B cells: germinal follicles

T cells: paracortex,
Thymus
Histiocytes: sinuses, skin
(Langerhans cell)
Nodal enlargement: <30
usually benign; >30
usually malignant
Metastasis MC nodal
Malignancy
Painful
lymphadenopathy:
inflammation
Anterior cervical nodes/
inguinal nodes MC site
localized painful
adenopathy
Generalized painful
adenopathy: SLE,
infectious mono
Painless
lymphadenopathy:
metastasis or primary
malignant lymphoma
Painless axillary nodes
woman: metastatic
breast cancer
Left supraclavicular
node metastasis:
stomach/pancreatic
carcinoma
Hilar node metastasis:
lung cancer
Pre-aortic node
metastasis: testicular
cancer
Follicular hyperplasia:
prominent germinal
follicles
Inguinal node
metastasis men/women:
penis/vulvar squamous
cancer
Dermatopathic
lymphadenitis: melanin
pigment in
macrophages
Cat-scratch disease:

B. henselae;
granulomatous
microabscesses
Toxoplasmosis:
mononucleosis-like
syndrome with painful
cervical adenopathy
Tularemia: zoonosis
(rabbits); F. tularensis;
ulceroglandular MC type
Plague: Y. pestis; Yop
gene protein products
inhibit phagocytosis and
kill phagocytes
Transmission: bite of
infected fleas that have
bitten infected rodents
(reservoir of bacterium)
Bubonic plague mainly
in Western U.S.
Bubonic plaque (MC),
septicemic plague,
pneumonic plague
Bubonic plague: bite on
leg; inguinal node
involvement
Inguinal node
enlargement: bacteria
proliferate, cause edema
but few inflammatory
cells present; nodes
rupture
Septicemic plague:
endotoxemia; massive
organ involvement;
septicemia
Sinus histiocytosis in
axillary nodesgood
prognostic sign in
breast cancer
NHL: majority B-cell
Origin
Extranodal sites:
stomach (MC), CNS,
Peyer patches
NHL: MC malignant
lymphoma adults/
children
EBV: Burkitt lymphoma,

primary CNS lymphoma

(HIV)
HTLV-1: adult T-cell
leukemia/lymphoma
HCV: B cell lymphoma
H. pylori: low-grade
malignant lymphoma in
stomach
NHL autoimmune
disease: Sjgren
syndrome, Hashimoto
thyroiditis
NHL: mutation blocks
B/T cells at specific
stage of development
Precursor T-cell
lymphoblastic
lymphoma/leukemia:
common in children
MF: CD4 TH cell
neoplasm; skin
involvement (Pautrier
microabscesses)
Szary syndrome: MF in
leukemic phase
Nodular sclerosing HL:
female dominant
Bimodal age
distribution: 1534
years old and >50 years
old
EBV: association with
mixed cellularity/
lymphocyte depletion/
lymphocyte rich HL
HL: defects in CMI;
Anergy cell-mediated immunity
Nodular sclerosing
classical HL: MostCommon type
of HL
Activated NF-B
important in HL
pathogenesis

Activation of the transcription factor NF-B (nuclear factor kappa-lightchainenhancer of activated B cells) is common in classical HL.
a. NF-B is activated by EBV or other factors.
b. Once activated, it turns on genes that promote proliferation of B cells.

RS cell neoplastic cell

of HL
RS cell required to
diagnose HL
HL: fever, weight loss,
night sweats; pruritus
Prognosis: stage more
important than type
of HL
Nodular sclerosis HL:
anterior mediastinal
mass + single group of
nodes above diaphragm
Rx HL: risk 2nd
malignancies (AML,
NHL)
Histiocytes: CD1+;
Birbeck granules
D-Dimers:

most sensitive
screen for DIC; negative
test excludes DIC
DIC: PT, PTT, D-dimers,
BT; platelets,
Fibrinogen
Letterer-Siwe:
malignant; skin
involvement; lytic bone
lesions
HSC: lytic skull lesions,
CDI, exophthalmos

Hand-Schller-Christian (HSC) disease

Eosinophilic granuloma:
benign histiocytosis;
unifocal lytic lesions in
bone
Mast cell disease:
pruritus, swelling,
hyperpigmentation

Urticaria pigmentosa (UP)

UP: dermatographism;
lesions remain
hyperpigmented
Mast cells:
metachromatic granules

Monoclonal Gammopathies)

MG: single M protein +

light chain
Majority have IgG M
Protein
BJ protein: light chains
in urine

Associated with plasma cell malignancies and Waldenstrm macroglobulinemia

SPE shows monoclonal
Spike

Serum protein electrophoresis

Serum free light chains:
more sensitive than
urine tests
MM: rare <40; blacks
> whites

Multiple myeloma (MM)

MM: IgG > IgA > light
chain myeloma
CRAB: calcium
elevation,
renal insufficiency,
anemia, and
bone lesions
MM: MM: normal
plasma cell MGUS(monoclonal gamopathy of undetermined significance3)
MM: lytic lesions,
plasma cells >10%;
pathologic fractures,
hypercalcemia
myeloma
MM: vertebrae MC bone
Site
BJ renal disease in MM:
proteinaceous casts
with multinucleated
giant cell reaction
MM: association with
primary (AL) amyloidosis
MM: anemia with
rouleaux, bleeding
time (platelet
aggregation defect)
MM: sepsis/renal failure
common causes of
death

MGUS: MC monoclonal
Gammopathy
Red pulp: fixed
Macrophages
White pulp: B and T
Cells
Functions: blood
filtration (encapsulated
bacteria), antigen
trapping/processing,
platelet reservoir, EMH
Gaucher disease:
glucocerebrosidase,
glucocerebroside,
macrophages fibrillary
appearance
Niemann-Pick:
sphingomyelinase,
sphingomyelin,
macrophages soap
bubble appearance
Massive splenomegaly:
infarctions with pain,
friction rub, and
left-sided pleural
effusion
Splenomegaly in
cirrhosis with portal
hypertension: sugarcoated
spleen
Hypersplenism:
destruction of
hematopoietic cells
produces cytopenias
PH MCC hypersplenism

Spleen in portal hypertension (PH

Splenic dysfunction:
risk for S. pneumoniae
sepsis; HJ bodies
Mechanisms: IgM,
tuftsin, splenic
macrophages