1/21/2013

1

Pathology of Hematopoietic and Lymphoid tissue

Pathology of Hematopoietic and Lymphoid tissue

PeerayutSitthichaiyakul,M.D.DepartmentofPathologyFacultyofMedicine,Naresuan University

PeerayutSitthichaiyakul,M.D.DepartmentofPathologyFacultyofMedicine,Naresuan University

CONTENTSCONTENTS

WhitebloodcellsandlymphnodesQuantitativedisorderofwhitebloodcellsReactivelymphadenopathiesInfectiouslymphadenitisTumormetastasisinlymphnodesMyeloidneoplasmsLymphoidneoplasms

WhitebloodcellsandlymphnodesQuantitativedisorderofwhitebloodcellsReactivelymphadenopathiesInfectiouslymphadenitisTumormetastasisinlymphnodesMyeloidneoplasmsLymphoidneoplasms

QUANTITATIVEDISORDERSOFWHITEBLOODCELLSQUANTITATIVEDISORDERSOFWHITEBLOODCELLS

LEUKOPENIA

Neutropenia(agranulocytosis)Reducedorineffectiveproductionofneutrophils

Suppressionofmyeloidstemcells:AASuppressionofgranulocyticprecursors:DrugIneffectivegranulopoiesis :megaloblastic anemiaInheritedcondition

LEUKOPENIA

Neutropenia(agranulocytosis)Reducedorineffectiveproductionofneutrophils

Suppressionofmyeloidstemcells:AASuppressionofgranulocyticprecursors:DrugIneffectivegranulopoiesis :megaloblastic anemiaInheritedcondition

AcceleratedremovalordestructionofneutrophilsImmunologicalmediatedinjury

SLEDrugs

SplenicsequestrationSplenomegaly

IncreasedperipheraluseSevereinfection

AcceleratedremovalordestructionofneutrophilsImmunologicalmediatedinjury

SLEDrugs

SplenicsequestrationSplenomegaly

IncreasedperipheraluseSevereinfection

1/21/2013

2

NeutrophiliaBacterialinfectionTissueinfarction

MonocytosisChronicinfectionCollagen-vasculardiseases

NeutrophiliaBacterialinfectionTissueinfarction

MonocytosisChronicinfectionCollagen-vasculardiseases

EosinophiliaAllergyDrugreactionParasiticinfiltrationCollagen-vasculardiseases

EosinophiliaAllergyDrugreactionParasiticinfiltrationCollagen-vasculardiseases

LYMPHADENOPATHIESLYMPHADENOPATHIES

LymphnodesenlargementReactivelymphadenopathyLymphadenopathyassociatedwithclinicalsyndrome

InfectionNeoplasm:lymphoma,leukemia,metastatictumor

LymphnodesenlargementReactivelymphadenopathyLymphadenopathyassociatedwithclinicalsyndrome

InfectionNeoplasm:lymphoma,leukemia,metastatictumor

REACTIVELYMPHADENOPATHY

Reactivelymphoidhyperplasia(reactivehyperplasia

IncreasedcellularityoflymphnodesPalpablemass~1cm.Axilla,inguinal,cervicalandsupratrochlear

REACTIVELYMPHADENOPATHY

Reactivelymphoidhyperplasia(reactivehyperplasia

IncreasedcellularityoflymphnodesPalpablemass~1cm.Axilla,inguinal,cervicalandsupratrochlear

1/21/2013

3

1/21/2013

4

LYMPHADENOPATHYASSOCIATEDWITHCLINICALSYNDROME

SLElymphadenopathy

SLE increasedriskoflymphomaandinfectionLymphnodebiopsy Excludetheseconditions

LYMPHADENOPATHYASSOCIATEDWITHCLINICALSYNDROME

SLElymphadenopathy

SLE increasedriskoflymphomaandinfectionLymphnodebiopsy Excludetheseconditions

1/21/2013

5

Kimuralymphadenopathy

AsianFemale>male,27-40yrsSlowlylymphnodeenlergementHeadandneck auricularareaEosinophiliaIncreasedserumlevelofIgE

Kimuralymphadenopathy

AsianFemale>male,27-40yrsSlowlylymphnodeenlergementHeadandneck auricularareaEosinophiliaIncreasedserumlevelofIgE

Kikuchi-Fugimoto lymphadenopathyAsian,femalePainlesscervicallymphadenopahty withfeverandmyalgia

Kikuchi-Fugimoto lymphadenopathyAsian,femalePainlesscervicallymphadenopahty withfeverandmyalgia

1/21/2013

6

INFECTIOUS LYMPHADENITISINFECTIOUS LYMPHADENITIS

Virallymphadenitis HIVlymphadenitis

Infectiousmononucleosislymphadenitis

Bacteriallymphadenitis Ordinarybacteriallymphadenitis

Mycobacteriumlymphadenitis

Cat-scratchdisease

Fungallymphadenitis

Virallymphadenitis HIVlymphadenitis

Infectiousmononucleosislymphadenitis

Bacteriallymphadenitis Ordinarybacteriallymphadenitis

Mycobacteriumlymphadenitis

Cat-scratchdisease

Fungallymphadenitis

HIVlymphadenitisHIVlymphadenitis

1/21/2013

7

InfectiousmononucleosislymphadenitisEbstein-BarrvirusFever,pharyngitis,lymphadenopathyTeenagersandyoungadultsPeripheralblood atypicallymphocytes(monocytoid

lymphocytes,Downeycells)

InfectiousmononucleosislymphadenitisEbstein-BarrvirusFever,pharyngitis,lymphadenopathyTeenagersandyoungadultsPeripheralblood atypicallymphocytes(monocytoid

lymphocytes,Downeycells)

1/21/2013

8

TUMOR METASTASISTUMOR METASTASIS

Adjacenttoordistantfocifromprimarysite

MovableoffixedtosofttissueSofttofirmconsistency

Adjacenttoordistantfocifromprimarysite

MovableoffixedtosofttissueSofttofirmconsistency

1/21/2013

9

MYELOID NEOPLASMSMYELOID NEOPLASMS

NeoplasmsofhematopoieticstemcellsAcutemyelogenous leukemia(AML)

accumulationofimmaturemyeloidcellsinbonemarrow

Myelodysplastic syndrome(MDS) ineffectivehematopoiesis

Chronicmyeloproliferative disease(MPD) increasedproductionofterminallydifferentiatedmyeloidcells

NeoplasmsofhematopoieticstemcellsAcutemyelogenous leukemia(AML)

accumulationofimmaturemyeloidcellsinbonemarrow

Myelodysplastic syndrome(MDS) ineffectivehematopoiesis

Chronicmyeloproliferative disease(MPD) increasedproductionofterminallydifferentiatedmyeloidcells

ACUTEMYELOGENOUSLEUKEMIA(AML) Inhibitionofterminaldifferentiation accumulationof

immaturemyeloidcellsinbonemarrow

Clinicalfeatures Adult,peakincidence15-39yrs. Anemia,leukopenia,thrombocytopenia,pancytopenia Infiltratetogumorspleen gumhyperthrophy,splenomegaly

ACUTEMYELOGENOUSLEUKEMIA(AML) Inhibitionofterminaldifferentiation accumulationof

immaturemyeloidcellsinbonemarrow

Clinicalfeatures Adult,peakincidence15-39yrs. Anemia,leukopenia,thrombocytopenia,pancytopenia Infiltratetogumorspleen gumhyperthrophy,splenomegaly

1/21/2013

10

MYELODYSPLASTICSYNDROME(MDS) Groupofclonalstemcellsdisorderscharacterizedby

maturationdefects Ineffectivehematopoiesis IncreasedriskoftransformationofAML

Clinicalfeatures Oldage~60yrs Anemia,leukepenia,thrombocytopenia

MYELODYSPLASTICSYNDROME(MDS) Groupofclonalstemcellsdisorderscharacterizedby

maturationdefects Ineffectivehematopoiesis IncreasedriskoftransformationofAML

Clinicalfeatures Oldage~60yrs Anemia,leukepenia,thrombocytopenia

1/21/2013

11

CHRONICMYELOPROLIFERATIVEDISEASES(ChronicMPD)

Neoplasticdiseaseofstemcells Chronicmyelogenous leukemia Polycythemiavera Essenthial thrombocythemia Chronicidiopathicmyelofibrosis

CHRONICMYELOPROLIFERATIVEDISEASES(ChronicMPD)

Neoplasticdiseaseofstemcells Chronicmyelogenous leukemia Polycythemiavera Essenthial thrombocythemia Chronicidiopathicmyelofibrosis

Chronicmyelogenous leukemia(CML) Peakincidence30–50yrs Philadelphiachromosome

t(9;22)(q34;q11) Clinicalfeatures

Chronicphase :fatigue,weakness,weightlossanorexia,cytopenia,splenomegaly Accerelatedphase :increasinganemiaandthrombocytopenia Blastphase :acuteleukemia

Chronicmyelogenous leukemia(CML) Peakincidence30–50yrs Philadelphiachromosome

t(9;22)(q34;q11) Clinicalfeatures

Chronicphase :fatigue,weakness,weightlossanorexia,cytopenia,splenomegaly Accerelatedphase :increasinganemiaandthrombocytopenia Blastphase :acuteleukemia

1/21/2013

12

LYMPHOID NEOPLASMSLYMPHOID NEOPLASMS

LymphocyticleukemiaLymphoidneoplasmspresentwithwidespreadinvolvementofthebonemarrow,occasionally inperipheralblood

LymphomaLymphoidneoplasmspresentwithdiscretetissuemass

LymphocyticleukemiaLymphoidneoplasmspresentwithwidespreadinvolvementofthebonemarrow,occasionally inperipheralblood

LymphomaLymphoidneoplasmspresentwithdiscretetissuemass

LymphoidneoplasmLymphadenopathyExtranodal mass skin,stomachB-symptoms

FeverWeightlossNightsweat

HodgkinlymphomaNon-Hodgkinlymphoma

LymphoidneoplasmLymphadenopathyExtranodal mass skin,stomachB-symptoms

FeverWeightlossNightsweat

HodgkinlymphomaNon-Hodgkinlymphoma

1/21/2013

13

NON-HODGKINLYMPHOMA

B-cell~75%,T-cell~25%,NK-cell<1%1. DiffuselargeB-celllymphoma2. PeripheralT-celllymphoma,unspecified3. Follicularlymphoma4. Extranodal marginalzoneB-celllymphoma

PrecursorT-lymphoblasticlymphomaBurkitt lymphoma

NON-HODGKINLYMPHOMA

B-cell~75%,T-cell~25%,NK-cell<1%1. DiffuselargeB-celllymphoma2. PeripheralT-celllymphoma,unspecified3. Follicularlymphoma4. Extranodal marginalzoneB-celllymphoma

PrecursorT-lymphoblasticlymphomaBurkitt lymphoma

1/21/2013

14

HODGKINLYMPHOMA

Tumorcell Reed-sternberg cellsPainlesslymphadenopathy

SingleormultipleCervical,supraclavicular,mediastinum

B-symptoms:fever,weightloss,nightsweatPruritusPain afteralcoholingestion

HODGKINLYMPHOMA

Tumorcell Reed-sternberg cellsPainlesslymphadenopathy

SingleormultipleCervical,supraclavicular,mediastinum

B-symptoms:fever,weightloss,nightsweatPruritusPain afteralcoholingestion

1/21/2013

15

PLASMACELLNEOPLASMS PeripheralB-cellneoplasmssecretesinglehomogeneous

immunoglobulinoritsfragments

PlasmacellmyelomaBonemarrow-basemultifocalplasmacellneoplasms:vertebra,ribs,skull Anemia Serummonoclonalprotein Skeletaldestruction osteolytic lesionorpathologicfracture

PLASMACELLNEOPLASMS PeripheralB-cellneoplasmssecretesinglehomogeneous

immunoglobulinoritsfragments

PlasmacellmyelomaBonemarrow-basemultifocalplasmacellneoplasms:vertebra,ribs,skull Anemia Serummonoclonalprotein Skeletaldestruction osteolytic lesionorpathologicfracture