Lymph nodes - not lymphoma
Inflammatory disorders (non-infectious)
Chronic lymphadenitis

Author: Jaya Balakrishna, M.D. (see Authors page)
Editor: Abdelsalam Sharabi, M.D.

Revised: 13 February 2016, last major update February 2016

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

PubMed Search: Chronic lymphadenitis [title]
Definition / General
  • Common, chronic inflammatory process of lymph nodes in response to various pathogens
  • May be specific or nonspecific, known or unknown
  • Lymph nodes show variable amounts of necrosis, abscesses, granulomas and fibrosis
Essential Features
  • Non-specific etiology
  • General histological features are follicular hyperplasia, prominence of post capillary venules, increased number of immunoblasts, plasma cells, histiocytes and fibrosis
Terminology
  • Also called chronic non-specific lymphadenitis
Sites
  • Cervical or any other lymph node groups can be affected
Clinical Features
  • Enlarged lymph nodes (by palpation or imaging)
  • Painless
Clinical Images

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Lymphadenopathy

Diagnosis
  • Biopsy and clinical history are necessary
  • Adjuvant diagnostic methods such as special stains, electron microscopy, immunohistochemistry, in situ hybridization analysis and polymerase chain reaction (PCR) techniques help delineate specific causative factors
Laboratory
  • Specific findings depend on the etiology
Prognostic Factors
  • Good prognosis in general, although prognosis and treatment vary based on specific etiology
Gross Description
  • Enlarged lymph node
  • Capsule may be thickened
Gross Images

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Due to tuberculosis

Micro Description
  • Follicular hyperplasia, prominence of post capillary venules, increased number of immunoblasts, plasma cells and histiocytes and fibrosis
  • Capsule may be inflamed or fibrotic
  • Inflammation / fibrosis may extend into the immediate perinodal tissues
  • Terms such as xanthogranulomatous lymphadenitis and eosinophilic lymphadenitis are used to describe cases with undue prominence of eosinophils, foamy macrophages or mast cells
Micro Images

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Dermatopathic lymphadenopathy



Cat-Scratch Disease related:

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Microabscesses

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Stellate necrosis

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Follicular hyperplasia

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Warthin-Starry



Lymphogranuloma Venereum related:

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Microabscesses

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Necrotic focus with neutrophils



Syphilis related:

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Hyperplasia, lymphoid follicles

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Florid follicular hyperplasia

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Chronic inflammation

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Prominent vasculitis



Herpes Simplex Virus related:

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Geographic necrosis

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Cowdry Type A inclusions

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Hematologic malignancies



Leprosy related:

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Foamy histiocytes


Toxoplasmosis related:

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Hyperplastic follicle

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Clusters, epithelioid cells

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Toxoplasma gondii


Cytology Description
  • Smear derived from reactive follicle: centroblasts, centrocytes, small lymphocytes and tingible body macrophages with nuclear fragments
  • Paracortical hyperplasia: spectrum of basophilic cells, ranging from mature plasma cells to immunoblasts with a background of many small lymphocytes
Positive Stains
  • T cell and B cell markers show reactive pattern
Negative Stains
  • Special stains for microorganisms
  • Immunohistochemical stains / patterns for lymphoma
Flow Cytometry Description
  • Reactive pattern: mixed / polyclonal population
Differential Diagnosis