LYMPHADENOPATHY Dr. Manjit Singh Saren Pathologist, MAHSA University College.

1. LYMPHADENOPATHY Dr. Manjit Singh Saren Pathologist, MAHSA University College.

2. HISTOLOGY HISTOLOGY

3. 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

5. LYMPHADENOPATHY Types: 1. REACTIVE LYMPHADENITISInflammation of lymph nodes 2. REACTIVE LYMPHADENOPATHYPrimary immune reactions

6. REACTIVE LYMPHADENITIS NON- SPECIFIC RESPONSE 1.Acute lymphadenitis 2.Chronic lymphadenitis 1) Acute lymphadenitis:draining inflamed area. >Bacterial infections >Foreign bodies in wounds Nodes: Enlarged and tender Untreated : Chronic adenitis, necrosis and abscess

8. 2) Chronic Lymphadenitis: • A). With follicular B cell hyperplasia • Non- specific lymphadenitis: • Commonest lesion • ii. Specific lymphadenitis: • Rheumatoid arthritis • Toxoplasmosis • Syphilis • AIDS

9. 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 dilatedsinuses.

10. LYMPHADENOPATHY • Primary: Lymphoid malignancies. • Amyloidosis • 2. Secondary: • i. Infections: • TB • Sarcoidosis • Syphilis • Castleman’s Disease • Dermatolymadenopathy • Filariasis • ii. Metastatic diseases

11. CAUSES OF LYMPADENOPATHY: 1.HIVrelated 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

12. CYTO MEGALIC VIRUS

13. CYTO MEGALIC VIRUS

14. Toxoplasma gondii

15. TUBERCULOUS LYMPHADENOPATHY Poor socio-economic background. Over-crowding Presentation: Night sweats Cough with hemoptysis Loss of weight Family history

16. Diagnosis History ESR Sputum examination for AFB TB Culture Chest X-rays CT Scan MRI BIOPSY

20. 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: Kviem’s Test: Intra-dermal test

22. 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.Complications:Chylous ascitis & chyluria

24. 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

25. PART I LYMPHADENOPATHY

27. CASTLEMAN’S DISEASE Definition: Single solid growth within lymphatic tissue Sites: Chest, stomach or neck . Abnormal enlargement of lymph nodes.

28. CASTLEMAN’S DISEASE Etiology: Unknown Rare disorder Types: 1. Hyaline type 90% 2. Plasma type: prevalent in young

29. DERMOTOPATHIC LYMPHADENOPATHY Definition:Reactive lymph node hyperplasia.Etiology:Secondary to eczema and dermatitisMicro: Intra-dermal macrophages containing fat and melanin

31. CAT SCRATCH DISEASE Children 80% Self limiting Gm-ve bacterial infection Localized lymphadenopathy Sarcoid-like granulomas Stellate abscess

33. LYMPHANGIITISInflammation of lymphatic vesselsi. Acute Lymphangiitis: Bacterial infections: B-Strep % & Staph. Micro: inflammatory exudate and clotted lymph ii. Chronic Lymphangitis:TB, Actinomyces, syphilis, radiation,& parasitesMicro:Fibrosis and chronic lymphedema

36. KIKUCHI’S DISEASE Presentation: Fever and Tender Adenitis Micro: Necrosis and stellate abscesses Neutrophils and nuclear dust Histiocytes but rarely any eosinophils

38. KIMURA’S DISEASE Introduction: Chronic inflammatory disorder Clinical Features: Age: 20-40 yrs and males Painless swelling of parotid Cervical lymphadenopathy

39. KIMURA’S DISEASE Micro: Lymph node biopsy: Eosinoplilia Proliferation of vascular endothelium. Focal eosinophilic abscess Hyperplasia of lymphoid follicles: Well vascularised Warthin-Finkeldey polykaryocytes

42. KIKUCHI’S DISEASE Common in children Cervical lymphadenopathy Also : Necrotizing histiocytic lymphadenitis Etiology: CMV EBV Herpes virus

43. KIMURA’S DISEASE PATHOPHYSIOLOGY Allergic reaction: -Parasites, viral, arthropod bites and candidiasis. Auto-immune reaction : IgE –mediated Type I hypersensitive reaction. Cytokines: Interleukin 4 and 5 produces:- > Eosinophiltrophic cytokines & IgE 20% with nephrotic syndrome

44. KAWASAKI’S DISEASEAge: <5yrsCause: UnknownLymphadenopathyClinically: Fever (>39C) red eyes Red and cracked lipsRash on chest and genitals Swollen tongue and enlarged lymph nodesComplications: Affects heart: Arrhythmias

49. Multicentric or Generalized Type CASTLEMAN’S DISEASE • Multiple sites • Symptoms: • Same as plasma type • Hepato-splenomegaly • ‘POEMS Syndrome • Complications : POEMS SYNDROME • Kaposi’s Sarcoma • Non Hodgkin’s Lymphoma

50. LANGERHANS CELL HISTIOCYTOSISHistiocytosis : Proliferative disorder of histiocytes or macrophages.Auto-immune disease & genetically relatedTypes:1. Benign: Histiocytic proliferation in lymph nodes.2. Malignant: Histiocytic lymphoma3. Intermediate: Langerhans cell Histiocytosis