Pathology of Lymph Node Enlargement 03

Views:
 
Category: Education
     
 

Presentation Description

No description available.

Comments

By: ysm1955 (42 month(s) ago)

good presentation

By: pathology2 (24 month(s) ago)

very good presentation. can u allow me to download?

 

By: drravneetkalra (45 month(s) ago)

thanks issamsabe

Presentation Transcript

Pathology of Lymph Node Enlargement : 

Pathology of Lymph Node Enlargement Dr Ravneet Kaur Moderator - Dr M. S. Bal

Slide 2: 

LN’s are most widely distributed and easily accessible components of lymphoid tissue and hence frequently examined for diagnosis of lympho - reticular disorders. LN’s, in their totality, represent the largest secondary organ, and thus major site of lymphoid pathology. The lymphoid immune system comprises of two major functional regions 1º & 2º lymphoid organs 2 PATHOLOGY OF LYMPH NODE ENLARGEMENT

Normal Lymph Node : 

Normal Lymph Node Human lymph nodes are Bean-shaped Capsulated structures. 3 major regions of a lymph node: Cortex, Paracortex, Medulla & lymph sinuses PATHOLOGY OF LYMPH NODE ENLARGEMENT 3

Slide 4: 

Lymphadenopathy refers to nodes that are abnormal in either size, consistency or number. Generalized if lymph nodes are enlarged in two or more noncontiguous areas. Localized if only one area is involved. Persistent Generalized lymphadenopathy (PGL) is the presence of enlarged lymph nodes of more than 1 cm diameter at 2 or more extra-inguinal sites for more than 3 months. Frequently seen with primary HIV infection. PATHOLOGY OF LYMPH NODE ENLARGEMENT 4

Causes of Lymphadenopathy : 

Causes of Lymphadenopathy PATHOLOGY OF LYMPH NODE ENLARGEMENT 5 General Infectious causes- Bacterial (e.g., all pyogenic bacteria, cat-scratch disease, syphilis, tularemia) Mycobacterial (e.g., tuberculosis, leprosy) Fungal (e.g., histoplasmosis, coccidioidomycosis , sporotrichiosis) Chlamydial (e.g., lymphogranuloma venereum) Parasitic (e.g., toxoplasmosis, trypanosomiasis, filariasis, pediculosis capitis, scabies etc) Viral (e.g., Epstein-Barr virus, rubella, hepatitis, CMV, HIV) Collagen vascular diseases (e.g., rheumatoid arthritis, systemic Lupus Erythematosus, still’s disease & dermatomyosistis)

Slide 6: 

Primary HL NHL Leukaemia PATHOLOGY OF LYMPH NODE ENLARGEMENT 6 Neoplastic Causes Burkitt’s L. (NHL)

Slide 7: 

Secondary Metastatic deposits Melanoma Kaposi's Sarcoma Neuroblastoma Seminoma Lung Cancer Breast Cancer Prostate Cancer Renal carcinoma Head and neck cancers GI cancers MALToma RCC Melanoma 7 PATHOLOGY OF LYMPH NODE ENLARGEMENT

Slide 8: 

Miscellaneous causes Common -Serum Sickness -Sarcoidosis -Hyperthyroidism Less Common -Kawasaki Disease -Amyloidosis -Niemann-Pick Disease -Gaucher's Disease 8 PATHOLOGY OF LYMPH NODE ENLARGEMENT

Slide 9: 

PATHOLOGY OF LYMPH NODE ENLARGEMENT 9 Auricular Erysipelas Herpes zoster Rubella Squamous cell ca Styes or chalazion Tularemia Lymphoma Leukemia Axillary Breast cancer Local infection Lymphomas Mastitis Occipital Lymphoma Leukemia Roseola Scalp infections Sebor. dermatitis Tick bite Tinea capitis LCH Cervical Lymphoma Leukemia Cat scratch fever Facial/ oral ca Infectious ) mononucleosis Mucocutaneous LN syndrome Rubella Thyrotoxicosis Tonsillitis Tuberculosis Varicella Submaxillary & submental Cystic fibrosis Dental infection Gingivitis Glossitis, Lymphoma Leukemia Inguinal/ femoral Chancroid LGV Syphilis Carcinoma Wucheriasis Popliteal Infections Causes of localized lymphadenopathy Supraclavicular Infections Met. Ca Stomach, Esophagus, Testis, Ovary, Lymphoma Leukemia Mediastinal Lymphoma Leukemia Met.. Ca Stomach, Esophagus, Testis, Ovary. Para Aortic Lymphoma Leukemia Met..Testis, Ovary

Famous nodes : 

Famous nodes PATHOLOGY OF LYMPH NODE ENLARGEMENT 10 Virchow’s Nodes - Left supraclavicular lymph nodes (gastric, testicular or thoracic ca) Sister Joseph Nodes - Para-umbilical nodes (adenocarcinoma of the stomach, colon, pancreas and ovary)

Slide 11: 

Delphian node - Prelaryngeal lymph nodes (thyroid or laryngeal ca). Node of Cloquet (Rosenmuller node) - Deep inguinal lymph nodes near femoral canal (prostrate cancer, ca cervix, urinary bladder ca) Cloquet's node is named after a french physician Jules Germain Cloquet. 11 PATHOLOGY OF LYMPH NODE ENLARGEMENT

Slide 12: 

PATHOLOGY OF LYMPH NODE ENLARGEMENT 12

Slide 13: 

DOx dIE~ iglHtIE~ Posted On September - 29 - 2010                                                 f`.mnjIq isMG b@l ਪਤਲੀ ਅਤੇ ਲੰਮੀ ਧੌਣ ਖ਼ਾਸ ਕਰਕੇ ਔਰਤਾਂ ਦੀ ਸੁੰਦਰਤਾ ਦਾ ਇਕ ਹਿੱਸਾ ਹੁੰਦੀ ਹੈ। ਇਸ ਵਿਚ ਮਹਿੰਗੇ ਮਹਿੰਗੇ ਗਹਿਣੇ, ਹਾਰ ਤੇ  ਗਾਨੀਆਂ ਪਹਿਨੀਆਂ ਜਾਂਦੀਆਂ ਹਨ। ਕਵੀ ਅਤੇ ਲੇਖਕ ਲੋਕ ਧੌਣ ਦੀ ਤੁਲਨਾ ਆਮ ਕਰਕੇ ਸੁਰਾਹੀ ਨਾਲ ਕਰਦੇ ਹਨ। ਪਰ ਇਸ ਵੇਲੇ ਧੌਣ ਦੇ ਗਹਿਣੇ, ਹਾਰਾਂ ਜਾਂ ਗਾਨੀਆਂ ਦੀ ਨਹੀਂ ਸਗੋਂ ਧੌਣ ਵਿਚ ਹੋਣ ਵਾਲੀਆਂ ਗਿਲਟੀਆਂ ਬਾਰੇ ਕੁਝ ਲਿਖਿਆ ਜਾ ਰਿਹਾ ਹੈ।ਧੌਣ ਸਾਡੇ ਸਰੀਰ ਦਾ ਇਕ ਅਤਿ ਜ਼ਰੂਰੀ ਭਾਗ ਹੈ। ਇਹ ਸਰੀਰ ਦੇ ਸੱਭ ਤੋਂ ਮਹੱਤਵਪੂਰਨ ਹਿੱਸੇ, ਅਰਥਾਤ ਸਿਰ ਨੂੰ ਧੜ ਨਾਲ ਜੋੜਦਾ ਹੈ। ਰੀੜ੍ਹ ਦੀ ਹੱਡੀ ਤੇ ਉਸ ਵਿਚ ਸੁਖਮਣਾ ਨਾੜੀ, ਪੱਠੇ, ਦਿਮਾਗ ਨੂੰ ਜਾਣ ਵਾਲੀਆਂ ਖੂਨ ਦੀਆਂ ਨਾੜੀਆਂ ਆਦਿ ਤੋਂ ਇਲਾਵਾ ਇਸ ਵਿਚ ਮਾਨਸ ਦੀਆਂ ਛੋਟੀਆਂ-ਛੋਟੀਆਂ ਗੰਢਾਂ ਜਿਹੀਆਂ ਹੁੰਦੀਆਂ ਹਨ ਜਿਨਾਂ ਨੂੰ ਲਿੰਫ ਨੋਡਜ਼ (Lymph Nodes) ਕਹਿੰਦੇ ਹਨ। ਇਹ ਗੰਢਾਂ ਸਰੀਰ ਦੇ ਕੁਝ ਹੋਰ ਨਿਸਚਿਤ ਥਾਵਾਂ ’ਤੇ ਵੀ ਹੁੰਦੀਆਂ ਹਨ ਜਿਵੇਂ ਕੱਛਾਂ ’ਚ, ਨਲਾਂ ’ਚ, ਪੇਟ ਦੇ ਅੰਦਰ ਅਤੇ ਛਾਤੀ ਅੰਦਰ ਆਦਿ। ਧੌਣ ਵਿਚ ਇਨ੍ਹਾਂ ਦੇ ਕੁਝ ਖਾਸ ਗਰੁੱਪ ਹੁੰਦੇ ਹਨ-ਠੋਡੀ ਦੇ ਥੱਲ਼ੇ (Sub mental), ਦੋਵੇਂ ਪਾਸੇ ਜਬਾੜਿਆਂ ਦੇ ਹੇਠਾਂ (Submandibular) ਧੌਣ ਦੇ ਦੋਵੇਂ ਪਾਸੇ ਜ਼ਰਾ ਡੂੰਘਾਈ ਤੇ (4eep cervical), ਗਿੱਚੀ ’ਚ’ (Occipital)।ਤੰਦਰੁਸਤੀ ਵਿਚ ਇਹ ਗੰਢਾਂ ਨਾ ਤਾਂ ਟੋਹੀਆਂ ਜਾ ਸਕਦੀਆਂ ਹਨ ਅਤੇ ਨਾ ਉਭਰੀਆਂ ਹੋਈਆਂ ਨਜ਼ਰ ਆਉਂਦੀਆਂ ਹਨ। ਜੇ ਇਹ ਵੱਡੀਆਂ ਹੋ ਜਾਣ ਤੇ ਹੱਥ ਨਾਲ ਟੋਹੀਆਂ ਜਾ ਸਕਣ ਤਾਂ ਸਮਝ ਲੈਣਾ ਚਾਹੀਦਾ ਕਿ ਇਹ ਕਿਸੇ ਬਿਮਾਰੀ ਦਾ ਪ੍ਰਤੀਕ ਹਨ। ਬਿਮਾਰੀ ਮਾਮੂਲੀ ਵੀ ਹੋ ਸਕਦੀ ਹੈ ਤੇ ਖ਼ਤਰਨਾਕ ਵੀ। ਗਿਲਟੀਆਂ ਬਣਨ ਦੇ ਖਾਸ ਖਾਸ ਕਾਰਨ ਇਸ ਪ੍ਰਕਾਰ ਹਨ:-(1) ਟੀ.ਬੀ. ਜਾਂ ਤਪਦਿਕ  (2) ਹੋਰ ਇਨਫੈਕਸ਼ਨਾਂ(3) ਕੈਂਸਰ   (4) ਫੁਟਕਲ ਕਾਰਨ ਅਤੇ  (5) ਏਡਜ਼।ਟੀ.ਬੀ. ਜਾਂ ਤਪਦਿਕ: ਕਈਆਂ ਲੋਕਾਂ ਦਾ ਖਿਆਲ ਹੈ ਕਿ ਟੀ.ਬੀ. ਸਿਰਫ ਫੇਫੜਿਆਂ ਵਿਚ ਹੀ ਹੁੰਦੀ ਹੈ,  ਜੋ  ਸਹੀ ਨਹੀਂ ਹੈ। ਟੀ. ਬੀ. ਦੀਆਂ ਗਿਲਟੀਆਂ ਨੂੰ (Tuberculous Lymphadenitis) ਕਿਹਾ ਜਾਂਦਾ ਹੈ। ਐਸੀਆਂ ਗਿਲਟੀਆਂ ਸਰੀਰ ਦੇ ਬਾਕੀ ਹਿੱਸਿਆਂ ਵਿਚ ਵੀ ਹੋ ਸਕਦੀਆਂ ਹਨ, ਪਰ ਆਮ ਕਰਕੇ, ਇਹ ਧੌਣ ਵਿਚ ਹੀ ਹੁੰਦੀਆਂ ਹਨ। ਇਹ, ਫੇਫੜਿਆਂ ਦੀ ਟੀ.ਬੀ.ਦੇ ਨਾਲ ਵੀ ਹੋ ਸਕਦੀਆਂ ਹਨ ਤੇ ਬਗੈਰ ਵੀ। ਕਈ ਵਾਰ ਤਾਂ ਸਿਰਫ ਇਕ ਹੀ ਗਿਲਟੀ ਹੁੰਦੀ ਹੈ; ਨਾ ਕੋਈ ਖੰਘ, ਨਾ ਰੇਸ਼ਾ ਤੇ ਨਾ ਕੋਈ ਹੋਰ ਤਕਲੀਫ। ਗਿਲਟੀ ਦੀ ਜਾਂਚ ਤੋਂ ਪਤਾ ਲਗਦਾ ਹੈ ਕਿ ਇਹ ਤਾਂ ਟੀ. ਬੀ.ਹੈ। ਧੌਣ ਵਿਚ ਜਾਂ ਹੋਰ ਕਿਤੇ, ਜੇਕਰ ਟੀ. ਬੀ. ਦੀਆਂ ਗਿਲਟੀਆਂ ਜ਼ਿਆਦਾ ਹੋਣ ਤਾਂ ਇਹ ਆਪਸ ਵਿਚ ਜੁੜੀਆਂ ਹੋਈਆਂ ਹੁੰਦੀਆਂ ਹਨ (Matted Lymph nodes)  ਜੋ ਵੱਡੇ ਢੇਲੇ ਵਾਂਗ ਮਹਿਸੂਸ ਹੁੰਦੀਆਂ ਹਨ। ਕਈ ਵਾਰ ਇਨ੍ਹਾਂ ਅੰਦਰ ਪਸ ਬਣ ਜਾਂਦੀ ਹੈ ਜੋ ਹੌਲੀ ਹੌਲੀ ਰਸਤਾ ਬਣਾ ਕੇ ਚਮੜੀ ’ਚੋਂ ਬਾਹਰ ਰਿਸਣ ਲਗਦੀ ਹੈ। ਪਹਿਲੇ ਸਮਿਆਂ ਵਿਚ ਲੋਕ, ਇਨ੍ਹਾਂ ਨੂੰ ਹਜੀਰਾਂ ਕਿਹਾ ਕਰਦੇ ਸਨ। 13 PATHOLOGY OF LYMPH NODE ENLARGEMENT

Acute Nonspecific lymphadenitis : 

Acute Nonspecific lymphadenitis PATHOLOGY OF LYMPH NODE ENLARGEMENT 14 Necrotising granuloma with neutrophils in the center surrounded by epithelioid histiocytes.

Slide 15: 

Cat scratch disease Agent is a coccobacillary pleomorphic bacterium Bartonella henselae axillary & cervical lymphadenopathy PATHOLOGY OF LYMPH NODE ENLARGEMENT 15 Show central stellate necrosis with neutrophils, M/E Cat Scratch Disease

Slide 16: 

Kikuchi’s lymphadenitis Kikuchi-Fujimoto disease is a necrotizing lymphadenitis. A benign and self-limiting cervical lymphadenopathy -characterized by large areas of necrosis and karyorrhectic debris PATHOLOGY OF LYMPH NODE ENLARGEMENT 16 Low-power view showing necrotizing change centered in the subcapsular region. High-power view showing the boundary between an area of karyorrhexis/pyknosis and an area of karyolysis.

Slide 17: 

PATHOLOGY OF LYMPH NODE ENLARGEMENT 17 Marked differences in size of germinal centers, their well-circumscribed character High-power view showing numerous ‘tingible body’ macrophages. Follicular Hyperplasia

Slide 18: 

AIDS related lymphadenopathy Lymphadenitis caused by infection with Human Immunodeficiency virus (HIV). Microscopically -Florid reactive hyperplasia- accompanied by monocytoid B cells in sinuses and neutrophils. May also show follicle lysis where the mantle zone invaginates into germinal centers giving a characteristic “moth eaten appearance” Explosive follicular hyperplasia PATHOLOGY OF LYMPH NODE ENLARGEMENT 18 The depicted germinal center shows disruption of its architecture by intrusion of small lymphocytes from the mantle zone.

Slide 19: 

PATHOLOGY OF LYMPH NODE ENLARGEMENT 19 Kimura’s disease

Slide 20: 

PATHOLOGY OF LYMPH NODE ENLARGEMENT 20 Hyaline vascular type germinal centers depleted of lymphocytes.Tight concentric layering of lymphocytes in mantle zone Vascular proliferation Hayalinization of GC Plasma cell type, massive infiltration by plasma cells. Castleman’s Disease

Slide 21: 

PATHOLOGY OF LYMPH NODE ENLARGEMENT 21 PATHOLOGY OF LYMPH NODE ENLARGEMENT 21 Interfollicular /paracortical hyperplasia Para cortical hyperplasia, identified by the prominence of post capillary venules Viral Lymphadenitis scattered immunoblasts resulting in a ‘salt-and-pepper’ appearance.

Slide 22: 

Dermatopathic lymphadenitis PATHOLOGY OF LYMPH NODE ENLARGEMENT 22 Massive expansion of the paracortical region, resulting in a wide, pale area between the capsule and the lymphoid follicles. Lipomelanosis Reticularis of Pautrier

Slide 23: 

PATHOLOGY OF LYMPH NODE ENLARGEMENT 23 Sinus hyperplasia The cells present in the sinus represent an admixture of histiocytes and sinus lining cells.

Slide 24: 

Rosai-Dorfman Disease Sinus Histiocytosis With Massive ymphadenopathy (SHML) PATHOLOGY OF LYMPH NODE ENLARGEMENT 24 High-power view showing lymphocytophagocytosis by the sinus histiocytes

Langerhans’ Cell Histiocytosis : 

Langerhans’ Cell Histiocytosis Characterized by diffuse proliferations of immature dendritic cells (langerhan’s cell) Clinical presentation ranges from focal (monostotic), polystotic bone involvement, cutaneous and systemic presentation. PATHOLOGY OF LYMPH NODE ENLARGEMENT 25 The infiltrate has a sinusal distribution. mononuclear and multinucleated langerhans’ cells with numerous eosinophils.

Slide 26: 

Whipple’s Disease- Infectious disorder caused by the bacteria Tropheryma whippelii results in marked enlargement of mesenteric lymph nodes with formation of numerous lipophagic granulomas. PATHOLOGY OF LYMPH NODE ENLARGEMENT 26 The lipophagic granulomas are defined as a collection of mononuclear and multinucleated giant cells, both of them exhibiting a cytoplasmic foamy appearance

Granulomatous lymphadenitis : 

PATHOLOGY OF LYMPH NODE ENLARGEMENT 27 Tuberculosis – caused by Mycobacterium tuberculosis. Lymphadenopathy most common location is cervical region (scrofula) & may form a draining sinus communicating with skin (scrofuloderma) Microscopically : ranges from multiple small epithelioid granulomas, to huge caseous masses surrounded by Langhans’ giant cells, epithelioid cells & lymphocytes Granulomatous lymphadenitis

Sarcoidosis : 

Sarcoidosis PATHOLOGY OF LYMPH NODE ENLARGEMENT 28 Numerous confluent non-necrotizing granulomas mainly composed of epithelioid cells Asteroid body in the cytoplasm of a multinucleated giant cell in sarcoidosis

Slide 29: 

Amyloid lymphadenopathy- the lymph node architecture is partially or completely replaced by deposits of acellular amorphous material known as amyloid. Grossly the nodes are moderately enlarged & firm, the architecture is obliterated and a waxy consistency PATHOLOGY OF LYMPH NODE ENLARGEMENT 29 Acellular, amorphous, eosinophilic amyloid deposits . Foreign body giant cells surround many of the amyloid deposits

Slide 30: 

Angioimmunoblastic Lymphadenopathy – seen in elderly individuals with clinical features of fever, skin rash hemolytic anemia, hypergammaglobulinemia and generalized lymphadenopathy. History of drug intake especially penicillin, greisofulvin, gentamycin etc M/E – Obliteration of lymph node architecture by a polymorphic cellular infiltrate & by extensive proliferation of finely arborizing vessel PATHOLOGY OF LYMPH NODE ENLARGEMENT 30 The PAS stain highlights the prominence of the postcapillary venules.

Hodgkin’s lymphoma : 

Hodgkin’s lymphoma PATHOLOGY OF LYMPH NODE ENLARGEMENT 31 Is a malignant lymphoma characterized by the presence of atypical, multinucleated giant cell (Reed-Sternberg cell) The disease is slightly more common in men Most patients have asymptomatic lymphadenopathy at the time of diagnosis The initial site of nodal involvement is: Cervical (65-80%) Axillary (10-15%) Inguinal (6-12%)

Non hodgkin’s lymphoma : 

Non hodgkin’s lymphoma PATHOLOGY OF LYMPH NODE ENLARGEMENT 32 Absence of Reed-Sternberg Cells May result from damage to DNA that controls growth of cells in immune system Increased incidence in immunodeficiency Enlargement of cervical lymphnodes Enlargement of supraclavicular lymphnodes Involve the oropharyngeal lymphoid tissue (Waldeyer’s ring) Fever, weight loss, night sweating B-Lymphoblastic high grade isolated histiocytes, starry sky pattern

Investigations : 

Investigations Hb TLC DLC ESR PBF FNAC- local CT guided- deep Excisional Biopsy U/S CT scan MRI 33 PATHOLOGY OF LYMPH NODE ENLARGEMENT

Slide 34: 

PATHOLOGY OF LYMPH NODE ENLARGEMENT 34 THANKS