comprehensive overview of the causes and patterns of lymph node hyperplasia.

1. PATTERNS OF LYMPH NODE
HYPERPLASIA
DR.DUR-E-ZAHRA

2. LEARNING OBJECTIVES
• Normal Lymph Node Anatomy
• Causes Of Lymph Node Hyperplasia
• Classification Of Patterns Of Lymph Node Hyperplasia
• Explanation Of Features Of Different Hyperplasia

3. • Histological Structure Of A
Lymph Node Can Be Divided
Into
• CORTEX
• MEDULLA
• HILAR ZONE
THE NORMAL
LYMPH NODE

5. CAUSES OF LYMPH NODE HYPERPLASIA
INFECTIOUS
IMMUNE NEOPLASTI
C

6. CLASSIFICATION
PATTERN OF HYPERPLASIA AT LOW
MAGNIFICATION
FOLLICULAR PARACORTICAL SINUS DIFFUSE MIXED
NON-
NEOPLASTIC
NEOPLASTIC

7. • IT IS THE INCREASE IN
NUMBER AND SIZE OF
THE LYMPH NODE
FOLLICLES
• THE FOLLICLES ARE
COMPOSED OF MAINLY
B-CELLS
FOLLICULAR /
NODULAR
HYPERPLASIA

8. FOLLICULAR HYPERPLASIA
NON-NEOPLASTIC
• Reactive FH
• Explosive FH
• Castleman Disease
• Rheumatoid Lymphadenopathy

9. • A Tingible Body
Macrophage Is A Type Of
Macrophage Containing
Many Phagocytized,
Apoptotic Cells In Various
States Of Degradation,
Referred To As Tingible
Bodies (Tingible Meaning
Stainable)
TINGIBLE BODY
MACROPHAGES

10. FOLLICULAR / NODULAR HYPERPLASIA
NEOPLASTIC
1. Follicular Lymphoma
2. Nodular Lymphocyte Predominant HD
3. Nodular Sclerosis HD
4. Mantle Cell Lymphoma
5. Marginal Cell Lymphoma

11. MANTLE/MARGINAL ZONE HYPERPLASIA
A: GERMINAL CENTRE
B: MANTLE ZONE
C: MARGINAL ZONE
• MONOMORPHIC PROLIFERATION OF
SMALL LYMPHOID CELLS
• WITH ROUND NUCLEI AND CLEAR
CYTOPLASM

12. FOLLICULAR HYPERPLASIA VS FOLLICULAR
LYMPHOMA
ARCHITECTU
RAL
FEATURES
CYTOLOGICAL
FEATURES
Rappaport et al & Nathwani et al

13. ARCHITECTURAL FEATURES
FOLLICULAR HYPERPLASIA FOLLICULAR LYMPHOMA
Preservation of nodal
architecture
Complete effacement of normal
architecture
Marked variation in size of the
follicles with presence of
elongated or dumb-bell shaped
follicles
Even distribution of follicles
throughout cortex and medulla
No, or only moderate, infiltration
of capsule and pericapsular fat
tissue with inflammatory cells.
Massive infiltration of capsule
and pericapsular fat
with or without formation of
neoplastic follicles outside
capsule.

14. FOLLICULAR HYPERPLASIA

15. FOLLICULAR LYMPHOMA

16. CYTOLOGICAL FEATURES
FOLLICULAR HYPERPLASIA FOLLICULAR LYMPHOMA
Centers of follicles (reaction
centers) composed of lymphoid
cells and histiocytes , with few
or no cellular and nuclear
irregularities
Follicles composed of
monomorphic neoplastic cells
exhibiting
cellular pleomorphism with
nuclear irregularities
Active phagocytosis in reaction
centers
Lack of phagocytosis
Tingible body macrophages give
starry sky appearance
Absence of tingible body
macrophages

18. • IT IS
CHARACTERIZED BY
REACTIVE CHANGES
IN PARACORTEX I.E
T-CELL REGION OF
THE LYMPH NODE.
PARACORTICAL
HYPERPLASIA

19. PARACORTICAL HYPERPLASIA
Paracortical
hyperplasia
Nodular
Dermatopathic Lymphadenitis
Nodal reaction to malignancy
Diffuse
Viral lymphadenitis
Drug reactions
Immunoblastic proliferation

20. SINUS HYPERPLASIA
• ALSO KNOWN AS SINUS HISTIOCYTOSIS OR SINUS CATARRH
• CHARACTERIZED BY DILATED AND PROMINENT SINUSES WITH INCREASED
NUMBER OF MACROPHAGES IN LUMEN
• CAN BE FOUND IN NODES DRAINING INFECTIOUS OR NEOPLASTIC PROCESSES

21. SINUS HYPERPLASIA
NON-NEOPLASTIC DISORDERS INVOLVING SINUSES
1. ROSAI-DORFMAN DISEASE (RDD)
2. LANGERHAN CELL HISTIOCYTOSIS
3. VASCULAR TRANSFORMATION OF SINUSES
4. VIRUS-ASSOCIATED HEMOPHAGOCYTOSIS
5. WHIPPLE DISEASE

22. SINUS HYPERPLASIA
NEOPLASTIC DISORDERS INVOLVING SINUSES
• LARGE CELL LYMPHOMA WITH SINUSOIDAL PATTERN
• NONLYMPHOID LEUKEMIA
• HISTIOCYTIC NEOPLASMS
• NON-HEMATOLYMPHOID NEOPLASMS

23. REFERENCES
• SURGICAL PATHOLOGY BY ROSAI AND ACKERMAN
• VIRTUAL PATHOLOGY
• WEB PATHOLOGY
• GOOGLE IMAGES
QUESTIONS?