Lymph nodes & spleen, nonlymphoma

Lymph node-nonspecific findings

Other nonspecific findings


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Cite this page: Balakrishna J, Sharabi A, DePond W. Other nonspecific findings. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/lymphnodesothernonspecific.html. Accessed October 28th, 2021.
Clofazimine induced changes

Definition / general
  • Clofazimine induced crystal storing histiocytosis

ICD coding
  • ICD-10: R59.9 - enlarged lymph nodes, unspecified

Epidemiology
  • Rare condition in patients taking clofazimine, an antileprosy medication

Sites
  • Most commonly subcutaneous tissue, spleen, lymph nodes, liver, lung and gastrointestinal tract

Clinical features
  • Red discoloration of skin and other tissues, mass formation, lymphadenopathy

Diagnosis
  • History of clofazimine intake, biopsy

Radiology description
  • Enlarged lymph nodes, particularly intra-abdominal lymph nodes

Prognostic factors
  • Extent of involvement

Case reports

Treatment
  • Excision of affected lymph node
  • Cessation of treatment apparently does not reverse the process

Gross description
  • Enlarged lymph node with light brown to dark red discoloration
  • Fixative and solutions used for processing the specimen turn red with the crystals dissolving in them

Microscopic (histologic) description
  • Marked interfollicular plasmacytosis and histiocytes containing crystals in their cytoplasm, which are elongated with irregular edges, some forming bundles
  • Crystals are typically deep red, but depending on the fixative and processing can be clear and colorless (crystals dissolve in alcohol)
  • Crystals show bright red birefringence if polarized
  • They can be seen in extra and intracellular locations

Positive stains
  • Plasma cells are highlighted by CD138 and are polyclonal by kappa and lambda light chain stains
  • Lymphocytes are mixed B and T cells and histiocytes show positive staining with CD68 and CD163

Negative stains
  • Crystals are negative for PAS and immunoglobulin heavy and light chains

Electron microscopy description
  • Transmission electron microscopy shows the empty spaces which crystals have been occupying
  • Crystals show some osmiophilic material which appear to be granular or multivesicular bodies
  • Upon higher magnification, these crystals show a multilamellar core or a lattice with elements spaced periodically

Electron microscopy images

Images hosted on other servers:

Elongated and rhomboid shaped dense crystals



Molecular / cytogenetics description
  • No clonal populations of cells

Differential diagnosis
  • Crystal storing histiocytosis with immunoglobulin crystals:
  • Fungi
  • Parasites

Additional references

Board review style question #1
Hyaline deposits

Definition / general

Microscopic (histologic) description
  • Extracellular eosinophilic material resembling amyloid but Congo Red negative
  • Hyaline sclerosis of small and midsized vessels of lymph nodes and organs (Blood 1995;86:1159)

Positive stains
  • Immunoglobulins

Negative stains

Differential diagnosis
Infarction

Definition / general

Microscopic (histologic) description
  • Extensive necrosis with perinodal inflammation and granulation tissue
  • May retain a rim of viable lymphatic tissue
  • Reticulin architecture is retained

Microscopic (histologic) images

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Coagulative necrosis

Marked congestion and fibrin thrombi

CD20+

Post gold injection

Loss of follicles, few lymphocytes and distended sinuses


Superficial lymph nodes:

Early infarction with
small thrombosed
veins and perinodal
neutrophils

Thrombosed vein next to node

Organizing thrombus of hilar vein

Recanalizing thrombus of hilar vein

Lymphocytes
beneath sinus,
perinodal infiltrate
is present

Retention of reticulin



Immunohistochemistry

Differential diagnosis

Additional references
Lymphedema

Definition / general

Treatment
  • Elevation of extremity, compression and massage; if necessary, excise thickened skin and replace with skin grafts

Microscopic (histologic) description
  • Markedly dilated dermal lymphatics, including in lymph nodes
  • Fibrous tissue deposition in overlying skin, subcutaneous tissue and fascia

Microscopic (histologic) images

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Dilated lymphatic spaces lined by endothelium



Additional references
Mantle cell / marginal zone hyperplasia

Definition / general
  • Gene rearrangement studies and followup recommended to rule out occult lymphoma in cases with clear cells (Am J Clin Pathol 2001;116:550)
  • Marginal zone hyperplasia is rare (except in mesenteric nodes) but does occur in reactive nodes (APMIS 2002;110:325)

Microscopic (histologic) description
  • Monomorphic proliferation of small lymphocytes with clear cytoplasm and round nuclei
  • No pericapsular infiltration, sinuses are identifiable, scattered reactive follicles

Microscopic (histologic) images

Contributed by Mark R. Wick, M.D.

Cortical hyperplasia



Positive stains

Negative stains
  • No light chain restriction

Molecular / cytogenetics description
  • Usually negative
Monocytoid B cell hyperplasia

Definition / general

Microscopic (histologic) description
  • Sinuses distended by small lymphoid cells with clear cytoplasm and central, round / oval nuclei
  • Variable neutrophils

Differential diagnosis

Additional references
Plasmacytosis

Definition / general

Case reports

Microscopic (histologic) description
  • Well preserved nodal architecture with plasma cells and plasma cell precursors in medullary cords
  • Sinuses are patent

Negative stains
  • No light chain restriction

Molecular / cytogenetics description
  • Not clonal

Differential diagnosis
Polykaryocytes

Definition / general
  • Warthin-Finkeldey polykaryocytes are associated with various benign and malignant lymphoid conditions
  • Initially identified in tonsils of patients with measles
  • Also present in HIV patients

Case reports

Microscopic (histologic) description
  • Multinucleated giant cells from 25 - 150 microns, with minimal cytoplasm and up to 60 nuclei

Microscopic (histologic) images

Images hosted on other servers:

Warthin-Finkeldey giant cells with numerous closely packed nuclei



Positive stains

Additional references
Sinus histiocytosis

Definition / general

Case reports

Microscopic (histologic) description
  • Dilated and prominent sinuses, often containing increased macrophages or sinus lining cells
  • May resemble signet ring cell carcinoma cells but lack atypia and are mucin negative

Microscopic (histologic) images

Images hosted on other servers:

Sinus histiocytosis



Cytology description
Board review style question #1
In crystal storing histiocytosis, the cell type which accumulates crystals is

  1. Histiocytes
  2. Lymphocytes
  3. Neutrophils
  4. Plasma cells
Board review style answer #1
A. The crystals in CSH in tissues get phagocytosed by histiocytes where they form collections. When these cells accumulate, they form a mass lesion.

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Reference: Other nonspecific findings
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