SYSTEMIC 1PLab LYMPH NODE 1

PATHOLOGY
Prelim Pracs 1 Dr. Myrna Espiritu | January 18 & 20, 2016

**** cortex = follicles

WHITE BLOOD CELLS, LYMPH NODES, SPLEEN and THYMUS **** Medullary sinuses – contain majority of macrophages; appear as map-like areas in the
HISTOLOGY OF THE LYMPH NODES center of the lymph node
- Bounded organ, encapsulated
- Underneath the capsule is a sinus – SUBCAPSULAR SINUS 1st slide: NORMAL
- Sinuses are found in medulla except for subcapsular sinus
- 2 parts
o Cortex – outer part, nearer to the capsule C C C CT
 Contain the LYMPHOID FOLLICLES, two types are listed below C F C C
o Medulla – inner part, more central and interior C

- Lymphoid follicles C PC
o Primary – has not reacted to any form of stimulus (unstimulated) C PC
C
o Secondary lymphoid follicle - undergone some kind of stimulation and C MS C
C
formed a germinal center; Paler area (germinal center) and area of C MC
lymphocytes (mantle zone) C
- Most of cells are lymphocytes
- B cells: are found in the cortex  follicles
- T cells: found in the paracortical/ parafollicular area
- In medulla: B-cell dependent area
o Medullary cords
o Medullary sinuses
Cortex (C) – B cell-rich territory, consists of follicles
Paracortex (PC) – lacks B-cell lymphoid follicles; T cell-rich territory
Medullary cords (MC) – contains both T and B lymphocytes and many plasma cells.
Medullary sinuses (MS) – dilated spaces lined by discontinuous endothelium; contains many
macrophages and sometimes neutrophils.

How to establish that these are B-cell and T-cell?

 Determine the difference based on Cluster of Differentiation (CD)
molecules/marker
Tests:
1. Flow cytometry – for use in blood and body fluids
2. Immunohistochemistry – for use in tissues; performed in a tissue block.

Why Immunohistochemistry?
 “Histo” because we are dealing with tissues
 “Immuno” because the molecules that are found in tissues are antigenic and the
reagents used to identify tissues contain antibodies. So it involves an antigen-antibody
reaction.
 “Chemistry” because antigen-antibody reaction will cause a color change
 Immunohistochemistry is also used for identification of cancers and lymphoma.

Eg. Cytokeratin- to determine if a tumor is carcinoma or epithelial in origin

***** must know. The primary way of determining pathology is via architecture *CD molecules are detected through the process of immunohistochemistry.
How do we know that follicles and the cortical areas are made up of B cells/ T cells?
- Request for T-cell marker and B-cell marker. Look for color change. Brown is a
positive color and has to be found in proper place.

Eg. CD markers- these are cell membrane antigens that represent a single or various lineage
of cells
 CD8, CD4 and CD3 – T cell markers
 CD20 – B cell marker
Others: Estrogen Receptor/Progesterone Receptor (ER/PR) – nuclear receptors for breast
CA diagnostics and prognostication
HER-2- cell membrane
Cytokeratin – cell membrane; CA of epithelial origin ie, carcinoma

1PLAB SYSTEMIC PATHOLOGY: Lymph Nodes 1

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2nd slide: CD20 Ag POSITIVE B CELL MARKER 3rd Slide: CD3 Antigen POSITIVE T CELL MARKER
Brown area is cortex and follicles (LPO): membrane (HPO) - Paracortical area is brown
Paler area: blue color in paracortical area, indicating a negative reaction - Cortex and follicles are blue in color

REACTIVE PROLIFERATIONS
Acute Non-specific Lymphadenitis
 Cervical Region
 Axillary/Inguinal
 Mesenteric

1PLAB SYSTEMIC PATHOLOGY: Lymph Nodes 1

- Simply put, it is an acute inflammation of the lymph nodes (eg. tonsils, appendix)
- The localized form is commonly caused by direct microbiologic drainage
- The systemic form is associated with bacteremia and viral infections particularly in
children.

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 Chronic Nonspecific Lymphadenitis
- Chronic nonspecific lymphadenitis is common in axillary and inguinal nodes, and is
characteristically non-tender due to slow enlargement.

MORPHOLOGY
FOLLICULAR HYPERPLASIA
Occurs in the presence of a stimuli that activate humoral immune responses eg,
inflammatory disorders, toxoplasmosis and early stages of HIV infection
 B-cell rich germinal centers (secondary follicles)
o The germinal centers have paler and bigger cells compared to the cells
found in the mantle region which are smaller
 Tingible body macrophages – macrophages which have ingested nuclear debris from
apoptotic B-cell
 Follicular dendritic cells extending up to the medulla
****CLUE to identification: many prominent germinal centers of varied sizes and shapes in
LPO (Dr. Rosales)
****kamukha sya ng normal but more germinal centers that are extending up to the
medulla can be found.
The nonspecific acute lymphadenitis is characterized by foci of necrosis and acute inflammatory cells.

1PLAB SYSTEMIC PATHOLOGY: Lymph Nodes 1

Green arrow – plasma cell; blue – tangible-body macrophage

Chronic lymphadenitis probably follicular hyperplasia

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 T-CELL HYPERPLASIA
 Aka paracortical hyperplasia; caused by stimuli that trigger T-cell mediated
responses as in acute viral infections.
 Characterized by reactive changes within the T-cell regions of the lymph node

Prominent germinal centers, surrounded by a rim of resting B cells, preserved architecture.

SINUS HISTIOCYTOSIS/SINUS HYPERPLASIA

 Characterized by prominent, distended lymphatic sinusoids caused by mared
hypertrophy of lining endothelial cells and infiltration with macrophages.
 Seen in lymph nodes draining cancers
 Host immune response vs. the tumor and its products
 AREA where there is viable tissue
 How to know the cause of necrosis? Look for the infiltrates  you will have

1PLAB SYSTEMIC PATHOLOGY: Lymph Nodes 1

neutrophilic infiltrate --- ACUTE LYMPHADENITIS

Follicular hyperplasia can be confused morphologically with follicular lymphomas. Features

favouring a reactive process include:
- Preservation of lymph node architecture
- Marked variation in follicular shape and size
- Frequent mitotic figures, phagocytic macrophages, and recognizable light and dark zones.

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