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1:
Sinus Histiocytosis with Massive Lymphadenopathy (Rosai-Dorfman Disease)
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Comments: Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease) is a disease of unknown etiology characterized by massive, painless enlargement of cervical lymph nodes. Note the distension of sinuses by histiocytes, lymphocytes, and plasma cells – diagnostic hallmark of the disease.
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5:
Kikuchi Lymphadenopathy
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Comments: Kikuchi Lymphadenitis (Necrotizing Lymphadenitis, Kikuchi-Fujimoto disease) is a self-limiting disease of unknown etiology usually seen in young women in Japan and other Asian countries. Patients present with painless cervical lymphadenopathy that may be accompanied by fever. Lymph nodes show well-circumscribed necrotizing lesions in paracortical areas.
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6:
Kikuchi Lymphadenopathy
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Comments: The image shows necrotic focus in the center with karyorrhectic debris surrounded by mononuclear cells which are plasmacytoid monocytes. The main differential diagnosis is with malignant lymphoma with secondary necrosis.
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7:
Kikuchi Lymphadenopathy
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Comments: High power view of a necrotic focus in Kikuchi lymphadenitis shows karyorrhectic debris and fibrin deposits (on the left) and collections of large mononuclear cells (on the right). Plasmacytoid monocytes are common but plasma cells and neutrophils are rare in the necrotic foci.
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8:
Sarcoidosis Lymphadenopathy
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Comments: The image shows numerous closely-packed non-necrotizing granulomas effacing the architecture in a lymph node affected by sarcoidosis.
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9:
Sarcoidosis Lymphadenopathy
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Comments: Intermediate-power view shows numerous sarcoid granulomas composed of epithelioid histiocytes, occasional Langhans’ giant cells and lymphocytes.
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10:
Sarcoidosis Lymphadenopathy
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Comments: In sarcoid granulomas, the Langhans’ giant cells are usually smaller with fewer nuclei than those seen in tuberculosis. Necrosis is usually absent. Necrotizing variant of sarcoidosis does exist, but it is usually extranodal.
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11:
Sarcoidosis Lymphadenopathy : Asteroid Body
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Comments: Asteroid bodies may be seen in the cytoplasm of epithelioid or giant cells in sarcoidosis as eosinophilic, stellate or spider-like inclusions. The radiating filamentous arms contain complex lipoproteins, calcium, phosphorus, silicon, and aluminum. Image courtesy of : Ed Uthman, MD, Houston, Texas. Used with permission.
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12:
Amyloid Lymphadenopathy
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Comments: The patient was a 54 y/o male who presented with isolated inguinal lymphadenopathy (4.5 cm). There was no systemic involvement. The lymph node was very firm and had a waxy consistency on cutting. Image courtesy of : Ed Uthman, MD, Houston, Texas. Used with permission.
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13:
Amyloid Lymphadenopathy
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Comments: Acellular, amorphous, eosinophilic amyloid deposits accounted for approximately 90% of the nodal volume. The residual lymphoid tissue was benign with small but well-formed germinal centers. Foreign body giant cells surround many of the amyloid deposits.Image courtesy of : Ed Uthman, MD, Houston, Texas. Used with permission.
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14:
Amyloid Lymphadenopathy : Congo Red
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Comments: Amyloid deposits stain orange-red with Congo Red stain. Image courtesy of : Ed Uthman, MD, Houston, Texas. Used with permission.
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15:
Amyloid Lymphadenopathy
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Comments: With Congo Red stain, amyloid deposits produce characteristic apple-green birefringence under polarized light. Image courtesy of : Ed Uthman, MD, Houston, Texas. Used with permission.
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16:
Castleman's Disease : Hyaline-Vascular Type
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Comments: Castleman’s disease (giant lymph node hyperplasia, angiofollicular lymph node hyperplasia, lymph node hamartoma) is a distinct form of lymph node hyperplasia. Hyaline-vascular type shows large lymphoid follicles scattered throughout the lymph node. Several sclerotic bands are also present. Hyaline-vascular type represents approximately 90% of cases of solitary form of Castleman’s disease. Remainder are plasma cell type.
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17:
Castleman's Disease : Hyaline-Vascular Type
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Comments: The follicles show abnormal germinal centers with marked vascular proliferation and hyalinization. The center of the follicle is usually depleted of lymphocytes and shows follicular dendritic cells. The follicle is surrounded by a broad mantle zone consisting of a concentric layering of lymphocytes resulting in an onion-skin appearance. The follicles are frequently penetrated radially by a sclerotic blood vessel.
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18:
Castleman's Disease : Hyaline-Vascular Type
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Comments: The interfollicular stroma shows abundant hyperplastic vessels of post-capillary venule type lined by plump endothelial cells. A mixed infiltrate of plasma cells, lymphocytes, eosinophils, immunoblasts, and plasmacytoid monocytes is also present in the stroma.
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19:
Castleman's Disease : Plasma Cell Type
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Comments: Multicentric or Systemic form of Castleman’s disease is usually of plasma cell type which shows diffuse plasma cell proliferation in the interfollicular region. The image shows a small follicle in the center with eosinophilic deposits of fibrin and immune complexes. Hyaline-vascular changes are absent. Plasma cell type of Castleman’s disease is often symptomatic and is accompanied by fever, anemia, elevated erythrocyte sedimentation rate, hypergammaglobulinemia, and hypoalbuminemia. In contrast, hyaline-vascular type is often asymptomatic.
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20:
Castleman's Disease : Plasma Cell Type
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Comments: High-power view of plasma cell type shows massive infiltration of the interfollicular region by plasma cells. Occasionally, the plasma cells may be multinucleated or show atypia. The solitary form of Castleman’s disease (usually hyaline-vascular type) can be treated by surgical excision. The long-term prognosis of systemic form of Castleman’s disease (usually plasma cell type) is poor and it may evolve into a clonal lymphoproliferative disorder.
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21:
Silicone Lymphadenopathy
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Comments: The patient was a 36 y/o female who underwent right modified radical mastectomy followed by breast reconstruction and silicone implants. She presented with right axillary lymphadenopathy which was biopsied. Low-power view shows liquid silicone droplets appearing as round vacuoles of varying sizes in lymph node parenchyma and sinuses.
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22:
Silicone Lymphadenopathy
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Comments: Silicone may escape from implants due to rupture, leak, or simply by “bleeding” through the surface of an intact implant and carried to the regional draining lymph nodes causing adenopathy. The image shows presence of silicone as a refractile, non-staining, and non-polarizable material within histiocytes creating a foamy or bubbly appearance. Silicone can be identified by infrared microspectroscopy or radiographic microanalysis in tissue samples.
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23:
Kimura Lymphadenopathy
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Comments: The patient was a 35 y/o female from Vietnam with history of recurrent inguinal masses. Resection of one of the subcutaneous nodules revealed hyperplasia of germinal centers and a prominent perinodal eosinophilic infiltrate. The features are diagnostic of Kimura’s disease – an inflammatory disorder of unknown origin endemic in the far east.
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24:
Kimura Lymphadenopathy
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Comments: Massive perinodal eosinophilic infiltrate is one of the diagnostic features of Kimura’s disease. Sometimes eosinophilic abscesses may be seen. Hyalinized blood vessels are often seen in the paracortical region in Kimura’s disease.
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