Lymph nodes

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Author: Mikael Häggström [note 1]

Gross processing

If suspected lymphoma, before putting tissue in formalin, ensure that tissue is preserved in appropriate media for any special tests.

In samples with tumors, slice through all included fat while palpating and looking for lymph nodes, and submit all that are found.

Microscopic examination

Look for whatever pathology is indicated by the referral, or findings in other submitted specimens. The main target conditions are:

Lymph node metastasis from a neuroendocrine tumor of the midgut.
  • Metastasis, which usually looks similar to the primary tumor (neuroendocrine tumor in picture at right).
  • Reactive lymphadenopathy, by inflammation in an adjacent area, or systemic.

Reactive lymphadenopathy

Main patterns:

  • Follicular hyperplasia is the most common pattern of reactive lymphadenopathy.[1] It is usually associated with varying degrees of paracortical and/or sinus hyperplasia.

It usually has varying amount of paracortical and/or sinus hyperplasia.[1] Older age, increased follicular density (especially back-to-back arrangement) and areas of diffuse nodal effacement leads to a suspicion of follicular lymphoma.[1] Further information: Follicular lymphoma versus reactive follicular hyperplasia

  • Reactive paracortical hyperplasia, with expansion of paracortical areas by a mixed infiltrate, often having a mottled appearance. It usually has a concomitant reactive follicular hyperplasia.[1] A T-cell lymphoma should be suspected if there is obliteration or marked diminution of the B-cell cortical region, or highly irregular or hyperchromatic nuclei.[1]
  • An unspecific pattern of lymph node enlargement next to an inflamed area may simply be diagnosed as "benign reactive lymph node".

Notes

  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. 1.0 1.1 1.2 1.3 1.4 Weiss, Lawrence M; O'Malley, Dennis (2013). "Benign lymphadenopathies ". Modern Pathology 26 (S1): S88–S96. doi:10.1038/modpathol.2012.176. ISSN 0893-3952. 

Image sources