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Lymphoid System

Lymphoid System. Dr. Raid Jastania Dec, 2006. By the end of this session you should be able to: Describe the components of the lymphoid system List the disorders of the lymphoid system List the causes of leukopenia and leukocytosis Be able to process a lymph node biopsy

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Lymphoid System

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  1. Lymphoid System Dr. Raid Jastania Dec, 2006

  2. By the end of this session you should be able to: • Describe the components of the lymphoid system • List the disorders of the lymphoid system • List the causes of leukopenia and leukocytosis • Be able to process a lymph node biopsy • Understand and pathology of common infections involving lymph nodes

  3. Contents • Introduction • Processing lymph node biopsy • Leukopenia and Leukocytosis • Infectious mononucleosis • Acute and chronic lymphadinitis • Cat-scratch disease • Granulomatous inflammation

  4. Basics • What is the lymphoid system? • Components, function

  5. Basics • What is the lymphoid system? • Components, function • Consists of the lymph with the lymphatic channels and vessels, lymph nodes, thymus, spleen, and the visceral lymphoid tissue (GI, respiratory tract etc.) • Function: Immune system.

  6. Basics • What are the types of lymphocytes?

  7. Types of lymphocytes • T cell: • Cellular immunity • Produced in the bone marrow, mature in the thymus and released in the peripheral circulation • 2 subsets: T helper, and T cytotoxic • Th1, Th2

  8. Types of lymphocytes • B cells: • Humoral immunity (antibody production) • Produced in the bone marrow, released to the lymphoid organs. When activated matures to form plasma cells

  9. Types of lymphocytes • What is the effect of T cells on B cells?

  10. Basics • What are the disorders of the lymphoid system?

  11. List of Causes (or Disorders) • Primary vs Secondary • Congenital/Genetic vs Acquired • The Acquired: Non-neoplastic, Neoplastic • Non-neoplastic: Inflammatory, Idiopathic • Inflammatory: Infection, Drugs, Toxins, Metabolic, Immune • Eg. Causes of hepatitis, heart failure, lymphadenopathy

  12. Basics • Symptoms and signs of lymphoid disorders.

  13. Symptoms and Signs • Primary, Secondary, Non specific • Anatomical and Functional • Complications of the disease process • Eg. Features of lymphoma • Lymphadenopathy, fever, night sweat, wt. Loss • Mass effect, vascular obstruction, eg. Superior vena cava syndorme. • Suppressed immunity. • Eg. Features of chronic liver disease.

  14. Basics • Clinical information needed • History, Examination, investigations.

  15. Basics Lymph Node Biopsy

  16. Basics • Normal lymph node

  17. Anatomy of the Lymph Node • 3 major zones: • Cortex: • B-cells, Follicles, Mantle cells, Marginal zones, secondary follicles, germinal centers • Paracortex: • T-cells, interdigitating dendritic cells, post capillary venules • Medulla: • Lymph sinuses, veins, arteries, plasma cells, B-cells mainly

  18. Cells in the Lymph Node • T-cells: • Bone marrow---Thymus---Paracortical area of LN • Cellular immunity • B-cells: • Bone marrow, gut lymphoid tissue • Cortex and Medulla of LN • Humoral immunity • Natural Killer cells • Do not mark as B or T • No specific distribution • Others: Histiocytes, follicular and interdigitation dedritic cells, plasma cells, neutrophils, endothelial cells

  19. Flow cytometry

  20. Case • 50 year old man with Diffuse large B cell lymphoma. • He received 4 cycles of chemotherapy. • Now he has neutropenia.

  21. List of Causes • Primary vs Secondary • Congenital/Genetic vs Acquired • The Acquired: Non-neoplastic, Neoplastic • Non-neoplastic: Inflammatory, Idiopathic • Inflammatory: Infection, Drugs, Toxins, Metabolic, Immune • Eg. Causes of hepatitis, heart failure, lymphadenopathy

  22. Non-Neoplastic disorders • Leukopenia • Any type of the white blood cell • Causes: congenital, acquired • Neutropenia

  23. Non-Neoplastic disorders • Leukopenia • Any type of the white blood cell • Causes: congenital, acquired • Neutropenia • Inadequate or ineffective hematopoiesis • Destruction of neutrophils • Clinical presentation: malaise, fever, infections, oral ulcers

  24. Reactive Leukocytosis • Neutrophilic leukocytosis • Lymphocytosis • Eosinophilic leukocytosis • Basophilic leukocytosis • Monocytosis

  25. Case • 21 year old female with history of bilateral cercical lymphadenopathy for 2 months. • The illness started with sore throat and few days of fever.

  26. List of Causes • Primary vs Secondary • Congenital/Genetic vs Acquired • The Acquired: Non-neoplastic, Neoplastic • Non-neoplastic: Inflammatory, Idiopathic • Inflammatory: Infection, Drugs, Toxins, Metabolic, Immune • Eg. Causes of hepatitis, heart failure, lymphadenopathy

  27. Infectious Mononucleosis • EBV infection • Acute self-limiting • Adolescents and young adults • Fever, sore throat, generalized lymphadenopathy • Lymphocytosis with atypical lymphocytes on smear • Positive serology for EBV

  28. Infectious Mononucleosis • Route of infection: saliva? • Types of infection: Productive , latent • Polyclonal B cell proliferation • Morphology: • Peripheral blood, Lymph nodes, Spleen, Liver • EBV in immunosuppresed individual • EBV in X-linked lymphoproliferative syndorme

  29. Case • 10 year-old boy with right axillary lymphadenopathy for 2 weeks • He had forearm injury with skin infection.

  30. List of Causes • Primary vs Secondary • Congenital/Genetic vs Acquired • The Acquired: Non-neoplastic, Neoplastic • Non-neoplastic: Inflammatory, Idiopathic • Inflammatory: Infection, Drugs, Toxins, Metabolic, Immune • Eg. Causes of hepatitis, heart failure, lymphadenopathy

  31. Case • 50 year old lady with Rheumatoid arthritis for several years • She has generalized lymphadenopathy.

  32. List of Causes • Primary vs Secondary • Congenital/Genetic vs Acquired • The Acquired: Non-neoplastic, Neoplastic • Non-neoplastic: Inflammatory, Idiopathic • Inflammatory: Infection, Drugs, Toxins, Metabolic, Immune • Eg. Causes of hepatitis, heart failure, lymphadenopathy

  33. Reactive lymphadenitis • Acute non-specific lymphadenitis • infections • Local or generalized • Morphology • Chronic non-specific lymphadenitis • Follicular hyperplasia • Paracortical lymphoid hyperplasia • Siuns histiocytosis

  34. Case • 15 year old boy with right cervical lymphadenopathy for 6 weeks • No previous history of illness • Lymph node biopsy shows necrotizing lymphadenitis

  35. List of Causes • Primary vs Secondary • Congenital/Genetic vs Acquired • The Acquired: Non-neoplastic, Neoplastic • Non-neoplastic: Inflammatory, Idiopathic • Inflammatory: Infection, Drugs, Toxins, Metabolic, Immune • Eg. Causes of hepatitis, heart failure, lymphadenopathy

  36. Cat-Scratch Disease • Infection: Bartonella henselae • Acute self-limiting • Children • Regional lymphadenopathy: axilla, neck • Regress over 2-4 months • Morphology

  37. Case • 28 year old Indian male. • Has generalized lymphadenopathy, more prominent in the neck bilaterally. • Lymph node biopsy shows granulomatous inflammation

  38. List of Causes • Primary vs Secondary • Congenital/Genetic vs Acquired • The Acquired: Non-neoplastic, Neoplastic • Non-neoplastic: Inflammatory, Idiopathic • Inflammatory: Infection, Drugs, Toxins, Metabolic, Immune • Eg. Causes of hepatitis, heart failure, lymphadenopathy

  39. Granulomatous inflammation • Types: necrotizing , non-necrotizing • Causes: infectious, non- infectious • Infections: bacterial (T.B), fungal (Histoplasma), Parasitic (Schistosoma), Viral (less likely) • Non-infectious: Foreign body, immune (sarcoidosis), idiopathic

  40. By the end of this session you should be able to: • Describe the components of the lymphoid system • List the disorders of the lymphoid system • List the causes of leukopenia and leukocytosis • Be able to process a lymph node biopsy • Understand and pathology of common infections involving lymph nodes

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