GPR: 2020 - Week 34

From MGH Learn Pathology

Clinical history

30 yo F with unilateral, painless cervical lymphadenopathy and several months of fevers, night sweats and weight loss. Representative section of excisional lymph node biopsy is shown.


GPR20-10 -NSCHL.jpg


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GPR20-10 -NSCHL.jpg

 
Nodular Sclerosis Classic Hodgkin Lymphoma
  • Most common subtype of CHL (70% of CHL cases in US and Europe)
  • Macroscopic: neoplastic nodules separated by bands of fibrosis.
  • Most common type of CHL
  • Microscopy: characteristic Reed-Sternberg cells with a polymorphous inflammatory background, often composed of eosinophils, neutrophils and/or histiocytes.
  • Age: peaks 15-34 years, M=F
  • Site: Mediastinal and/or cervical lymph nodes
 

GPR20-10 -Sarcoid.jpg

 

Sarcoidosis

  • Multisystem chronic granulomatous disease
  • Macroscopic: enlarged lymph nodes, often firm. Can sometimes see confluent granulomas
  • Microscopic: Effacement by non-caseating granulomas composed of epithelioid histiocytes with scattered giant cells
  • Site: Classically bilateral hilar lymphadenopathy, often with lung nodules
  • Age: 20-39
 

GPR20-10 -Follicular lymphoma.jpg

 

Follicular Lymphoma

  • Small B-cell lymphoma of germinal center derivation
  • Macroscopic: Enlarged, often matted lymph nodes. Effaced hilus and architecture. “Fish flesh” appearance of cut surfaces. Can also appear nodular, but without fibrous bands.
  • Microscopic: Effaced architecture by small B lymphocytes, often forming neoplastic follicles
  • Site: Cervical and inguinal lymph nodes > extranodal
  • Age: Median 59 years
 

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Dermatopathic Lymphadenitis

  • Benign paracortical hyperplasia usually associated with exfoliative or eczematoid skin disorders
  • Macroscopic: enlarged lymph nodes with bulging cut surfaces. In severe cases can see melanin pigment along periphery
  • Microscopic: enlarged, hyperplastic paracortical nodules composed of T-cells, dendritic cells, Langerhan cells and macrophages with melanin.
  • Site: axillary and inguinal lymph nodes most common
  • Age: any
 
  • Dr. Judy Ferry
  • Dr. Aliyah Sohani

This week's Gross Pathology Roundup was presented by Megan Johnson Fitzpatrick, MD on Mon, Aug 17, 2020.