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Typical Morphologic Patterns of Infectious and Other Reactive Lymphadenopathies

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Practical Lymph Node and Bone Marrow Pathology

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Abstract

In this chapter, we describe the key histopathologic features in needle core, incisional, and/or (optimally) excisional biopsies, to be able to distinguish benign from malignant lymphadenopathy (LAD). Multiple schemata have been proposed by several authors to follow a pattern-based approach to the diagnosis of lymph node (LN) pathology [1, 2]. We adapt similar principles here. It is important to recognize that histologic features in any given diagnostic entity will vary based on whether LN was biopsied early or late into the time course of disease. Thus, patterns may overlap, or one pattern may predominate over another depending on the timing for any given disease.

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Abbreviations

AITL:

Angioimmunoblastic T-cell lymphoma

ALCL:

Anaplastic large cell lymphoma

ANA:

Antineutrophil antibody

anti-CCP:

Anti-citrullinated peptide/protein antibody

anti-dsDNA:

Anti-double-stranded deoxyribonucleic acid

anti-Sm:

Anti-Smith antibody

AOSD:

Adult-onset Still’s disease

cHL:

Classic Hodgkin lymphoma

CF:

Complement fixation

CLL/SLL:

Chronic lymphocytic leukemia/small lymphocytic lymphoma

CMV:

Cytomegalovirus

CRP:

C-reactive protein

DAT:

Direct antiglobulin test/direct Coombs test

DLBCL:

Diffuse large B-cell lymphoma

EBER ISH:

EBV-encoded RNA in situ hybridization

EBV :

Epstein Barr virus

EBV-IM:

EBV-related infectious mononucleosis

EIA:

Enzyme immunoassay

ESR:

Erythrocyte sedimentation rate

FDC:

Follicular dendritic cell

FRFH:

Florid reactive follicular hyperplasia

GC:

Germinal center

HIV/AIDS:

Human immunodeficiency virus/acquired immunodeficiency syndrome

HHV8:

Human herpesvirus 8

HLH:

Hemophagocytic lymphohistiocytosis/hemophagocytic syndrome

HRS:

Hodgkin/Reed-Sternberg

HSV:

Herpes simplex virus

HTN:

Hypertension

HV:

Hyaline vascular

IBD:

Inflammatory bowel disease

IFH:

Interfollicular hyperplasia

IFH/DFH:

Interfollicular hyperplasia/diffuse hyperplasia

IgG4-RD:

IgG4-related disease

IgG4-R-LAD:

IgG4-related lymphadenopathy

IHC:

Immunohistochemistry

IPT:

Inflammatory pseudotumor

KFD:

Kikuchi-Fujimoto disease

LA:

Latex agglutination

LAD:

Lymphadenopathy/lymphadenitis

LCH:

Langerhans cell histiocytosis

LDH:

Lactate dehydrogenase

LFA:

Lateral flow assay

LN:

Lymph node

LPL:

Lymphoplasmacytic lymphoma

MAI:

Mycobacterium avium intracellulare

MCD:

Multicentric Castleman disease

MCL:

Mantle cell lymphoma

MF:

Mycosis fungoides

MTB:

Mycobacterium tuberculosis

MZL:

Marginal zone lymphoma

NAAT:

Nucleic acid amplification test

NHL:

Non-Hodgkin lymphoma

NLPHL:

Nodular lymphocyte predominant Hodgkin lymphoma

NOS:

Not otherwise specified

NTM:

Non-tuberculous/atypical mycobacteria

PB:

Peripheral blood

PC:

Plasma cell

POEMS:

Polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes

PTCL:

Peripheral T-cell lymphoma

PTGC:

Progressive transformation of germinal centers

PTLD:

Post-transplant lymphoproliferative disorder

RA:

Rheumatoid arthritis

RDD/SHML:

Rosai-Dorfman-Destombes/sinus histiocytosis with massive lymphadenopathy

RF:

Rheumatoid factor

RFH:

Reactive follicular hyperplasia

SLE:

Systemic lupus erythematosus

TCHRLBL:

T-cell histiocyte-rich large B-cell lymphoma

TTP:

Thrombotic thrombocytopenic purpura

UCD:

Unicentric Castleman disease

VCA:

Viral capsid antigen

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Acknowledgments

We would like to thank Dr. Russell Brynes for generously sharing his extensive photomicroscopy slide collection, which supplied several of the figures in this chapter. We are also very grateful to Dr. Dennis O’Malley for kindly sharing photomicrographs from his collection of relatively rare entities.

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Authors and Affiliations

  1. Clinical Pathology, Hematopathology Service, Department of Pathology, LAC+USC Medical Center, Keck School of Medicine of USC (University of Southern California), Los Angeles, CA, USA

    Maria (Ria) Vergara-Lluri

  2. Clinical Pathology, Department of Pathology, Keck School of Medicine of USC (University of Southern California), Los Angeles, CA, USA

    Rosemary She

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Correspondence to Maria (Ria) Vergara-Lluri .

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  1. Department of Pathology, Duke University School of Medicine and Duke Health System, Durham, NC, USA

    Endi Wang

  2. Department of Pathology, Duke University School of Medicine and Duke Health System, Durham, NC, USA

    Anand Shreeram Lagoo

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Vergara-Lluri, M.(., She, R. (2020). Typical Morphologic Patterns of Infectious and Other Reactive Lymphadenopathies. In: Wang, E., Lagoo, A.S. (eds) Practical Lymph Node and Bone Marrow Pathology. Practical Anatomic Pathology. Springer, Cham. https://doi.org/10.1007/978-3-030-32189-5_18

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