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Reactive Conditions of the Lymph Node

(This is a continuation of the notes I have taken from the Sabah Lymphoma talk)

I. Lymphadenopathies
Lymphadenopathies are divided into three:
1. Reactive lymphoid hyperplasia
2. Atypical lymphoid hyperplasia
3. Progressive transformation of germinal centre

1. Reactive lymphoid hyperplasia

  • Has a follicular pattern OR may present as diffuse paracortical hyperplasia.
  • Characteristics: architecture preserved, capsule intact, enlarged germinal centre, mitotically active, tingible body macrophages, mantle zone present.
  • Main differential of follicular pattern: follicular lymphoma.
2.  Progressive transformation of germinal centre
  • Mainly in adolescent males.
  • Numerous follicules in different stages with follicular hyperplasia.
  • Late stage: small lymphocytes infiltrating germinal centres, germinal centre disrupted.
II. Castleman's disease

1.  Hyaline vascular variant
  • Can be unilocular or multiple places.
  • Numerous follicles with small germinal centre, onion-skin pattern of mantle zone.
  • Hyaline deposit in germinal centre.
  • Lollipop sign - when blood vessel enters the follicles
  • Twinning of germinal centre (eg 1 follicle contains 2 germinal centres.
  • Prominent blood vessels (with plump endothelial cells) surrounded by eosinophils and lymphocytes.
  • It may involve only 1-2 follicles
  • May see cracking artefact around the follicles.
2.  Plasma cell variant
  • Reactive follicles with interfollicular plasmacytosis.
  • Germinal centre penetrated by prominent blood vessels.
  • Sheets of mature plasma cells.
III. Rosai-Dorfman disease
  • Greatly expanded sinuses filled by foamy macrophages and histiocytes with lymphocytes and plasma cells.
  • Emperipolesis: lymphocytes in macrophages.
IV. Kikuchi disease
  • Self-limiting, typically young Asian females.
  • Unwell for a few weeks to months.
  • Loosely cohesive granulomatous nodules in paracortex with 'blastic' macrophages.
  • Presence of central necrosis.
  • Absence of lymphocytes and neutrophils at the necrotic centre.
  • Immunohistochemistry: macrophages are positive for MPO and negative for CD20 and CD3.
V. Sarcoidosis
  • Non-caseating granuloma.
  • Lymph node: architecture partially or totally replaced.
VI. Systemic Lupus Lymphadenopathy
  • Site: usually cervical, generalised.
  • Associated with active disease.
  • Histology: necrosis surrounded by histiocytes with paracortical hyperplasia.  Also presence of nuclear dust and basophilic haematoxylin bodies.
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