Block 3 PATH Exam -- Lymphadenopathy & Splenomegaly (#16)
Terms
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- Sinus hyperplasia is frequently a normal finding in which nodes (2)?
-
Mesenteric
Axillary - What cells is a primary follicle composed of?
- Virgin B cells
- What cells is the interfollicular zone comprised of?
- T cells
- Lymphadenopathy in which nodes is almost always due to malignancy (2)?
-
Supraclavicular
Retroperitoneal -
Occurence and extent of lymphadenopathy is greater in whom?
Children OR adults - Children
- Biopsied LNs from infectious mono. can look like what other conditions (3)?
-
Non-Hodgkin's lymphoma
Waldenstrom's macroglubilinemia
Lymphocyte-predominant Hodgkin's - What pts. often have epitrochlear, axillary, and inguinal lymphadenopathy?
-
Manual laborers
Repeated, minor injuries to extremities cause repeated small infections
NOTE: the nodes are usually non-tender - What anti-epileptic drug is associated w/ lymphadenopathy?
- Dilantin
- How do NON-neoplastic nodes typically appear on exam?
-
Enlarged
Flat
Relatively soft - How do neoplastic nodes typically appear on exam?
-
Enlarged
Irregular
Rubbery hard - How do infected nodes typically appear on exam?
-
Enlarged
Variable hardness
Tenderness
Redness
Heat
Pain
NOTE: Hodgkin's may occasionally present w/ tender LNs - A LN larger than ____ should be considered enlarged
- 1 cm
- Rubella has a tendency to affect which LNs?
- Posterior auricular
- Toxoplasmosis has a tendency to affect which LNs?
- Posterior cervical
- Intra-thoracic/abdominal carcinomas usually affect which LNs?
-
Supraclavicular
Scalene - Sarcoidosis usually affects which LNs?
-
HILAR
Supraclavicular
Scalene - Hodgkin's disease has a tendency to affect which LNs?
- Mediastinal
- Subacute necrotizing lymphadenitis has a tendency to affect which LNs?
- Posterior cervical
- What is sinus histiocytosis?
-
Benign disorder of young adults
Painless, massive cervical lymphadenopathy (bilateral)
Histiocytic infiltration in the sinuses of the LN - Secondary syphilis has a tendency to affect which LNs?
-
Epitrochlear
(bliaterl) -
What are the charactertistics of Castleman's disease?
(w/ regards to lymphadenopathy) -
Large, solitary mediastinal mass
Atypical hyperplasia, w/ burned out germinal centers
Marked capillary proliferation - Which important veneral disease does NOT produce lymphadenopathy?
- Gonorrhea
- Which lymphatic disease often mimics appendicitis?
- Acute mesenteric lymphadenitis
- Pts. w/ marked enlargement of the retroperitoneal LNs often present w/ what?
-
Backache
(assoc. w/ other findings weight loss, sweats, etc.) - Where are the epitrochlear LNs located?
- In the "elbow pit"
- Why is a LN biopsy NOT indicated in CLL?
- Peripheral blood and marrow findings are diagnostic
- Increased what in peripheral blood is diagnostic of infectious mono?
- Atypical lymphocytes
- What is the white pulp composed of (2)?
-
Secondary lymph follicles
Periarterial lymphatic sheaths - What is the red pulp composed of?
- Splenic cords and sinuses
- What cell type are the marginal zones of the spleen rich in?
- Monocytes
- Flow of venous drainage from the spleen
- Sinuses --> pulp veins --> trabecular veins --> splenic hilar veins
- What are splenic cords?
- Extravascular collections of hematopoietic cells (mostly red)
- Where does arterial blood flow of the spleen empty into?
- Splenic cords
- Lymphatic drainage of the spleen
-
Confined to the white pulp
Lymphatics coalesce to form trabecular lymphatic vessels
Run adjacent to trabecular arteries - What LNs does lymphatic drainage of the spleen drain into?
-
Splenic hilar nodes
Celiac nodes - Where are the marginal zones located in the spleen?
- At the junction of the white and red pulp
- % of cardiac output that is blood flow to the spleen
- 5%
- What is chronic passive congestion?
-
Splenomegaly due to an increase in portal vein pressure
NOTE: splenomegaly is due to expansion of the RED pulp - Degree of splenic sequestration for RBCs, granulocytes, platelets
-
RBCs - 1%
Granulocytes - 20%
Platelets - 30% - With enlargement of the spleen, how much red cell pooling can occur?
- 25%
- With enlargement of the spleen, how much platelet pooling can occur?
- Up to 90%
- What type of organisms is the spleen specialized for removing?
- Encapsulated organisms
- What is normal spleen size and weight?
-
4 x 8 x 12 cm
<= 200 grams - Normal size spleen is usually no longer palpabe after what age?
- 3 - 4 years old
- What is primary splenic hyperplasia?
- Splenomegaly in which a specific underlying disorder is not found
- Most common causes of splenomegaly in the Western hemisphere (2)
-
Hematologic disorders
Congestive splenomegaly - 7 clinical manifestations of splenomegaly
-
LUQ pain, discomfort, fullness
Left supraclavicular pain
Early satiety
Weight loss
Excess sweating
Manifestations of cytopenias
Hematemesis from varices - LUQ pain is not common in absence of what?
- Splenic infarction
- Left supraclavicular pain in splenomegaly is due to what?
- Irritation to the left diaphragm
- What is Felty's syndrome?
- Syndrome of Rheumatoid arthritis, splenomegaly, and neutropenia
- Organisms that can cause the "infectious mono symptom complex"
-
EBV
CMV
Toxoplasmosis - What do Rouleau formations indicate?
-
Hypergammaglobulinemia
(can be either poly- or monoclonal) - Type of gammaglobulin assoc. w/ Waldenstrom's macroglobulinemia
- Monoclonal IgM
- Hallmarks of an increased rate of RBC destruction (5)
-
Poikilocytosis
Anisocytosis
Schistocytosis
Polychromatophilia
Nucleated RBCs -
Splenomegaly is more often seen in what pts. w/ ALL
Children or adults -
Children
NOTE: splenomegaly is DISTINCTLY UNUSUAL in adults w/ acute leukemia - What is the most common cause of stomatocytosis?
- Heavy alcohol intake
- Charactertistic blood findings in the thalassemias
-
Target cells
Hypochromic microcytes
Basophilic stippling - How is diagnosis of hereditary pyropoikilocytosis confirmed?
- Demonstrating increased fragility to heat
- Most common cause of Autoimmune hemolytic anemia
- Drugs
- Charactertistic finding on the smear in AIHA
- Autoagglutination of RBCs
- Most common underlying disease process in congestive splenomegaly
- Intrinsic liver disease
-
Splenectomy is often indicated in this condition
(even if spleen is NOT enlarged) - Autoimmune thrombocytopenia