Pathology 6 White blood cell and lymph node disorders (1)

1. Pathology 6White blood cell and lymph node disorders (1)

2. Toxic changes in neutrophils include all the following, except: • Cytoplasmic basophilia • Large basophilic granules • Hypersegmentation • Cytoplasmic vacuoles • Dohle bodies

3. Large granular lymphoma is associated with • Neutropenia • Lymphocytopenia • Neutrophilia • Eosinophilia • Basophilia

4. Monocyopenia is associated with which one of the following tumors • Lymphoplasmacytic lymphoma • Chronic lymphocytic leukemia • Large granular lymphoma • Hairy cell leukemia • Hodgkin lymphoma

5. Nonneoplastic WBC disorders. • High number (cytosis) • Low number (cytopenia) • Abnormal function

6. 5 major types of WBCs • Neutrophils • Lymphocytes • Monocytes • Eosinophils • Basophils

7. What is the characteristic finding that lymphocytes display on peripheral blood in patients with pertussis? • Reactive lymphocytes • Lymphocytes with cleaved nuclei • Normal lymphocytes • Prominent nucleoli • Hairy cytoplasmic extensions

8. Neutropenia • Decrease in the number of neutrophils • When severe, it is called agranulocytosis • Usually less than 500 • Increased risk of infection • Two major mechanisms • Decrease production • Increase peripheral destruction of neutrophils

9. Decrease production • Marrow hypoplasia in patients who receive chemotherapy • Leukemia or other tumors replacing the marrow • Medications • Certain types of neoplastic lymphocytic proliferations such as large granular leukemia (LGL)

10. Increased peripheral use • Autoimmune destruction • Overwhelming bacterial, fungal or rickettsial infection • splenomegaly

11. Clinical manifestations • Infection, infection, infection!!! • bacterial • Fever, chills, malaise • Mucocutaneous necrotizing ulcers • High risk of sepsis

12. Treat with broad spectrum antibiotics • Depending on the clinical setting, treat with G-CSF

13. lymphocytopenia • Low number of lymphocytes • Less than 1000 in adults • Less than 3000 in children <2 years of age

14. Increased risk of • Opportunistic infections • Autoimmune disorders • Malignancy

15. Causes • Acquired: • HIV/AIDS • Protein malnutrition • Viral infections • Autoimmune disorders: SLE and RA • Certain leukemia or lymphoma tumors

16. Inherited • Severe combined immunodeficiency • Wiscott-Aldrich syndrome

17. Clinical manifestations • Infections with unusual microoganisms • Pneumocystis jiroveci • Fungal infections • CMV • Zoster These infection could be fatal • Risk of malignancies • Autoimmune disorders

18. Symptoms of associated diseases • Small or absent tonsils or lymph nodes in HIV or immune deficiency diseases • Lymphadenopathy: again in early HIV or lymphoma • Eczema in WAS • Stigmata of pancytopenia in cases of leukemia

19. Treatment • Treat infections • Treat underlying condition • IVIG for certain types of immune deficiency • Bone marrow transplantation

20. Monocytopenia • In the setting of other pancytopenia • Associated with hairy cell leukemia

21. eosinopenia • Can be found in healthy individuals • Of limited clinical significance • Steroid use • Acute inflammatory condition

22. Basopenia • Limited clinical significance • Acute hypersensitivity • Thyrotoxicosis • Infection

23. Neutrophilia • Increased number of neutrophils • Caused by • Acute bacterial infections • Sterile inflammation • Burns • Myocardial infarction • Morphology: TOXIC CHANGES

26. Toxic changes • Occur in the setting of bacterial infection • Cytoplasmic basophilia • Vacuoles • Dohle bodies

27. Lymphocytosis • Increased number of lymphocytes • Chronic bacterial infections • TB, brucella • Pertussis • Viral infection • Morphology depends on the cause

28. Infectious mononucleosis • Reactive lymphocytes

29. Pertussis

30. Monocytosis • Increased number of monocytes • Chronic infections such as TB (associated with lymphocytosis) • Endocarditis • Rickettsial infection • Collagen vascular disease such as SLE • Inflammatory bowel disease • Certain myeloid leukemia with monocytic differentiation

31. Eosinophilia • Allergic disorders • Parasitic infections • Medications • Collagen vascular disorders • Vasculitis • Atheroembolic disorders (transient) • Certain myelproliferative neoplasms • Certain lymphoma, specifically Hodgkin lymphoma

32. Basophilia • Rare, • Usually in the setting of chronic myelogenous leukemia.

33. Reactive lymphadenopathies

35. Acute nonspecific lymphadenitis • Enlargement of a localized or generalized group of lymph nodes • Localized in cases of draining a site of infection • Generalized viral or bacterial infection

36. Painful enlargement of the lymph nodes. • Histology: • Large follicles with germinal center formation • Frequent GC macrophages • Sinus enlargement with histiocytes • Parafollicular neutrophils, necrosis and possible pus formation

37. Chronic Nonspecific Lymphadenitis • It assumes three patterns • Follicular hyperplasia • Paracortical hyperplasia • Sinus histiocytosis

38. Follicular hyperplasia

39. No neutrophils • Can be confused with follicular lymphoma (1) the preservation of the lymph node architecture; (2) variation in the shape and size of the germinal centers; (3) the presence of a mixture of germinal center lymphocytes of varying shape and size; (4) prominent phagocytic and mitotic activity in germinal centers. (5) BCL2 is negative in the follicles and positive in follicular lymphoma

40. Paracortical hyperplasia • Viral infections • Medications • After vaccines

42. Sinus histiocytosis

43. Toxic changes in neutrophils include all the following, except: • Cytoplasmic basophilia • Large basophilic granules • Hypersegmentation • Cytoplasmic vacuoles • Dohle bodies

44. Large granular lymphoma is associated with • Neutropenia • Lymphocytopenia • Neutrophilia • Eosinophilia • Basophilia

45. Monocyopenia is associated with which one of the following tumors • Lymphoplasmacytic lymphoma • Chronic lymphocytic leukemia • Large granular lymphoma • Hairy cell leukemia • Hodgkin lymphoma

46. What is the characteristic finding that lymphocytes display on peripheral blood in patients with pertussis? • Reactive lymphocytes • Lymphocytes with cleaved nuclei • Normal lymphocytes • Prominent nucleoli • Hairy cytoplasmic extensions