Pathology Cheat Sheet
Read the Node Pattern
Lymph node and spleen for NEET-PG: follicular vs paracortical hyperplasia, tingible body macrophages, tubercular lymphadenitis, and splenomegaly causes.
MedNext Academy | 3 min read
Read the Node Pattern
Lymph node and spleen for NEET-PG: follicular vs paracortical hyperplasia, tingible body macrophages, tubercular lymphadenitis, and splenomegaly causes.
The causes and patterns of reactive lymphadenopathy, tubercular lymphadenitis, and splenomegaly.
High-yield lines
- The lymph node has three functional compartments: the B-cell cortex, the T-cell paracortex, and the medulla.
- Follicular hyperplasia expands the B-cell cortex and occurs in rheumatoid arthritis, early HIV, and toxoplasmosis.
- Reactive follicular hyperplasia shows variable follicle size, polarised germinal centres, and tingible body macrophages, unlike monotonous follicular lymphoma.
- Paracortical hyperplasia expands the T-cell zone and is typical of viral infections such as infectious mononucleosis.
- Immunoblasts in EBV lymphadenitis can mimic Reed-Sternberg cells but are CD45 positive and CD15 negative.
- Sinus histiocytosis expands the medullary sinuses and is common in nodes draining tumours.
- Tubercular lymphadenitis shows caseating granulomas with Langhans giant cells and acid-fast bacilli.
- Cervical tubercular lymphadenitis (scrofula) is the most common form of peripheral tuberculous lymphadenopathy in India.
- Splenomegaly has causes including congestion from portal hypertension, infection, haematological malignancy, and storage disease.
- Massive splenomegaly is seen in chronic myeloid leukaemia, myelofibrosis, and chronic malaria.
- A rubbery persistent node suggests lymphoma while a hard fixed matted node suggests metastatic carcinoma.
- Recognising which nodal compartment is expanded is the key first step in classifying lymphadenopathy.
Mapped competency codes
- PA19.1
- PA19.2
- PA19.3
Continue into the full chapter
This summary maps to PA19-lymph-node-and-spleen.
Frequently Asked Questions
How is reactive follicular hyperplasia distinguished from follicular lymphoma?
Reactive hyperplasia shows variable follicle sizes with polarised germinal centres and tingible body macrophages, whereas follicular lymphoma has monotonous non-polarised follicles that lack tingible body macrophages.
What is the histology of tubercular lymphadenitis?
Caseating granulomas with epithelioid macrophages and Langhans giant cells, with acid-fast bacilli demonstrable on Ziehl-Neelsen staining.
Which conditions cause massive splenomegaly?
Chronic myeloid leukaemia, myelofibrosis, chronic malaria, and certain storage diseases such as Gaucher disease.
How do lymphoma and metastatic nodes differ on palpation?
Lymphomatous nodes are typically rubbery and mobile, whereas metastatic carcinoma produces hard, fixed, matted nodes.
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