages in lymph nodes reactive chages in lymph nodes • chronic • chronic – hyperplasia of paracortical zone – sisuses enlargement (è macrophages) (è T cells) • neoplasms • EBV • vaccination • drugs • slight changes of the node • „paraimmunoblasts” 1 13.01.16 cat-scratch disease cat-scratch disease • Bartonella (Rochalimaea) henselae morphology: • children/teenagers (90% below 18yrs.) • follicular hyperplasia (early stage) • sefl-limiting è sarkoid-like granulomas (in lymph (nodes enlargement 2 wks è decreased 2-4 nodes) mths) è central necrosis – follicular hyperplasia è neutrophils (abscesses) – hyeplasia of paracortical zone – changes in sinuses – + sometimes changes in: • liver • spleen & bones Actinomycosis actinomycosis def: Pato: • chronic infection caused by Actinomyces • microspy: – most common in head and neck area (after – during 1st phase pyogenic infiltration and trauma, after tooth extraction) abcesses formation (with bacterial colonies) Epidemiology: – then arround abcesses develops intensive fibrosis • Bacteriae could be found on the mucosa or within tonsilar crypts. EBV EBV • Infectious ononukleosis (typical) • clinic (+serology) • teenager/young adult: • Lymph node biopsy NOT needed – ferev, – sorethroat • Atypical cases (lymphadenopaty without – neck lymph node enlargement fever, nor sorethroat, nor spelnomegaly) – slight hepatitis è need to exclud lymphoma – in peripheral blood atypical limphocytes è BIOPSY (cytotoxic T CD8+) 2 13.01.16 EBV Lymphogranuloma venereum • micro: • STD – „blurred” lymph node morphology (immunoblasts in sinuses) • Chlamydia trachomatis (serotypes L1, L2 and L3) – Follicular hyperplasia, multiple macrophages, high mitoses • Endemic in tropical areas – granulocytes • In Western Europe homosexuals (males) – Usually without necrosis – immunoblasty Reed-Sternberg-like immunoblasts – CD20+, CD15-, CD30- Toxoplasmosis Lymphogranuloma venereum (Piringer-Kuchinka lymphadenitis) • 3 phases: • Common obligatory intracellular parasit – early – small foci of necrosis with neutrophils (Toxoplasma gondii) – late – “starry” abscesses surrounded by • Syptomless infection epithelioid cells • Lymph nodes enlargement (usually posterior – abcesses + (fistulas) neck; young females) • in macrophages sometimes visible • Dangerous in pregnant women pathogens (in vacuoles) • From cat feces and raw meet Toxoplasmosis (Piringer-Kuchinka lymphadenitis) • Preserved lymph node structure • Enalrgement of follicles +: – Numerous mitoses – Numerous apoptotic bodies – Small non-caseous granulomas (typically within germinal centers) THYMUS • Sometimes giant cells (Langhans type) 3 13.01.16 myastenia gravis myastenia gravis • AChR on postsynaptic membrane (auto- • Role of T cells (?) Ab) è damage to myocytes • è stimulation of B cells (production of auto-Ab) ● AChR present in normal thymus and on • thymoma (?) myocytes • Proliferation of thymus stromal cells (?) • • Abnormal and numerous dendritic cells ● in thymus may develop ectopic germinal • Role of TLR-4 centers (B cells producing pathogenic Ab) myastenia gravis clinic • 10% with other autoimmune disease (G-B, RA) • autoAb against titin (muscle protein) • 65% with thymus hyperplasia • 25% normal thymus • 10% thymoma SPLEEN • Risk factors: M 50+ with symptoms • Develop in 30-45% patients with thymoma (even after years) splenomegaly • Mass over 1000g • causes: – CML – Gaucher dis. – hairy cell leukemia, – marginal zone B cell lymphoma, – myelofibrosis, – plasmacytoma, – prolymphocytic leukemia 4 .
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