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LAB
Exercise no. 15 GERMINAL CENTER where you see B lymphocytes,
Lymph Nodes I very rich in B lymphocyte
Dr. Rosales / October 10,2016
Midterms MANTLE/MARGINAL ZONE surround germinal
center; B lymphocytes are also the cells seen
LYMPH NODES
PARACORTEX where you see T lymphocytes, space
between your follicles is your T cell region

GERMINAL CENTER

SINUSES

CORTEX
o outer part; where you see LYMPHOID
FOLLICLE If you have a slide of your lymph node, first ask yourself if its
o the area with your follicles you can also see Reactive or Neoplastic. For this afternoon we will focus only
some of your sinuses on REACTIVE Processes involving your lymph node.

MEDULLA
o where you see SINUSES
o located in the center
o pink areas with lakes

REACTIVE LYMPH NODES

SUBCAPSULAR SINUS ACUTE NON-SPECIFIC LYMPHADENITIS

o where METASTATIC TUMORS are usually GROSS : swollen, gray-red & engorged (with pain and
first seen; first area to be infiltrated tenderness), sometimes warm, in contrast to chronic
o Where metastasis is evaluated before they lymphadenitis which is painless.
invade the parenchyma

LYMPHOID FOLLICLES:
o PRIMARY no germinal center; not
stimulated
o SECONDARY have reactive germinal center;
stimulated

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MICROSCOPIC: prominence of large reactive germinal PATTERNS of Chronic Non-Specific Lymphadenitis
centers; macrophage contains particulate debris a. FOLLICULAR HYPERPLASIA
o Caused by stimuli that activates humoral
immune response
o Folliclles are seen in the medulla, however it
should have varisized reactive germinal
center
o GROSS: varisized nodes
o MICROSCOPIC: varisized follicles with
large reactive germinal center
surrounded by a collar of resting nave B
lymphocytes

PYOGENIC/SUPPURATIVE centers of the follicles

became necrotic
SINUSES endothelial cell hyperplasia

PATTERNS in Acute Non-Specific Lymphadenitis

a. SUPPURATIVE LYMPHADENITIS
o Staphylococcal infection, mesenteric GERMINAL CENTERS:
lymphadenopathy, lymphogranuloma o Centroblast
venereum, cat-scratch disease o Centrocytes
o Tingible body macrophage
b. ACUTE NECROTIZING LYMPHADENITIS o Inconspicuous Dendritic cells
o Tularemia, Anthrax, Typhoid fever, Kikuchi
necrotizing lymphadenopathy

CHRONIC NON-SPECIFIC LYMPHADENITIS

Palpable nodes that are painless.
Common: axillary and inguinal lymph nodes
Chronic immune stimulation can cause aggregation of
lymphocytes (immune cells) in nonlymphoid organ
o Such as in the Stomach, in the case of H.
pylori infection
o Typhoid ileitis, in the Small intestine

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GRANULOMA
Specific type of chronic inflammation
Caseating
Non-caseating
b. PARACORTICAL HYPERPLASIA

o Stimuli that triggers T-lymphoctye immune

response IMMUNOHISTOCHEMISTRY
o Kasi diba sabi natin yung T-lymphocytes natin BASIC PRINCIPLE: Antigen-Antibody Reaction
nasa periphery, so sila yung dadami BASIC LYMPHOMA PANEL:
o Viral infection such as in Mononucleosis a. Leukocyte Common Antigen (LCA)/ CD45
o T-cell regions: immunoblasts b. CD3
o Activated T-lymphocytes: large lymphocyte c. CD20
with large nuclei, open chromatin, prominent
nucleoli and moderate amounts of pale A. LCA/CD 45
cytoplasm For the identification of lymphoid origin
o T cell regions can encroach in and efface B-cell Differentiates lymphoma , from carcinoma,
follicles, so maiipit na yung mga B follicles natin sarcoma, etc.
sa loob kasi naipit ng parami ng parami na T Reaction location: membrane
lymphocyte
o With hypertrophy of vascular and sinus B. CD 3
endothelial cells Identification of T cells an dtheir neoplasms
such as T and or NK cells
c. SINUS HISTIOCYTOSIS (Reticular Hyperplasia) Normal LN: paracortical areas
o Distention and expansion of sinuses T cell lymphoma: diffused staining
o Hypertrophy of the endothelial cells lining the Reaction location: membrane and cytoplasm
sinuses
o Increased number of macrophages
o Tumor-draining sinuses
o Observed in malignancies

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C. CD 20
Idenitification of the B cell lineage and different
types of B cell lymphoma
Normal LN: germinal center
B cell lymphoma: diffused staining pattern
Reaction location: membrane

BIOPSY: Lymph node reveals diffuse proliferation of

lymphocyte-like cells.

NEXT STEP: IMMUNOSTAINING

REMINDERS in IMMUNOHISTOCHEMISTRY:
Always request for a panel, avoid requesting for
one after the other
Interpretation should be based together with an
H&E slide INTERPRETATION:
Interpret immune slides only if you have good Reactive lymph nodes because staining is seen where you
control. expect them to be seen.
Consider pre-analytical, analytical and post-
analytical factors **IF, LCA (-), CD 20(+), CD3(+) REJECT!
If not clinically compatible, other
immunohistochem stains are available

CASE
18 year old female
Cervical lymph adenopathies
2 weeks: cough
Amoxicillin 500 mg TID x 3 days

WHAT ARE YOUR DIFFERENTIALS?

TB
Respiratory Tract Infection
Malignancy (depends)

WHAT IS YOUR NEXT STEP?

GS of sputum
AFS
Culture
CBC

RESULTS: Unremarkable DO BIOPSY.

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