Dr. Monika Nema

Dr. Monika Nema

Non neoplastic conditions

Filaria lymphadenitis.

Drug induced lymphadenopathy.

Kimura disease.

Angiolymphoid hyperplasia with

eosinophilia.

Dermatopathic lymphadenopathy.

Eosinophilic granuloma of lymph node.

Dr. Monika Nema

Neoplastic conditions

Mixed cellularity Hodgkin disease

Eosinophilic myeloid disorder

Angioimmunoblastic T cell Lymphoma

Dr. Monika Nema

Dr. Monika Nema

Endemic in tropical countries.

Transmitted by mosquitoes.

Caused by infection with filarial parasite like

Wuchereria bancrofti,

Brugia malayi,Brugia timor.

Dr. Monika Nema

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

Blockage of the lymphatics in the lower

limbs may cause elephantiasis of the legs,

more often in the elderly persons.

Dr. Monika Nema

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.

Dr. Monika Nema

Microfilaria embedded in the

eosinophil infiltrate

Dr. Monika Nema

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

Dr. Monika Nema

Dr. Monika Nema

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.

Dr. Monika Nema

Clinical feature- hepatitis, gingival

hyperplasia,fever,

skin rash,eosinophilia,gum hyperplasia

and lymphadenopathy,

hepatospleenomegaly ,facial edema.

Dr. Monika Nema

Lymphodenopathy,regress after

anticonvulsants are discontinued, but they

may reappear if the same drug is resumed.

Dr. Monika Nema

Dr. Monika Nema

Dr. Monika Nema

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.

Dr. Monika Nema

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

Dr. Monika Nema

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

Dr. Monika Nema

KIMURA

LYMPHADENOPATHY

ANGIOLYMPHOID

HYPERPLASIA WITH

EOSINOPHILIA

Dr. Monika Nema

Dr. Monika Nema

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.

Dr. Monika Nema

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 histiocytesare 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

Dr. Monika Nema

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

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.

Dr. Monika Nema

Sheets of Langerhans cells with eosinophil

Sheets of Langerhans cells with eosinophil

Dr. Monika Nema

Dr. Monika Nema

• 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

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

Dr. Monika Nema

Dr. Monika Nema

Dr. Monika Nema

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

Dr. Monika Nema

Dr. Monika Nema

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

Dr. Monika Nema

Dr. Monika Nema

Dr. Monika Nema

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,epithelioidcells.

Bone marrow,spleen,liver,lung may be involved.

Dr. Monika Nema

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

Presentation by – Dr. Monika Nema

Dr. Monika Nema