2. COMPETENCY
PA 19.3 & PA 19.5
1) Identify and describe the features of tuberculous
lymphadenitis in gross and microscopic specimen.
2) Identify and describe the features of Hodgkin’s lymphoma in
gross and microscopic specimen
TOPICS TO BE COVERED
Gross and microscopy of Lymph node:
1) Tuberculous lymphadenitis
2) Hodgkin’s lymphoma
3. NORMAL LYMPH NODE
Microscopy:
• Capsule,
• Subcapsular sinuses,
• Cortical lymphoid follicles(with pale germinal centres and
peripheral mature cells),
• Paracortical area(with T-lymphocytes)
• Medulla(plasma cells, lymphocytes and sinuses) closer to the
hilar region.
4.
5. TUBERCULOUS LYMPHADENITIS
Tuberculosis of the lymph nodes is always secondary to tuberculosis
elsewhere
GROSS-
• The lymph nodes are enlarged and are matted together due to
peri- adenitis.
• The cut surface in the tuberculous areas is yellow, cheesy, opaque
and caseous(caseous necrosis) while elsewhere is grey brown.
6.
7. MICROSCOPY
• The caseous areas show debris composed of fragmented
coagulated cells.
• The periphery of caseous foci shows granulomatous
inflammation consisting of epithelioid cells (identified by large
size, epithelium-like appearance, abundant pale cytoplasm and
oval vesicular nuclei) surrounded by lymphocytes and some
plasma cells.
• Epithelioid cells may fuse to form giant cells in the granuloma
and may have a nuclear arrangement at the periphery of the
cell (Langhans’ giant cells) or the nuclei may be distributed
haphazardly (foreign body giant cells)
• Normal nodal architecture may be seen at the periphery only.
10. Classical Hodgkins Disease is further subclassified as:
a) Lymphocytes predominant
b) Nodular sclerosis
c) Mixed cellularity
d) Lymphocyte depleted
11. GROSS
• The affected lymph nodes are enlarge and matted together.
• The cut surface is homogeneous and fleshy.
• Necrosis and hemorrhage are rare.
• Nodular sclerosis type shows nodular scarring while there is
abundance of necrosis in mixed cellularity type.
12. MICROSCOPY
• Characteristic cells of Hodgkins disease is termed Reed-Sternberg
cell or R-S cell.
• There are 5 morphological variants of RS cells.
13. 1. Classical RS cell:
• Large cell with bilobed nucleus having prominent large
eosinophilic nucleoli in each lobe.
• Cytoplasm is abundant and amphophilic or weakly
acidophilic
• Seen in all sub types of HD.
14. 2. Mononuclear cell
• Similar morphology as classical RS cell except has single large
nucleus with eosinophilic nucleolus
15. 3. Popcorn type
• Seen in mixed cellularity type and lymphocyte prerdominant HD
has a lobulated nucleus or multi multi lobulated nucleus of the
shape of popcorn kernel.
16. 4. Lacunar type
• Similar morphology as any of the above cell type except having
clear perinuclear zone of cytoplasm due to artefactual
shrinkage of cytoplasm .
• Seen in nodular sclerosis type.
17. 5. Pleomorphic RS cell
• RS cell with pleomorphic and atypical nuclei seen in Lymphocyte
depleted typed.
18.
19.
20. Classical microscopic picture of mixed cellularity hodgkins
disease:
• Preresence of classical and mononuclear RS cells.
• Complete effacement of lymph node architecture.
• RS cells are admixed with eosinophils, plasma cells and
sometimes neutrophils evenly infiltrating the complete lymph
node.
• Necrosis is very rare. However microgranuloma formation may
be seen.
• Immunohistochemistry : RS cells are positive for CD30 and
CD 15 immunostain.
