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Reactive lymphatic tissue disease
MBCHB III
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Lymphoreticular system
Lymph nodes
Spleen Mucosa associated lymphatic system (Peyer
patches)
Thymus
Bone marrow
Tonsills, adenoids
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Primary and Secondary
Lymphoid TissueTheimage cannotbe displayed.Your computer may nothaveenough memory toopen theimage,or theimagemay havebeen corrupted.Restartyour computer,and then open thefileagain.If thered x stillappears,you mayhavetodeletethe imageand then insertitagain.
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The
LymphaticSystem
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Benign reactive lymph node, high power
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Identification of lymphatic cells Morphology
Immunohistochemistry
B-cells
T-cells
Natural killer cells
Moleculargenetic methods Immunoglobulin rearrangements
T-cell receptor rearrangements
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T-cell associated antigens
Antigen Detection
CD1 Cortical thymocytes and Langerhans cells
CD2 All T-cellsCD3 Thymocytes, peripheral T-cells, NK cells
CD4 T helper cells
CD5 T-cells and small subset of B-cells
CD7 T-cells and myeloid precursors
CD8 Cytotoxic peripheral T-cells
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B-cell associated antigens
Antigen Detection
CD10 Marrow pre-B cells and follicular center B
cells ( CALLA)CD19 Marrow pre- B cells and mature B cells
CD20 Marrow pre- B cells and mature B cells
CD21 Mature B cells, foll. dendr. retic. cells
CD22 Mature B cells,
CD23 Mature activated B cells
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Monocyte and macrophage
associated antigensAntigen Detection
CD13 Immature and mature monocytes and
granulocytesCD14 Monocytes
CD15 Granuocytes, Reed-Sternberg cells
CD33 Myeloid progenitors and monocytes
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NK cell associated antigens
Antigen Detection
CD16 All NK cells and granulocytes
CD56 NK cells and subset of T-cells
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Stem cell and Progenitor cell
associated antigensAntigen Detection
CD34 Pluripotent haematopoetic stem cells and
progentior cells of many lineages
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Leukocyte marker
Antigen Detection
CD45 Present on all leukocytes, Leukocyte
common antigen
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Response of lymphoid tissue to injurious stimuli
Predominantly B-lymphocyte immune
response: Follicular hyperplasia and plasmacytosis
Predominantly T-cell immune response: Paracortical hyperplasia
Macrophage response: Reactive sinus histiocytosis (monocytoid B-cell
reaction)
Sinus histiocytosis with massiv
lymphadenopathy (Rosai Dorfmann-disease) Dermatopathic
lymphadenitis
Epitheloid cell transformation and
granuloma fomation
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Enlargement of different
compartments in
response to variousstimuli
A Follicular
B Paracortical
C Normal
D Medullary
E Sinusoidal
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Benign reactive lymph node, low power
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Benign reactive lymph node, high power
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Benign reactive lymph node, high power
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Progressive transformation of germinal centre
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Progressive transformation of germinal centre
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Dermatopathic lymphadenopathy
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Dermatopathic lymphadenopathy
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Malignant lymphoma, diffuse small lymphocytic type, lymph node,
low power
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Types of lymphadenitis
Acute lymphadenitis: Bacterial infections
Chronic lymphadenitis Yersinia
Tuberculosis Fungal diseases
Lympogranuloma venerum (Chlamydia)
Cat-scratch disease (small gram-negative
bacillae, Bartonella henselae) Syphilis
Toxoplasomosis
Leishmanioisis
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Types of lymphadenitis
Infectious mononucleosis
Others:
Drugs, foreign body material
Autoimmune lymphadenitis
Rheumatoid arthritis
Lupus erytematodes
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Cat scratch
disease
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Mycobacterial lymphadenitis
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Epitheloid histiocytes and Langhans-type giant cells
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Mycobacteria
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Cytomegalovirus lymphadenitis. Florid follicular hyperplasia
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Endothelial cells with large inclusions
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Cryptococcal lymphadenitis, silver stain
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Rheumatoid arthritis: Florid follicular hyperplasia
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Follicular lysis in rheumatoid arthritis
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LNsarcoidosis
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LN sarcoidosis
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L
N sarcoidosis
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Sarcoidosis
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Th i tb di l d Y t th h t th i th i h b t d R t t t d th th fil i I fth d till h t d l t th i d th i tit i
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LN sarcoidosis
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e age a o be d sp ayed ou o pu e ay o a ee oug e o y oope e age, o e age ay a ebee o up ed es a you o pu e, a d e ope e eaga e ed s appea s, you ay a e ode e e e age a d e se aga
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Carbonpartikels from Tattoo
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Carbonpartikels from Tattoo
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Anthracosis
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AIDS
Persistent generalised
lymphadenpathy
Follicular hyperplasia
Follicular involution with regressively
transformed germinal centers
Lymphocyte depletion
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Subdivision of HIV-related
lymphadenopathy into phases Histopathological criteria
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Phase I
IRREGULAR FOLLICULARHYPERPLASIA (IFH)
Follicle Interfollicular space
- Follicles increased and
enlarged
- Hypercellularity
- Bizzare follicle shapes - Predominant cell types- Centroblasts dominant - Lymphocytes, macrophages
- Multiple starry sky cells - Individual epithelioid
- Regular fibre structure - (Warthin-Finkeldey type)
- Mantle zone intact - Lymphoblasts, immunoblasts
- High mitosis rate - Nests of interdigitating ret. cells
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Phase IIFOLLICULARTRANSFORMATION WITH DESTRUCTION/
BEGINNINGOF FOLLICULAR DESTRUCTION (BFD)
Follicle Interfollicular space
- Large irregularly formed
follicles
- Reduction of cell density
- Reticular cells (FDCs) andstarry sky cells - Small groups of epitheliod cells
- Irregular formed and broken
mantle zone with
- Monocytoid B lymphocytes
-The occurrence of monocytoid
B lymphocytes
- Reduction of lymphoblasts and
immunoblasts- Incipient dissolution of the
reticular fibre structure
- Nests of interdigitating
reticulum cells (IRCs)
- angioneogenesis
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Phase IIIPROGRESSIVE FOLLICULAR DESTRUCTION (PFD)
Follicle Interfollicular space
- Large indistinctly demarcated,
fading (exploding) and /or
shrinking follicles
- Increased angioneogenesis
- Loss of mantle zone - Reduction of lymphocytes andIRCs
- Depletion of monocytoid B
lymphocytes
- Marked reduction of lymphatic
germinal centre cells and starrysky macrophages
- Increased macrophages
- Marked increase in
lymphocytes
- Depletion of monocytoid B
lymphocytes
- Incipient vascularisation of
large fading follicles
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Phase IV
FOLLICULAR INVOLUTION AND ATROPHY (FI/FA)
Follicle Interfollicular space
- Hyalinisation of shrinking
follicles
- Marked increase in
angioneogenesis
- Vascularisation of fadingfollicles - Further reduction oflymphocytes and IRCs
- Follicles occupied almost
exclusively by lymphocytes
- Marked increase in
macrophages and plasma cells
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Phase V
COMPLETE LOSS OF LYMPHNODE STRUCTURE (CLLNS)
- naked connective tissue structure
- Diffuse distribution of macrophages, plasma cells
and scattered lymphocytes
- Hyaline plaques and foci of vascular proliferation as
follicle remnants
- Occasionally extreme angioneogenesis
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The spleen
Normal function:
Filtration of blood
Secondary organ of the immune system
Source of lymphoreticular cells
Reserve and storage side
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Normal spleen and accessory spleen
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Normal spleen, low power
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Splenomegaly
Infections
Congestion related to portal
hypertension
Lymphohaematogenous disorders
Immunologic-inflammatory conditions
Storage diseases
Miscellanous
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Splenomegaly from portal hypertension
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Splenomegaly with myeloproliferative disorder
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Splenic infarcts
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Thymus
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Developmental disorders
Thymic hypoplasia
DiGeorge syndrome
Thymic cysts
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Thymic hyperplasia
Thymic follicular hyperplasia
Linked to myasthenia gravis in 70% of
cases
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Thymomas
Benign thymoma
Malignant thymoma
Th i tb di l d Y t th h t th i th i h b t d R t t t d th th fil i If th d till h t d l t th i d th i tit i
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