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Questions and Answers
What type of granulomas are typically associated with sarcoidosis?
Which of the following is a hallmark finding in sarcoidosis?
Which laboratory test is commonly used to confirm infectious mononucleosis?
What symptoms are typically associated with infectious mononucleosis?
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What is the causative agent of Cat Scratch Disease?
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Which condition is characterized by caseating granulomas in lymph nodes?
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In a patient with Toxoplasmosis, what type of lymphocyte predominance is expected?
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What is a common symptom of Cat Scratch Disease?
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What condition is referred to when lymph nodes are abnormal in size or consistency?
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Which of the following is a common cause of lymph node enlargement due to chronic inflammation?
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What describes the microscopic appearance of early tuberculous lymphadenitis?
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In which of the following conditions does a 'cold abscess' form?
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Which lymph nodes are primarily infected in tonsillar cases of tuberculosis?
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Which of the following describes sarcoidosis?
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What distinguishes caseating tuberculous lymphadenitis from early tuberculous lymphadenitis?
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Which of these diseases is NOT considered a chronic specific lymphadenitis?
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What is the most likely source of infection for lymphadenopathy?
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Which lymph node finding is characteristic of Cat Scratch Disease (CSD)?
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What is typically seen within giant cells in granulomas in sarcoidosis?
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Which agent causes Cat Scratch Disease (CSD)?
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Which condition is associated with 'cold abscesses' in the lymph nodes?
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What is the most likely diagnosis for a patient with non-caseating granulomas and bilateral hilar lymphadenopathy?
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What is the most likely diagnosis for a child with swollen, tender lymph nodes and caseating necrosis in biopsy?
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What is the confirmed causative agent in a patient with positive monospot test and symptoms of infectious mononucleosis?
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What type of pathological finding is typically associated with lymph nodes affected by tuberculosis?
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Which condition is most likely to present with enlarged lymph nodes and a positive heterophile antibody test?
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A biopsy showing reactive hyperplasia with a predominance of T lymphocytes is most suggestive of which condition?
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What type of lesion is characterized by a circular formation with epithelioid cells, giant cells, and necrosis in the context of lymph node biopsy?
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In a patient with fever and swollen lymph nodes who traveled to a malaria-endemic area, which diagnosis is most likely?
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Study Notes
Lymph Node Diseases
- Lymphadenopathy: Refers to abnormal lymph nodes in size or consistency.
- Causes of Lymphadenopathy: Inflammatory or neoplastic.
Acute Lymphadenitis
- Acute Non-Specific Lymphadenitis: Occurs in nodes draining acutely inflamed areas, like tonsillitis.
- Gross Morphology: Enlarged and tender nodes.
- Microscopic Morphology: Large germinal centers, neutrophilic infiltrate, and abscess formation in severe cases.
Chronic Lymphadenitis
- Chronic Non-Specific Lymphadenitis: Prolonged inflammatory or infective etiology.
- Reactive Hyperplasia: Commonest cause of lymph node enlargement.
- Chronic Specific Lymphadenitis: Caused by specific infections like tuberculosis, sarcoidosis, cat scratch disease, infectious mononucleosis, syphilis, and toxoplasmosis.
Tuberculosis
- Common Cause: Lymph node enlargement, especially in children.
- Primary Infection: Usually in children.
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Common Sites:
- Cervical lymph nodes: Infected from tonsils.
- Mediastinal lymph nodes: Infected by primary pulmonary tuberculosis.
- Mesenteric lymph nodes: Infected by ingesting infected milk (Tabes mesenterica).
- Early Tuberculous Lymphadenitis: Microscopic infiltration of small, pale tubercles with epithelioid cells, Langhan's giant cells, and minimal caseation.
- Caseating Tuberculous Lymphadenitis: Caseous necrosis replacing most nodal tissue with multiple tubercles at the periphery.
- Cold Abscess: Accumulation and liquefaction of caseous material, surrounded by TB granulation tissue and fibrosis; may open to outside forming multiple sinuses.
Sarcoidosis
- Cause: Unknown, affecting lungs and lymph nodes.
- Morphology: Non-caseating granulomas form in various organs.
- Microscopic Morphology: Well-circumscribed epithelioid granulomas with giant cells surrounded by lymphocytes.
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Giant Cell Inclusions:
- Astroid bodies: Star-shaped inclusions.
Cat Scratch Disease
- Causative Agent: Bartonella henselae.
- Transmission: Scratch or bite from infected cat.
- Symptoms: Swollen lymph nodes forming stellate abscesses.
Infectious Mononucleosis
- Causative Agent: Epstein-Barr virus (EBV).
- Transmission: Saliva.
- Symptoms: Pain, sore throat, fever, jaundice.
- Presentation: Reactive lymphadenopathy with increased lymphocytes and follicular hyperplasia.
Summary of Key Points for Each Diagnosis
- Tuberculosis: Caseating granulomas, enlarged lymph nodes (especially cervical), history of exposure to TB or pulmonary infection.
- Sarcoidosis: Non-caseating granulomas, elevated ACE levels, commonly affects lungs and lymph nodes, bilateral hilar lymphadenopathy.
- Infectious Mononucleosis (EBV): Sore throat, fever, lymphadenopathy, splenomegaly, positive Monospot test.
- Cat Scratch Disease: Stellate abscesses in lymph nodes, history of cat scratch or bite.
- Toxoplasmosis: Swollen lymph nodes with predominance of T lymphocytes, common in immunocompromised individuals or travel to endemic areas.
Questions and Answers
- Question 1: The most likely source of infection for cervical lymphadenopathy in a patient with tuberculosis is c) Tonsillar infection.
- Question 2: Stellate abscesses in lymph nodes are characteristic of b) Cat Scratch Disease (CSD).
- Question 3: Astroid bodies and Schaumann bodies are typically seen within the giant cells in granulomas of a) Sarcoidosis.
- Question 4: The causative agent of Cat Scratch Disease (CSD) is b) Bartonella henselae.
- Question 5: Cold abscesses are associated with c) Tuberculosis.
- Question 6: Bilateral hilar lymphadenopathy with non-caseating granulomas and no history of tuberculosis points to b) Sarcoidosis.
- Question 7: Swollen and tender cervical lymph nodes with caseating necrosis in a child with frequent tonsillitis suggests c) Tuberculosis of the lymph nodes (TB lymphadenitis).
- Question 8: Reactive lymphoid hyperplasia with predominance of lymphocytes is the most likely finding in enlarged lymph nodes in a patient with infectious mononucleosis (EBV), a positive Monospot test and symptoms of fever, sore throat and swollen neck lymph nodes.
- Question 9: A circular lesion composed of epithelioid cells, giant cells, and central necrosis in a lymph node biopsy is most likely b) Tuberculosis.
- Question 10: A 24-year-old man with persistent sore throat, fever, enlarged posterior cervical lymph nodes, splenomegaly, jaundice, and a positive heterophile antibody test (Monospot) likely has b) Infectious mononucleosis.
- Question 11: Multiple enlarged, painful axillary lymph nodes with reactive hyperplasia and a predominance of T lymphocytes in a 28-year-old woman presenting with fever, swollen lymph nodes, and recent travel to a malaria endemic area is likely caused by b) Toxoplasmosis.
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Description
Explore the key concepts of lymph node diseases, including lymphadenopathy, acute and chronic lymphadenitis, and specific causes like tuberculosis. This quiz covers inflammatory processes, morphological changes, and the implications of lymph node enlargement in various conditions.
