This document discusses various non-neoplastic and neoplastic conditions that can cause lymphadenopathy. It focuses on filariasis as a cause of non-neoplastic lymphadenopathy. Filarial parasites can infect the lymphatics and lymph nodes, causing inflammation and blockage. On pathology, the lymph nodes show an intense inflammatory reaction around dead or dying larvae with eosinophils and multinucleated giant cells. Rarely, microfilaria can be seen embedded in the lymph node tissue. The document emphasizes that a diligent search is needed to identify the parasite and make an accurate diagnosis.

1. Dr. Monika Nema

2. Dr. Monika Nema

3. Non neoplastic conditions
Filaria lymphadenitis.
Drug induced lymphadenopathy.
Kimura disease.
Angiolymphoid hyperplasia with
eosinophilia.
Dermatopathic lymphadenopathy.
Eosinophilic granuloma of lymph node.
Dr. Monika Nema

4. Neoplastic conditions
Mixed cellularity Hodgkin disease
Eosinophilic myeloid disorder
Angioimmunoblastic T cell Lymphoma
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5. Dr. Monika Nema

6. Endemic in tropical countries.
Transmitted by mosquitoes.
Caused by infection with filarial parasite like
Wuchereria bancrofti,
Brugia malayi,Brugia timor.
Dr. Monika Nema

7.  In humans, adult filariae worms colonize
lymphatic vessels and lymph nodes.
 In men, the worms are most commonly found
in the lymphatics of the epididymis and testis,
and in women in the lymphatics of the breast.
 They also invade the lymphatics of the legs
and the inguinal and pelvic lymph nodes.
 The lymphatics become occluded and
inflammed.
Dr. Monika Nema

8. Blockage of the lymphatics in the lower
limbs may cause elephantiasis of the legs,
more often in the elderly persons.
Dr. Monika Nema

9.  It is very rare to see microfilaria in the lymph node tissue
which is an accidentally trapped site.
 The larve can migrates through the blood vessels and
lymphatics to be lodged in the lymphatics and mature to adult
worm.
 Viable microfilariae in lymphatics usually do not cause lesions.
 When the adult worm or larva lodge in the lymph node and
die, they produce an intense inflammatory reaction with the
larva in the center accompanied by dense eosinophil infiltrate
with microabscess and multinucleated giant cells.
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10. Microfilaria embedded in the
eosinophil infiltrate
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11. The longitudinal, loosely
arranged nuclear column
typical of W. bancrofti
species and the
adherence of
inflammatory cells to the
border of the sheath are
visible
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12. Dr. Monika Nema

13. Associated with a systemic hypersensitivity
reaction to arene oxide- producing
anticonvulsant drugs.
Triad of fever,rash and lymphadenopathy.
Lymph node abormalities usually appear
early, within weeks or months, after the
initiation of anticonvulsant drug therapy.
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14. Clinical feature- hepatitis, gingival
hyperplasia,fever,
skin rash,eosinophilia,gum hyperplasia
and lymphadenopathy,
hepatospleenomegaly ,facial edema.
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15. Lymphodenopathy,regress after
anticonvulsants are discontinued, but they
may reappear if the same drug is resumed.
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16. Dr. Monika Nema

17. Dr. Monika Nema

18.  Over the years, there has been considerable
confusion between Kimura disease and
angiolymphoid hyperplasia with eosinophilia
(ALHE).
 Clinically, both conditions present as soft
tissue swellings that usually arise in the head
and neck region with an indolent, prolonged
clinical course. Microscopically, both
processes show eosinophilic infiltrates and
vascular proliferations.
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19. Features Kimura
lymphadenopathy
Angiolymphoid
hyperplasia with
eosinophilia
Age group Young Elderly
Race Asians Caucasian
Sex Males Females
Most affected site Deep subcutaneous
cervical masses with
regional lymph node and
salivary gland
involvement.
The lesions usually
involve skin in the form
of multiple small
superficial papules,
frequently
erythrematous.
Peripheral eosinophilia
and elevated serum IgE
levels
Often Rare
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20. Histological Features Kimura
lymphadenopathy
Angiolymphoid
hyperplasia with
eosinophilia
Follicular hyperplasia,
dense eosinophil
infiltrate with
microabscess formation
and eosinophilic
proteinaceous material in
the germinal centers.
Vasculoendothelial
proliferation with
formation of
angioendothelial lobules
having aggregates of
plump endothelial cells
with epithelioid
morphology with some
cytological atypia or
cytoplasmic
vacuolization. The
endothelium often shows
tomb stone like lining of
vessel lumen.
Fibrosis Usually present Rare
Multinucleated giant cells Can be seen
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21. KIMURA
LYMPHADENOPATHY
ANGIOLYMPHOID
HYPERPLASIA WITH
EOSINOPHILIA
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22. Dr. Monika Nema

23.  Lymphadenopathy associated with chronic
dermatologic lesions representing the lymph
node reaction to the drainage of melanin and
various skin antigens.
 Axillary and inguinal lymph nodes are most
commonly involved.
 Lymph nodes are enlarged,firm,movable and
nontender.
 Peripheral eosinophilia is frequently present.
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24.  Maintained lymph node
architecture with paracortical T
zone expansion.
 Lymphoid follicles and germinal
centres are present.
 Histiocytes are located in the
cortex towards the periphery of
node.
 Intermingled with the histiocytes
are variable number of plasma
cells,eosinophils and occasionally
neutrophils.
 The lymph node medulla contains
pronounced infiltrates of plasma
cells,and medullary sinuses are
distended and filled with
histiocytes,plasma cells and
eosinophils.
Dr. Monika Nema

25. Dr. Monika Nema

26. It is a form of Langerhans Cell
Histiocytosis that inolves only lymph nodes
and does not infiltrate any other organ.
Considered as a benign disease and
resolves spontaneously.
Occurs mainly in children and young adults
and show a slight preponderance of males.
Dr. Monika Nema

27.  Lymph nodes are predominately infiltrated by
Langerhans cells.
Langerhans cells are -
 Mononuclear histiocyte like cells with oval nuclei with
well defined round or oval cytoplasm.
 A prominent nuclear groove (coffee bean nuclei) can
be seen in most of the nuclei.
 Eosinophilic cytoplasm.
 Contain Birbeck granules on electron microscopy and
are lysozyme negative.
 Mixture of inflammatory cells.
 Giant cells can be present.
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28. Sheets of Langerhans cells with eosinophil
Sheets of Langerhans cells with eosinophil
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29. Dr. Monika Nema

30. • 2nd most common type of Hodgkin
lymphoma in general population.
• The most common variety in HIV+
patients.
• Most patients present with peripheral
and/or abdominal adenopathy and B-
symptoms (fever, night sweats, and
weight-loss).
Dr. Monika Nema

31.  The lymph node architecture is diffusely
effaced by a polymorphous population of
small lymphocytes, histiocytes, plasma
cells, and eosinophils in varying
proportions along with Reed-Sternberg
cells
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32. Dr. Monika Nema

33. Dr. Monika Nema

34.  Represent a heterogenous group of disorders.
WHO classification-
 (1) myeloid and lymphoid neoplasms with
PDGFRA rearrangement.
 (2) myeloid neoplasms with PDGFRB
rearrangement.
 (3) myeloid and lymphoid neoplasms with FGFR1
abnormalities.
 (4) chronic eosinophilic leukemia not otherwise
specified.
 (5) idiopathic hypereosinophilic syndrome.
 (6) idiopathic hypereosinophilia.
Dr. Monika Nema

35. Dr. Monika Nema

36. Dr. Monika Nema

37. The term ‘Angioimmunoblastic’ refers to
the characteristic morphology with
prominent vascular proliferation and
increased numbers of immunoblasts
throughout the node.
The immunoblasts are often positive for
EBV by in situ hybridization and EBV PCR
on nodal tissue is positive in most cases
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38. Dr. Monika Nema

39. Dr. Monika Nema

40.  Effaced lymph node architecture.
 Diffuse cellular proliferation.
 Characteristic triad of (a)
arborization,hyperplasia of small vessels; (b)
immunoblasts,predominately T-cell type;(c)
PAS positive material,clear cell
immunoblasts,Reed Sternberg like
cells,plasma cells,eosinophils,epithelioid
cells.
 Bone marrow,spleen,liver,lung may be
involved.
Dr. Monika Nema

41.  Whenever there is tissue or peripheral blood
eosinophilia, especially in a patient from
tropics or subtropics, the possibility of a
parasitic infection should be thought.
 If the organism is not seen in the initial
sections, extensive sampling, adequate serial
sectioning and vigilant search should be
made to arrive at a correct diagnosis and to
avoid misdiagnosis and mismanagement of
the patient.
Dr. Monika Nema

42. Presentation by – Dr. Monika Nema
Dr. Monika Nema