Lymph nodes & spleen, nonlymphoma
Lymph node-nonspecific findings
Other nonspecific findings
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PubMed Search: Clofazimine induced changes, Hyaline deposits lymph node, Infarction[TI] lymph node, Lymphedema[TI] lymph node[TI], Mantle cell marginal zone hyperplasia, Monocytoid B cell hyperplasia, Plasmacytosis lymph node, Polykaryocytes[TIAB], Sinus histiocytosis[TI] lymph nodes
Table of Contents
Clofazimine induced changes | Hyaline deposits | Infarction | Lymphedema | Mantle cell / marginal zone hyperplasia | Monocytoid B cell hyperplasia | Plasmacytosis | Polykaryocytes | Sinus histiocytosis | Board review style question #1 | Board review style answer #1Cite this page: Balakrishna J, Sharabi A, DePond W. Other nonspecific findings. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/lymphnodesothernonspecific.html. Accessed April 25th, 2024.
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
- 32 year old man with chronic abdominal pain (Am J Surg Pathol 2000;24:129)
- 41 year old leprosy patient with abdominal pain (Pathology 1993;25:24)
- 44 year old woman with adenocarcinoma of colon and crystal storing histiocytosis (Lepr Rev 2004;75:171)
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:
- Usually associated with a lymphoid or plasma cell neoplasm
- Fungi
- Parasites
Additional references
- PLoS One 2012;7:e47494, Head Neck Pathol 2012;6:111, Antimicrob Agents Chemother 2016;60:3470, Antimicrob Agents Chemother 2011;55;4000, J Pharmac Sciences 2017;106:1162
Board review style question #1
Hyaline deposits
Definition / general
- Also called proteinaceous lymphadenopathy
- Often present in stroma of pelvic or abdominal nodes
- Nonspecific finding
- Increases with age (Am J Pathol 1975;78:7, Histol Histopathol 2003;18:1169)
- May reduce nodal function
- Associated with
- Rheumatoid arthritis and systemic sclerosis (J Clin Pathol 1994;47:138, Br J Rheumatol 1995;34:1087)
- Hypergammaglobulinemia (Arch Pathol Lab Med 1990;114:34, Am J Surg Pathol 1979;3:137)
- Posttreatment changes for carcinoma (Histopathology 1996;29:63)
- May calcify
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
- Uncommon
- Associated with fever, pain and lymphadenopathy (Am J Clin Pathol 1980;74:687)
- Causes:
- Lymphoma
- Melanoma or granulocytic sarcoma (APMIS 2003;111:1133)
- Venous thrombosis
- Arterial occlusion in vasculitis (polyarteritis nodosa)
- Emboli (cholesterol) (Hum Pathol 1978;9:597)
- Heart lung transplantation (J Thorac Cardiovasc Surg 1990;99:861)
- Fine needle aspiration (J Clin Pathol 1982;35:855, Diagn Cytopathol 2001;25:104)
- Mediastinoscopy (Ann Thorac Surg 1989;48:247)
- Gold injection (J Clin Pathol 2001;54:562)
- Dengue fever with DIC (BMC Clin Pathol 2005;5:11)
- Infectious mononucleosis (Int J Surg Pathol 2002;10:223)
- Parvovirus B19
- Intestinal volvulus
- Examine node carefully (possibly with levels or immunohistochemistry) and follow patient to rule out lymphoma or other malignancies (Histopathology 1986;10:571, Indian J Pathol Microbiol 2005;48:510)
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
Images hosted on other servers:
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
- Tumor cells may stain with traditional markers (keratin, S100), even if remaining node is necrotic but be cautious (Arch Pathol Lab Med 2003;127:60, Arch Pathol Lab Med 2003;127:922)
Differential diagnosis
- Granulomatous inflammation
- Infectious mononucleosis
- Kikuchi disease
- Malignancy: lymphoma or melanoma
- Mucocutaneous lymph node syndrome
Additional references
Lymphedema
Definition / general
- Either congenital, infectious, obstructive, traumatic or idiopathic
- Congenital: also called Milroy disease (primary hereditary lymphedema), autosomal dominant (OMIM: Lymphedema, Hereditary, IA; LMPH1A [Accessed 28 June 2018], OMIM: Lymphedema, Hereditary, II; LMPH2 [Accessed 28 June 2018], OMIM: Yellow Nail Syndrome [Accessed 28 June 2018], OMIM: Lymphedema-Distichiasis Syndrome [Accessed 28 June 2018])
- Infectious: due to schistosomiasis in endemic areas; occasionally due to minor infection such as furuncle
- Obstructive: associated with malignancy or nodal dissection (axilla or groin most common)
- Traumatic: may be as minor as sprained ankle
- Idiopathic: called lymphedema praecox (if before age 35 years) or tarda
- All causes are associated with lymphangitis, cellulitis and recurrent infections
- Postmastectomy lymphedema may lead to angiosarcoma
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
Images hosted on other servers:
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
- BCL2 (by marginal zone B cells) (Am J Surg Pathol 2003;27:888)
Negative stains
- No light chain restriction
Molecular / cytogenetics description
- Usually negative
Monocytoid B cell hyperplasia
Definition / general
- Benign disorders are toxoplasmosis, cat scratch disease, EBV, HIV, autoimmune disorders, zoonotic Brugia (Am J Surg Pathol 2005;29:595, Hum Pathol 1985;16:979, Am J Clin Pathol 1996;105:384)
- Also associated with mantle cell / marginal zone hyperplasia
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
- Common in paracolic lymph nodes draining tumor (Virchows Arch A Pathol Anat Histopathol 1987;411:239)
- Associated with idiopathic plasmacytic lymphadenopathy, which resembles Castleman disease (Int J Surg Pathol 2004;12:25)
Case reports
- 72 year old woman with Sjögren syndrome and plasmacytosis resembling myeloma (J Korean Med Sci 2005;20:506)
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
- Plasmacytic SLL / CLL:
- Diffuse, not just involvement of medullary cords
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
- 65 year old woman with systemic lupus erythematosus (Hum Pathol 1988;19:1358)
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
- Also called sinus hyperplasia
- Nonspecific finding associated with various etiologies (benign or malignant), including postprosthesis
- May represent pregranulomatous phase of sarcoidosis (Am J Surg Pathol Acta Histochem 2006;107:473)
- Rarely occurs in pelvic nodes of prostate cancer and axillary nodes of breast cancer patients (Cancer 1997;80:277)
Case reports
- 16 year old girl with parvovirus (J Clin Pathol 2005;58:872)
- 68 year old woman with postarthroplasty histiocytic lymphadenopathy (Arch Gynecol Obstet 2004;269:217, J Urol 1997;158:128)
- 70 year old diabetic patient with signet ring cell sinus histiocytosis resembling carcinoma (Am J Clin Pathol 1989;92:509, Int J Clin Oncol 2003;8:184)
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
- Polygonal histiocytes with rounded nuclei (Acta Cytol 1998;42:1347)
Board review style question #1
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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Reference: Other nonspecific findings
