patologi sistem retikulo endhotelial_1
TRANSCRIPT
Prof. DR. Ambar Mudigdo, Sp.PA(K)
dr. Erna Sulistyowati, M.Kes
Lymph Node
Lymph Node1. AFF LYMPH. VES.
2. CAPSULE
3. PERI PHER SINUS
4. PARA FOLICULAR CORTEX/ T CELL ZONE
5. LYMPHOID FOLICLE/ B CELL ZONE
6. EFF LYMPH VES
7. ARTERI & VEIN
8. MEDULLA
9. MEDULLARY SINUSES
White cell Disorders
Defisiensi (leukopenia) Proliferatif
reaktif →infeksi neoplasma
Reactive leukocytosis Peningkatan leukosit Penyebab → mikrobial
→ non mikrobial
Reactive leukocytosis
Causes of leucocytosis Neutrophilic → acut bacterial infections Eosinophilic → allergic Basophilic → jarang,myeloproliferative
disease Monocytosis → chronic infections(TB),bact
endocarditis, rickettsiosis,malaria Lymphocytosis → accompanies with
monocytosis in chronic immunologic stimulation (TB,brucellosis); viral (hep A, CMV,EBV); Bordetella pertusis.
Infectious Mononucleosis Acute Self-limited disease Adolescent and young adult “Kissing disease” Caused by B lymphocytotropic EBV
(member herpesvirus family) Gx:
fever,sore throat and generalized lymphadenitis
Increased lymphocytes in blood (atypical) Humoral antibody response to EBV
Polyclonal activation and proliferation of B cells
Morphology Lymphocytosis (12.000-18.000/L) Atypical lymphocytes (abundant
cytoplasm,multiple nuclear vacuolation, oval, folded nucleus)
Lymph nodes: typically discrete,enlarged,post cervical,axillary and groin regions)
Spleen: enlarged Liver: impaired, atypical lymphocytes in
the portal areas and sinusoids
Infectious Mononucleosis
Infectious Mononucleosis
Atypical lymphocytes
Reactive Lymphadenitis
Infections and nonmicrobial inflammatory stimuli cause leucocytosis but also involve lymph nodes (defensive barriers)
Acute nonspecific lymphadenitis Chronic nonspecific lymphadenitis Chronic specific lymphadenitis
ACUTE NON SP LYMPHADENITIS
REACTIVE CHANGES : Micro organism Cell debris Foreign
material
cervicalaxillariesinguinal
Macros : Enlarged, swollen, grey-red, pain.
Micros : Lymphoid foll prominent, large germinal center,histiosit, neutrophil.
Reactive changes Cervical, axillaries, inguinal, mesentericMorphology : enlarged, swollen, grey-
red, distended caps tender.Histopathology : Lymph. Follicles
>>, Large germ C with mitotic activity, neutrophil infiltration. Sinuses cell hyper trophi / plasia.
ACUTE NON SP LYMPHADENITIS
Inguinal, axillaries, not tender. Histopathology:
follicular hyperplasia-B celldark zone, light zone, plasma cell, histiosit, PMN, eosinophyl.
Three patterns: Follicular hyperplasia Paracortical lymphoid hyperplasia Sinus histiocytosis
CHRONIC NON SP LYMPHADENITIS
CHRONIC NON SP LYMPHADENITIS
I. Follicular hyperplasiaactivated B cell, larged, round germinal center.
II. Paracortical lymphoid hyperplasiaReactive chages T cellViral Infection.
III. Sinus histiocytosis.Distention-prominent sinusoidLymph node draining cancer
CHRONIC SPECIFIC LYMPHADENITIS
TUBERCULOSA MACROS :
bergerombol, packed, central caseous.
MICROS :tubercle, cheese, necrotic, langhans cell,epitheloid cell.
CHRONIC SPECIFIC LYMPHADENITIS
Morphology : besar, multiple, bergerombol, tdk nyeri, livide, fistel
Histopatology: tuberc, epiteloid, caseosa, langhans.
Lokasi: Leher, Supraclav, axilla
NEOPLASTIC PROLIFERATIONS OF WHITE CELLS
Divided into 3 categories: Lymphoid neoplasms (HL,NHL,lyphocytics
leukemias, plasma cells dyscrasias) Myeloid neoplasms (acute myelogenous
leukemia, chronic myeloproliferative disorder,myelodisplastic syndr)
Hystiocytic neoplasms → proliferations of hystiocytes
LYMPHOID NEOPLASMA LYMPHOID NEOPLASMA
HODGKIN’S LIMPHOMA NON HODGKIN’S LYMPHOMA
LYMPHOMA
Hodgkin Disease
Chain nodes-spread characteristic Giant cells, Reed-Stenberg cell
induced Rx lymph, histiocyt, granulocyt.
Nodular sclerosismixed cellularitylymph predominant lymphocyte-depleted
Hodgkin Disease
Hodgkin DiseaseHodgkin Disease
Hodgkin disease
100% kel limfe Tunggal menyebar 20-40 th(30-35 th) Jenis
Nodular sclerosis : 65% Mixed cellularity : 25% Limfositik predominan :10% Limfositik depletion
Clinical staging of HD
HD & NHL
HDHD NHLNHL
Local lymph .CER-Local lymph .CER-ME.ST-P.AME.ST-P.A
MULTIPHERIPHERALMULTIPHERIPHERAL
CONTIQUITYCONTIQUITY NONO
EXTRA NODAL EXTRA NODAL UNCOMMONUNCOMMON
COMMONCOMMON
WALDEYER & WALDEYER & MESENTERIC MESENTERIC INVOLVED RAREINVOLVED RARE
COMMONCOMMON
NODULAR SCLEROSIS
Most common 65-75%, ♀, Young
Prognosa BAIK, Kel limfe Leher Supraclavicular, Mediastinum. Nodular, Variant Reed Stenberg, Lacunar cell,
collagen band, divide lymphositis-nodule.
Reed-Stenberg cell
Microskopis : Reed-stenberg
cell: besar, binukleus, berhadap-kaca, kadang-kadang multi nuc, single lob, sekitar halo area
Lacunar cell : nodular sel
HD; mixed cell type
25%,♂, older, prognosa baik Diffuse heterogen cell infiltrat, classic RS
cell, some mononucleus v
HD; lymphocytes predominant
6%, ♂, <35 th, prognosa exelent Lymph leher, axilla Nodular inf by lymph small round,RS cell
jarang, popcorn cell, << necrosis, fibrosis
Non Hodgkin Lymphomas
B-cell lymphoma
Chronic lymphocitic lymphoma Folicular lymphoma Diffus large B cell lymphoma Burkitt lymphoma Plasma cell neoplasm, etc.
MULTIPLE MYELOMA
PLASMA CELL bone, ♂ > ♀ , Immunoglobulin > , prot Bence
Jones (urine), Midle age (50). Clinic :
Multiple bone destruct: bone pain; Vert, Ribs, Skull, pelvis, femur, Rö bulat oval, batas fract. Patol.Micros : plasma cell >> pleomorphic, exentric nucleus plasma blast spleen, liver, kidney, lungs
Recurrent inf St.aureus, Str.pneumoniae Renal insuff; prot Bence Jones
Folicular lymphoma
NHL : paling sering(45%) ♀~♂; dewasa Micros : nodular struktur, small cell irreg.
inti lebih besar, cell chrom >>, nucleoli >
Clinical : painless limfadenopati, general, extra nodal rare, median survival 7-9 th
Tx : Chemoteraphy, radiasi, palliative Tx
Diffuse Large B-cell Lymphoma
20% NHL ♀<♂, 60 th Micros :
Diffus patern Large cell : 4-5x limf kecil Nuclei : bulat-oval, cleaved-lobulasi Anak inti : 2-3 atau 1 di tengah
Clinic :pembesaran kel. limf., kadang-kadang extra nodal : Git, bone, brain, skin.
Prog : Jelek Tx : Intensive mix chemo Tx complete remission 60-
80%, 50% for several years.
T cell lymphoma & natural killer cell N
1. Peri T cell L UNSP2. Adult T cell Lymphoma3. Mycosis fungoides4. Hodgkin disease
Klasifikasi bervariasi mnrt : Asal :sel B,sel T. Struktur : FOL,DIF. Vol.sel : LARGE,SM. DIFERENSIASI : WORKING FROM.,REAL
CLAS.,RAPPAPORT.
Precursor B Cell & T cell NPrecursor B Cell & T cell N
Acut Lymphoblastic LAcut Lymphoblastic L
di AS : 2500 KASUS BARU/THdi AS : 2500 KASUS BARU/TH < 15 th, kulit putih 2X< 15 th, kulit putih 2X ♂ ♂ > atau = ♀, balita, < 15 th.> atau = ♀, balita, < 15 th. Mic : Str Norm kel lif rusak, sel limfoblas Mic : Str Norm kel lif rusak, sel limfoblas
dominan : Besar. Inti Lobulated, Mitosis dominan : Besar. Inti Lobulated, Mitosis >>>>
Clinn : Anemia, Lemah, Panas Clinn : Anemia, Lemah, Panas acut. acut. Infeksi, Bone pain, Spleen & liver Infeksi, Bone pain, Spleen & liver enlargement, General limfadenopati, dllenlargement, General limfadenopati, dll
ACUT LIMFOBLASTIC LIMFOMA/LEUKEMIAACUT LIMFOBLASTIC LIMFOMA/LEUKEMIA
Chronic lymphocitic / small cell limfoma
Sering pada dewasa Small B cell pd sirkulasi (leukemia) Micros : str NL rusak, Small limfosit
predominan, inti kecil, kombinasi dgan sel > besar (prolimfositic)
Clin : > 50 tahun ♀< atau = ♂, sering asimptom, BB↓, lemah,
anoreksi, Lekosit >>, Limfadenopatia, spleen+ Liver
Burkitt limfoma
Endemic-sporadic-agresif (Afrika). Mic : invasi intermed size sel
limfosit, inti oval-bulat, nucleoli>1 kromatin kasar, mitosis>> starry sky patern (macrophages, ingest nuc debris)
Clinic : extra nodal manifes, mandibula,
organ intra Abdomen. Children, muda.
SPLEEN
SPLEEN
150 GR : 12 x 7 X 3 CM MACROS : KAPSUL TIPIS, ABU-ABU
TRABEKULA PD. PARENKIM MERAH DGN BERCAK PUTIH-WHITE PULP. RED PULP. SINUSSOID DGN KAPILER DD TIPIS
FUNGSI
1. Pembentukan sel darah (diluar sumsum tulang).
2. Proses hemolisis3. Reservoir darah, mobilisasi bila perlu4. Reaksi pertahanan-kekebalan tubuh,
produksi limfosit dan zat anti
Gangguan sirkulasi
1. Bendungan akut2. Bendungan menahun3. Sindroma banti : splenomegali
kongestif >>, lekopeni, anemi.4. Infark : Obstr. Emboli cor single/
multiple-Baji. Gamna-Gandy bodies : bercak abu2-coklat
(fibrosis+ endapan pigmen) pd Banti sindrom
Splenomegali
1. Infeksi : Typ. TBC, Mal syph2. Congestiv : Cirh, decomp, portalthrom3. Limfo-hematogen dis.4. Immunogenic5. Storage dis : gaucher, niemann-Pick6. Lain : amyloid, neopl
Neoplasm : JarangNeoplasm : Jarang
Benign : Hemangioma, Limfangioma, fibromaBenign : Hemangioma, Limfangioma, fibroma