Lab_WBC and Lymph Nodes

8/8/2019 Lab_WBC and Lymph Nodes

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DISEASE OF WHITE BLOOD CELLS

AND LYMPH NODES


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Objectives: At the end of the section,

the student shall be able to: 1.Cite important parts of the clinical history, physical

examination and diagnostic tests in diagnosis of the givencases.

2. Using histopathologic slides/photographs/gross

specimens, demonstrate the following:a. Reactive follicular hyperplasia, lymph node.

b. Hodgkins lymphoma

c. Non-Hodgkins lymphoma

3. Recognize the gross and microscopic features of thegiven cases.

4. Explain the pathology of the above conditions in relationto diseases of lymph nodes.


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CASE 1:

REACTIVE FOLLICULARHYPERPLASIA, LYMPH NODE


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CASE 1: REACTIVE FOLLICULAR

HYPERPLASIA, LYMPH NODE

20 year old female

Cough and colds with low-grade fever

Hyperemic pharyngeal mucosa with enlargedbilateral tonsils with exudates

Neck revealed a few enlarged tender lymph

nodes Microscopic exam showed increase in number

and size of cortical lymphoid follicel


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Reactive Follicular Hyperplasia

T cells in parafollicular area germinal centers B cells

individual follicles react inc in number of follicles inc white areas bec

increase in cytoplasm, macrophages and debris lymph node expands

trabeculae separates germinal centers

Different sizes of germinal centers


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Actual Lab Slide Follicular Hyperplasia

Germinal Center


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The WHO Classification of Lymphoid

Neoplasms

PRECURSOR B-CELL NEOPLASMS

PERIPHERAL B-CELL NEOPLASMS

PRECURSOR T-CELL NEOPLASMSPERIPHERAL T-CELL AND NK-CELL NEOPLASMS

HODGKIN LYMPHOMA


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Hodgkin Lymphoma

only 1/3 or of the cells are malignant

Classic subtypes

oNodular sclerosisoMixed cullularity

o Lymphocyte-rich

o Lymphocyte depletion

Lymphocyte Predominance


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Case 2

Hodgkins Lymphoma,nodular sclerosis


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Case 2 Hodgkins Lymphoma, nodular

sclerosis

20 year old female presented with weight loss, nightsweating, low grade fever, enlarging neck mass

Chest x-ray revealed widening of mediastinum

Biopsy of neck mass revealed several bands of collagenthat divide lymphoid tissue into circumscribed nodules

nodules mostly composed of small T-lymphocytes,eosinophils, plasma cells and macrophages

Neoplastic cells were large, multiple or single nucleuswith multiple nuclear lobes, each with large inclusion-like nucleolus


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painless swelling of lymph nodes

Hard


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Widening of mediastinum


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Reed Sternberg cells (Owl Eye)


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Case 3:

Non-Hodgkins Lymphoma,

diffuse large B-cell type


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Case 3: Non-Hodgkins Lymphoma, diffuse large B-cell type

30 yr old male presented w/ difficulty in swallowing w/ rapidly

enlarging lymph nodes along the neck and oropharyngeal area

Numerous nodules involving the liver and spleen

Lymph node architecture was completely effaced by large cells w/

round to oval vesicular nuclei; some were multilobated or with

cleaved nuclei

Nuclei ranged from 2-3, located adjacent to the nuclear

membrane,or single and centrally placed

Cytoplasm was pale or basophilic

Immunophenotyping studies- (+) for CD 19 & CD 20 (B-cell

markers)


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Case 4:Multiple Myeloma


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Case 4: Multiple Myeloma

Px: 50 year old maleComplaint:

Weakness

On and off pain in the back and extremitiesWork up:

Multiple bone lesions and fractures

Gross: red, soft and gelatinous Bence Jones proteins in the urine

BM: plasma cells, occasional multinucleatedcells


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Multiple Myeloma

Flame- shaped Plasma cell

(Note the perinuclear

clearing)


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Lab_WBC and Lymph Nodes