Lymph Node Pathology for Clinicians

217 Pages·2019·32.304 MB·English

by  Michel R. Nasr, Anamarija M. Perry, Pamela Skrabek

Pathology for Clinicians
Michel R. Nasr
Anamarija M. Perry
Pamela Skrabek
Lymph Node
Pathology
for Clinicians
Pathology for Clinicians
Series Editor
Ivan Damjanov
University of Kansas School of Medicine
Kansas City, KS, USA
More information about this series at http://www.springer.com/series/13438
Michel R. Nasr
Anamarija M. Perry • Pamela Skrabek
Lymph Node Pathology
for Clinicians
Michel R. Nasr Anamarija M. Perry
State University of New York Upstate University of Michigan Medical School
Medical University Ann Arbor, MI
Syracuse, NY USA
USA
Pamela Skrabek
University of Manitoba
Max Rady College of Medicine
Winnipeg, MB
Canada
ISSN 2570-3382 ISSN 2570-3382 (electronic)
Pathology for Clinicians
ISBN 978-3-030-11514-2 ISBN 978-3-030-11515-9 (eBook)
https://doi.org/10.1007/978-3-030-11515-9
Library of Congress Control Number: 2019936448
© Springer Nature Switzerland AG 2019
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To my beloved family – my wife, Rima; my
children, Roene and Roy; my father; my
mother; and my siblings, Hadi, Doli, and
Issam. M.R.N.
To my teacher, mentor, and friend – Dr.
Marin Nola – as I promised, the first one is
for you. A.M.P.
Preface
Lymph node pathology is a complex and rapidly evolving field that requires integra-
tion of morphologic findings with a number of ancillary studies, as well as clinical
information, to diagnose neoplastic and nonneoplastic hematopoietic disorders.
Lymphoma classification has evolved significantly over the last few decades; cur-
rently, the 2016 Revision of the World Health Organization (WHO) Classification is
followed. This classification emphasizes, and for some diagnoses mandates, the
integration of clinical information in diagnostic decision-making. Successful col-
laboration and teamwork between pathology and clinical specialties (especially
hematology/oncology) are paramount for excellent patient care. In addition to diag-
nosis, pathology plays a significant role in lymphoma prognostication and therefore
contributes to patient’s management and follow-up.
The number of entities that can be encountered in neoplastic and nonneoplastic
lymph node pathology is substantial and can be overwhelming even to a trained
hematopathologist. Moreover, some entities are very rare and therefore rarely
encountered. Appropriate utilization and integration of ancillary studies is required.
This book was envisioned as a concise overview of different entities in lymph node
pathology with the primary audience being clinicians. Not all entities have been
covered, but, rather, the most common and/or clinically most relevant ones were
included. Even though the book is focused on lymph node pathology, some primar-
ily extranodal entities (e.g., MALT lymphoma, nasal NK/T-cell lymphoma) were
included.
This text is intended as a quick reference for a clinician to become familiar with
pathologic aspects of lymphomas and the thought process of a pathologist. We hope
that hematologists/oncologists, surgeons, trainees in oncology and surgery, as well
as radiologists or anybody involved in the diagnosis and care of patients with lymph
node disorders will find this book to be useful.
Syracuse, NY, USA Michel R. Nasr
Ann Arbor, MI, USA Anamarija M. Perry
Winnipeg, MB, Canada Pamela Skrabek
vii
Acknowledgments
Writing a book is no easy task and a number of colleagues and friends helped us
along the way. Drs. Lauren Smith, Sarah Choi, Jeffrey Myers, and Denise Sulavik
provided numerous excellent cases for microscopic images. Drs. Jared Bullard and
Arshad Ahsanuddin reviewed selected chapters and offered constructive advice.
And last but not least, we are very grateful to Megan Wiseley who worked continu-
ously and tirelessly to put this book together.
ix
Contents
1 Basic Concepts in Lymph Node Pathology . . . . . . . . . . . . . . . . . . . . . . . . 1
General Principles and Lymphoma Classification . . . . . . . . . . . . . . . . . . . . 1
Acquisition, Handling, and Processing of Lymph Node Specimens . . . . . . 5
2 Histologic Examination and Ancillary Studies
in Lymph Node Pathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Normal Lymph Node Histology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Ancillary Studies in Lymph Node Pathology . . . . . . . . . . . . . . . . . . . . . . . . 13
3 Benign Disorders of Lymph Nodes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Viral Lymphadenitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Bacterial Lymphadenitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Mycobacterial Lymphadenitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Fungal Lymphadenitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Protozoal Lymphadenitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Reactive Lymphoid Hyperplasia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Progressive Transformation of Germinal Centers . . . . . . . . . . . . . . . . . . . . . 49
Sinus Histiocytosis with Massive Lymphadenopathy . . . . . . . . . . . . . . . . . 52
Kikuchi-Fujimoto Lymphadenitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Sarcoidosis Lymphadenopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Lymphadenopathy Associated with Autoimmune Disorders . . . . . . . . . . . 60
Dermatopathic Lymphadenopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
Castleman Lymphadenopathy (Disease) . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Silicone Lymphadenopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
4 Precursor Lymphoid Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
B-Lymphoblastic Leukemia/Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . . 73
T-Lymphoblastic Leukemia/Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
5 Mature B-Cell Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma . . . . . . . 79
Splenic Marginal Zone Lymphoma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
Hairy Cell Leukemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Lymphoplasmacytic Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Extraosseous Plasmacytoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
xi
xii Contents
Extranodal Marginal Zone Lymphoma of Mucosa-Associated
Lymphoid Tissue (MALT Lymphoma) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Nodal Marginal Zone Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Pediatric-Type Nodal Marginal Zone Lymphoma . . . . . . . . . . . . . . . . . . . 98
Follicular Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Pediatric-Type Follicular Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Duodenal-Type Follicular Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
In Situ Follicular Neoplasm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Mantle Cell Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
In Situ Mantle Cell Neoplasia (isMCN) . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Diffuse Large B-Cell Lymphoma, NOS . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
T-Cell/Histiocyte-Rich Large B-Cell Lymphoma . . . . . . . . . . . . . . . . . . . . 114
EBV-Positive Diffuse Large B-Cell Lymphoma NOS . . . . . . . . . . . . . . . . 116
Primary Mediastinal (Thymic) Large B-Cell Lymphoma. . . . . . . . . . . . . . 119
Plasmablastic Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
Burkitt Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
High-Grade B-Cell Lymphoma with MYC and BCL2
and/or BCL6 Rearrangements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
High-Grade B-Cell Lymphoma, NOS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
B-Cell Lymphoma, Unclassifiable, with Features
Intermediate Between Diffuse Large B-Cell
Lymphoma and Classic Hodgkin Lymphoma . . . . . . . . . . . . . . . . . . . . . . . 131
6 Mature T- and NK-Cell Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Extranodal NK/T-Cell Lymphoma, Nasal Type . . . . . . . . . . . . . . . . . . . . . 133
Intestinal T-Cell Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
Hepatosplenic T-Cell Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
Peripheral T-Cell Lymphoma, NOS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
Angioimmunoblastic T-Cell Lymphoma. . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Anaplastic Large Cell Lymphoma, ALK-Positive . . . . . . . . . . . . . . . . . . . 150
Anaplastic Large Cell Lymphoma, ALK-Negative . . . . . . . . . . . . . . . . . . . 153
Breast Implant-Associated Anaplastic Large Cell Lymphoma . . . . . . . . . . 156
7 Hodgkin Lymphomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Nodular Lymphocyte-Predominant Hodgkin Lymphoma . . . . . . . . . . . . . 159
Classic Hodgkin Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
8 Immunodeficiency-Associated Lymphoproliferative Disorders . . . . . . 169
Lymphomas Associated with HIV Infection . . . . . . . . . . . . . . . . . . . . . . . . 169
Posttransplant Lymphoproliferative Disorders . . . . . . . . . . . . . . . . . . . . . . 171
Other Iatrogenic Immunodeficiency-Associated
Lymphoproliferative Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
Contents xiii
9 Histiocytic and Dendritic Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
Histiocytic Sarcoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
Langerhans Cell Histiocytosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Follicular Dendritic Cell Sarcoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205