Reactive Lymphnode

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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

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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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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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LN sarcoidosis




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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)


- 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)


- 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)


- Hyalinisation of shrinking

follicles


angioneogenesis

- Vascularisation of fadingfollicles - Further reduction oflymphocytes and IRCs

- Follicles occupied almost

exclusively by lymphocytes


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

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Reactive Lymphnode