LYMPHOID TISSUE I. Lymphadenopathy a. Locations of lymphoid tissue i.

Locations: regional LN, tonsils & adenoids (Waldeyers ring), Peyers patches & appendix, white pulp of spleen ii. B cells: germinal follicles in LN, peripheral areas of spleen white pulp iii. T cells: paracortex (parafollicular) in LN, periarteriolar sheath in spleen, thymus iv. Histiocytes: sinuses in LN, skin (Langerhans cells) v. Locations of lymphoid disorders 1. Germinal follicle: reactive lymphadenitis, follicular B-cell lymphoma 2. Sinus: metastasis, sinus histiocytosis, Langerhans cell histiocytosis, histiocytic lymphoma 3. Paracortex: reactive hyperplasia, T-cell lymphoma b. Lymphadenopathy i. Epidemiology 1. Age a. < 30 yo: nodal enlargement is benign (80%) b. > 30 yo: nodal enlargement is benign (60%) 2. Causes a. Reactive lymphadenitis: hyperplasia of B cells, T cells or histiocytes b. Infiltrative disease, i.e. metastasis (most common), malignant lymphoma ii. Clinical findings 1. Painful nodes imply inflamm, i.e. infection a. Localized i. Drain sites of infection, i.e. tonsillitis ii. Most common sites: ant cervical, inguinal b. Generalized i. Systemic disease ii. Ex: infectious mononucleosis, SLE 2. Painless nodes imply malignancy a. LN indurated & fixed to surrounding tissue b. Localized i. Nodes draining primary cancer site, i.e. axillary nodes in breast CA ii. Hodgkins lymphoma c. Generalized i. Metastasis in leukemia ii. Follicular B-cell lymphoma 3. Key nodal groups involved in primary or metastatic cancer a. Submental: metastatic SCC in floor of mouth

LYMPHOID TISSUE b. Cervical: metastatic H & N tumors (larynx, thyroid, nasopharynx), HL c. L-sided supraclavicular (Virchows nodes): metastatic abd CA (stomach, pancreas) d. R-sided supraclavicular: metastatic lung & esophageal CA, HL e. Axillary: metastatic breast CA f. Epitrochlear: cat-scratch disease, non-Hodgkins lymphoma g. Hilar: metastatic lung CA, sarcoidosis (bilateral) h. Mediastinal: metastatic lung CA, HL (nodular sclerosing type), Tcell lymphoblastic leukemia i. Tonsillar (sup jugular node): metastatic squamous CA in oral cavity j. Para-aortic: metastatic testicular CA (testicles migrate to scrotum from abd location), Burkitts lymphoma k. Inguinal: metastatic vulvar & penis CA c. Types of reactive lymphadenitis i. Follicular hyperplasia 1. B-cell antigenic response a. Germinal follicles are sharply demarcated from paracortex b. Cells are in different stages of development c. Ex: early stages of HVI infection, RA, SLE ii. Paracortical hyperplasia 1. T-cell antigenic response a.