Pathology
Lymph Node and Spleen
Lymph node and spleen pathology for MBBS and NEET-PG: lymphadenopathy, tuberculous lymphadenitis, Hodgkin and non-Hodgkin lymphoma and splenomegaly, mapped to NMC codes PA19.1 to PA19.7.
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Lymph Node and Spleen
Lymph node and spleen pathology for MBBS and NEET-PG: lymphadenopathy, tuberculous lymphadenitis, Hodgkin and non-Hodgkin lymphoma and splenomegaly, mapped to NMC codes PA19.1 to PA19.7.
This chapter covers diseases of the lymph nodes and spleen. It sets out the causes and pathology of lymphadenopathy including tuberculous lymphadenitis, the classification and features of Hodgkin and non-Hodgkin lymphoma, the causes of splenomegaly, and the pattern of metastatic disease in lymph nodes.
High-yield: Lymph Node and Spleen
- Lymphadenopathy is enlargement of lymph nodes, caused by reactive, infective, malignant or granulomatous processes.
- Tuberculous lymphadenitis shows caseating granulomas with Langhans giant cells, most often in the cervical nodes.
- Hodgkin lymphoma is defined by the Reed-Sternberg cell, a large binucleate owl-eye cell.
- Reed-Sternberg cells are typically positive for CD15 and CD30 on immunohistochemistry.
- Nodular sclerosis is the most common subtype of Hodgkin lymphoma and often presents with mediastinal disease in young adults.
- Hodgkin lymphoma spreads in a predictable, contiguous fashion from one node group to the next.
- B symptoms of lymphoma are fever, drenching night sweats and weight loss, and indicate a worse prognosis.
- Non-Hodgkin lymphomas are a heterogeneous group that spread non-contiguously and are commoner than Hodgkin lymphoma.
- Diffuse large B-cell lymphoma is the most common aggressive non-Hodgkin lymphoma.
- Follicular lymphoma is an indolent B-cell lymphoma associated with the t(14;18) translocation and BCL2 overexpression.
- Burkitt lymphoma shows a starry-sky appearance and a t(8;14) translocation involving the MYC gene.
- Splenomegaly has many causes, including portal hypertension, infections, haemolytic anaemias and leukaemias and lymphomas.
- Hypersplenism causes cytopenias by increased pooling and destruction of blood cells in an enlarged spleen.
- Metastatic carcinoma in a lymph node points to a primary epithelial tumour draining to that node.
Hodgkin versus non-Hodgkin lymphoma
- **Diagnostic cell:** Hodgkin: Reed-Sternberg cell (CD15, CD30 positive).
- **Spread:** Hodgkin spreads contiguously; non-Hodgkin spreads non-contiguously.
- **Commonest NHL:** Diffuse large B-cell lymphoma (aggressive); follicular lymphoma (indolent).
- **Key translocations:** Follicular t(14;18) BCL2; Burkitt t(8;14) MYC, starry-sky pattern.
NMC competencies in this chapter
- **PA19.1:** Causes and pathology of lymphadenopathy
- **PA19.2:** Pathology of tuberculous lymphadenitis
- **PA19.3:** Causes and pathology of splenomegaly
- **PA19.4:** Classification, pathology and pathogenesis of Hodgkin lymphoma
- **PA19.5:** Classification, pathology and pathogenesis of non-Hodgkin lymphoma
- **PA19.6:** Pathology of metastatic disease in lymph nodes
- **PA19.7:** Role of fine needle aspiration cytology in lymph node diagnosis
Frequently Asked Questions
What cell defines Hodgkin lymphoma?
The Reed-Sternberg cell, a large binucleate owl-eye cell that is characteristically positive for CD15 and CD30.
How do Hodgkin and non-Hodgkin lymphoma spread differently?
Hodgkin lymphoma spreads in a predictable contiguous fashion from one node group to the next, while non-Hodgkin lymphoma spreads non-contiguously.
What does tuberculous lymphadenitis show?
Caseating granulomas with Langhans giant cells, most often in the cervical lymph nodes.
What are the B symptoms of lymphoma?
Fever, drenching night sweats and unexplained weight loss, which indicate a poorer prognosis.
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