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A Pattern Approach to Lymph Node Diagnosis

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Autore: Leong
Editore: Springer
Anno: 2011
Pagine: 418
ISBN: 9781441971753
Prezzo: 140,00€
I prezzi indicati possono subire variazioni poiché soggetti all'oscillazione dei cambi delle valute e/o agli aggiornamenti effettuati dagli Editori.
  • Written by experts in lymphoproliferative diseases
  • High quality color illustrations of each major diagnostic entity
  • The volume is organized in accordance with the primary pattern of presentation of each diagnostic entity
While a pattern approach to diagnosis is taught and practiced with almost every other tissue or organ in the body, the lymph node remains a mystery to most residents starting out in pathology and those pathologists with limited experience in the area. A Pattern Approach to Lymph Node Diagnosis demonstrates that a systematic approach to lymph node examination can be achieved through recognition of morphological patterns produced by different disease processes. It presents a combination of knowledge-based assessment and pattern recognition for diagnosis covering the major primary neoplastic and non neoplastic diseases and metastatic tumors in lymph nodes. This volume demonstrates that lymph node compartments can be recognized histologically especially with the aid of immunohistological markers and how this knowledge can be employed effectively to localize and identify pathological changes in the different compartments in order to facilitate histological diagnosis. It also defines histological features that, because of their pathological occurrence in lymph nodes, are useful pointers to specific diagnoses or disease processes. The volume is organized in accordance with the primary pattern of presentation of each diagnostic entity. Differential diagnosis is discussed and each diagnostic entity is accompanied by color illustrations that highlight the diagnostic features. Immunohistochemistry, clinical aspects, relevant cytogenetics and molecular information of each entity is provided by an author who is an expert in lymphoproliferative diseases. An algorithmic approach to diagnosis is adopted at the end of each section by listing a set of questions that help to consider diagnostic entities that can present with the morphological features observed. A Pattern Approach to Lymph Node Diagnosis is an essential text for residents and fellows in pathology and general pathologists making first hand lymph node diagnoses as well as to hematologists and physicians who treat patients with lymphoprolifeative diseases.

Contents
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
SECTION I
1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Knowledge-Based Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Systematic Examination of the Lymph Node . . . . . . . . . . . . . . . . . . . . 7
Cell Type Identification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Cell Size and Cellularity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Immunohistology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Cytological Preparations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
The Pattern Approach to Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . 14
Selected Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
2. Handling of the Lymph Node Biopsy . . . . . . . . . . . . . . . . . . . . . . . 19
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
The Biopsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Lymph Node Triage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
3. Immunohistology and Other Diagnostic Techniques . . . . . . . . . . . . . . . . 23
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Immunohistology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
B Cell Markers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
T Cell Markers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Natural Killer and T/NK Cell Markers . . . . . . . . . . . . . . . . . . . . . . . 38
Precursor B- and T Cell Markers . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Monocyte/ Macrophage Markers . . . . . . . . . . . . . . . . . . . . . . . . . 39
Langerhans Cell, Follicular Dendritic Cell, and Interdigitating Dendritic
Reticulum Cell Markers . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Markers of Reed–Sternberg Cells in Hodgkin Lymphoma . . . . . . . . . . . . . 42
Miscellaneous Markers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Myeloid Cell Markers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Mast Cell Markers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Diagnostic Approach with Immunohistochemical Stains . . . . . . . . . . . . . . 47
Staining for Follicular Dendritic Cells . . . . . . . . . . . . . . . . . . . . . . . 47
Immunohistological Identification of Diffuse Lymphoid Infiltrates . . . . . . . . 49
Histochemical Stains . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Flow Cytometry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Molecular Diagnostics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Detection of Clonality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Immunoglobulin Heavy- and Light-Chain Genes . . . . . . . . . . . . . . . . . 57
T Cell Receptor Chain Genes . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
vii
viii Contents
Genotype Subgroups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Conventional Cytogenetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Fluorescence In Situ Hybridization (FISH) . . . . . . . . . . . . . . . . . . . . 60
Southern Blot Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Polymerase Chain Reaction (PCR) . . . . . . . . . . . . . . . . . . . . . . . . . 60
Gene Expression Profiling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
4. Anatomical and Functional Compartments . . . . . . . . . . . . . . . . . . . . . 63
B Cell Differentiation and Corresponding B Cell Lymphomas . . . . . . . . . . . 64
The Cortex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
The Lymphoid Follicle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
T Cell Differentiation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
The Paracortex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
High-Endothelial Venules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Medullary Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Connective Tissue Framework . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
SECTION II
5. Nodular Lymphoid Infiltrates . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Follicular Pattern . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
Neoplastic Follicles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Follicular Lymphoma (FL) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Follicular Hyperplasia Versus Follicular Lymphoma . . . . . . . . . . . . . . . . 91
Other Follicular Patterns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Mantle Pattern . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Mantle Cell Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Marginal Zone Pattern . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Nodal Marginal Zone Lymphoma (Monocytoid B Cell Lymphoma) . . . . . . . . 107
Nodular Pattern . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Heterogenous Nodules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Pseudofollicular Pattern . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Hodgkin Lymphoma (HL) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
Classical Hodgkin Lymphoma (CHL) . . . . . . . . . . . . . . . . . . . . . . . 116
Post-transplant Lymphoproliferative Disorders . . . . . . . . . . . . . . . . . . . 127
Colonization of Follicles by Neoplastic Cells . . . . . . . . . . . . . . . . . . . . 131
Homogenous Nodules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
Reactive Hyperplasia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
Follicular and Paracortical Hyperplasia . . . . . . . . . . . . . . . . . . . . . . . 136
Non-specific Follicular Hyperplasia . . . . . . . . . . . . . . . . . . . . . . . . . 137
Progressive Transformation of Germinal Centers (PTGC) . . . . . . . . . . . . . 137
Rheumatoid Lymphadenopathy . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Toxoplasma Lymphadenopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Human Immunodeficiency Virus/Acquired Immunodeficiency Disease
Syndrome (HIV/AIDS) Lymphadenitis . . . . . . . . . . . . . . . . . . . 142
Kimura Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
Castleman Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Syphilis Lymphadenopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Kikuchi Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
Contents ix
Systemic Lupus Erythematosus . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Infectious Mononucleosis Lymphadenopathy . . . . . . . . . . . . . . . . . . . 158
Other Viral Lymphadenopathies . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Paracortical Nodules/Expansion . . . . . . . . . . . . . . . . . . . . . . . . . . 165
Dermatopathic Lymphadenopathy (DL) . . . . . . . . . . . . . . . . . . . . . . 165
Drug-Induced Lymphadenopathy . . . . . . . . . . . . . . . . . . . . . . . . . 166
The Diagnostic Approach to Nodular Infiltrates in Lymph Nodes . . . . . . . . . 167
Are They Follicles or Nodules? . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
Are the Follicles Reactive or Neoplastic? . . . . . . . . . . . . . . . . . . . . . . 168
Are Follicles Infrequent and “Constricted”? . . . . . . . . . . . . . . . . . . . . 168
Are the Follicles Exceptionally Large? . . . . . . . . . . . . . . . . . . . . . . . 169
Do the Enlarged Germinal Centers Contain Atypical Cells? . . . . . . . . . . . . 169
Are the Nodules Homogenous or Heterogenous in Composition? . . . . . . . . . 169
Homogenous Nodules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Heterogenous Nodules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
If There Is Marked Follicular Hyperplasia, Can a Specific Diagnosis Be Made? . . . 170
Do the Vague Nodules Represent Paracortical Nodules? . . . . . . . . . . . . . . 171
6. Diffuse Lymphoid Infiltrations . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
B Cell Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL) . . 176
Lymphoplasmacytic Lymphoma (LPL) . . . . . . . . . . . . . . . . . . . . . . . 186
Diffuse Large B Cell Lymphoma (DLBCL) . . . . . . . . . . . . . . . . . . . . 194
Clinical Subtypes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Burkitt Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212
B Cell Lymphoma, Unclassifiable, with Features Intermediate Between
DLBCL and BL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
Nodal Involvement by Primary Extranodal Lymphomas and Leukemias . . . . . . 218
T Cell and NK Cell Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . 218
T-Lymphoblastic Leukemia/Lymphoma (Precursor T Cell Lymphoblastic
Leukemia/Lymphoma) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
Peripheral T Cell Lymphoma, Not Otherwise Specified (PTCL-NOS) . . . . . . . 223
Angioimmunoblastic T Cell Lymphoma . . . . . . . . . . . . . . . . . . . . . . 229
Anaplastic Large Cell Lymphoma (ALCL), ALK-Positive . . . . . . . . . . . . . 238
Immunohistology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244
Anaplastic Large Cell Lymphoma, ALK-Negative . . . . . . . . . . . . . . . . . 249
Adult T Cell Leukemia/Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . 250
Nodal Involvement by the Cutaneous T Cell Lymphomas . . . . . . . . . . . . . 255
Histiocytic and Dendritic Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . 260
Histiocytic Sarcoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262
Langerhans Cell Histiocytosis . . . . . . . . . . . . . . . . . . . . . . . . . . . 268
Interdigitating Dendritic Cell (IDC) Sarcoma . . . . . . . . . . . . . . . . . . . 272
Follicular Dendritic Cell (FDC) Sarcoma . . . . . . . . . . . . . . . . . . . . . . 275
Hodgkin Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 278
Diagnostic Approach to Diffuse Infiltrates in lymph Nodes . . . . . . . . . . . . 279
Is the Infiltrate Truly Diffuse? . . . . . . . . . . . . . . . . . . . . . . . . . . . 279
Does the Diffuse Infiltrate Involve the Node Partially or Completely? . . . . . . . 280
Is the Infiltrate Monomorphous or Polymorphous? Are the Cells Small or Large? . 281
x Contents
7. Defining Microscopic Features . . . . . . . . . . . . . . . . . . . . . . . . . . . 287
Granulomas and Foam Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287
Infective Granulomatous Lymphadenitis . . . . . . . . . . . . . . . . . . . . . . 287
Mycotic Lymphadenitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 294
Protozoan and Parasitic Lymphadenitides . . . . . . . . . . . . . . . . . . . . . 300
Non-infective Granulomatous Lymphadenitis . . . . . . . . . . . . . . . . . . . 301
Granulomas, Non-necrotizing . . . . . . . . . . . . . . . . . . . . . . . . . . . 304
Foreign Body and Lipid Granulomatous Lymphadenitis . . . . . . . . . . . . . . 307
Lipid Lymphadenopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 310
Sinus Pattern . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
Sinus Histiocytosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 314
Rosai–Dorfman Disease (Sinus Histiocytosis with Massive Lymphadenopathy) . . 316
Necrosis, Apoptosis, and Infarction . . . . . . . . . . . . . . . . . . . . . . . . . 317
Clear Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319
Mast Cell Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 320
Hairy Cell Leukemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321
Spindled Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 324
Inflammatory Myofibroblastic Tumor . . . . . . . . . . . . . . . . . . . . . . . 325
Palisaded Myofibroblastoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325
Kaposi Sarcoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
Vascular Prominence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 330
Bacillary Angiomatosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331
Vascular Transformation of Lymph Node Sinuses . . . . . . . . . . . . . . . . . 331
Hemorrhage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333
Starry Sky Pattern . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 334
Mottled Pattern . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 334
Fibrosis/Hyalinization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335
Signet Ring Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 336
Bizarre or Multinucleated Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . 337
Extramedullary Hematopoiesis . . . . . . . . . . . . . . . . . . . . . . . . . . . 337
Prominent Eosinophils . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337
Prominent Neutrophils . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 338
Prominent Plasma Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339
Infiltration of Pericapsular Fat . . . . . . . . . . . . . . . . . . . . . . . . . . . 339
Extraneous Cells – Pigmented Cells, Epithelial Cells, Foreign Material,
Dermatopathic Lymphadenitis, Hemosiderin . . . . . . . . . . . . . . . . . 340
Inclusions of Benign Extraneous Cells . . . . . . . . . . . . . . . . . . . . . . . 340
8. Nodal Involvement by Leukemias and Extranodal Lymphomas . . . . . . . . . . 345
Nodal Involvement by Leukemia . . . . . . . . . . . . . . . . . . . . . . . . . . 345
Myeloid Leukemia/Myeloid Sarcoma . . . . . . . . . . . . . . . . . . . . . . . 345
Primary Myelofibrosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 346
B and T Cell Prolymphocytic Leukemias . . . . . . . . . . . . . . . . . . . . . . 348
NK Cell Lymphoproliferative Disorders . . . . . . . . . . . . . . . . . . . . . . 350
Nodal Involvement by Extranodal Lymphomas . . . . . . . . . . . . . . . . . . 351
Splenic B Cell Marginal Zone Lymphoma . . . . . . . . . . . . . . . . . . . . . 352
Hairy Cell Leukemia (HCL) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353
Heavy-Chain Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 354
Contents xi
Plasma Cell Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 355
Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma . . . . . . . . . . . . 356
Primary Cutaneous Diffuse Large B Cell Lymphoma (DLBCL) – Leg Type . . . . 358
Lymphomatoid Granulomatosis . . . . . . . . . . . . . . . . . . . . . . . . . . 359
Extranodal NK/T Cell Lymphoma – Nasal Type . . . . . . . . . . . . . . . . . 359
Blastic Plasmacytoid Dendritic Cell Neoplasm . . . . . . . . . . . . . . . . . . . 361
EBV-Associated T Cell Lymphoproliferative Disorders . . . . . . . . . . . . . . . 363
EBV-Positive T Cell Lymphoproliferative Disorders of Childhood . . . . . . . . . 363
9. Needle Core Biopsies and Aspirates . . . . . . . . . . . . . . . . . . . . . . . . 367
Needle Core Biopsies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 367
Advantages of Needle Core Biopsies . . . . . . . . . . . . . . . . . . . . . . . . 367
Disadvantages of Needle Core Biopsies . . . . . . . . . . . . . . . . . . . . . . . 368
Handling of Needle Core Biopsies . . . . . . . . . . . . . . . . . . . . . . . . . 368
Diagnostic Approach to Needle Core Biopsies of Lymph Nodes and
Potential Pitfalls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 368
Fine-Needle Aspiration Samples . . . . . . . . . . . . . . . . . . . . . . . . . . 399
Polymorphous Infiltrates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400
Monomorphous Infiltrates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 402
Subject Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 405

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