Veterinary Lymphadenitis and Lymphoma Quiz
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Questions and Answers

What is a key feature of eosinophilic lymphadenitis?

  • Increased macrophages and neutrophils
  • Presence of large atypical lymphocytes
  • Predominantly neutrophils present
  • Greater than 3% eosinophils (correct)

    • Which condition is most commonly associated with mixed cell lymphadenitis?

  • Fungal infections like histoplasmosis
  • A predominance of monomorphic lymphocytes
  • A combination of various etiologies (correct)
  • Chronic inflammation from higher-order bacteria

    • What characterizes lymphoma based on the lymphocyte population?

  • Less than 50% of lymphocytes are atypical
  • A predominance of a monomorphic lymphocyte population over 50% (correct)
  • Predominance of mixed cell types
  • Presence of more than 3% eosinophils

    • What is a potential cause of pyogranulomatous lymphadenitis?

    <p>Chronic inflammation (C)</p> Signup and view all the answers

    In lymphomas, which immunophenotype classification yields important treatment implications?

    <p>B-cell vs. T-cell (D)</p> Signup and view all the answers

    What is the primary purpose of staging in relation to lymphadenomegaly?

    <p>To check for the presence of metastatic disease (C)</p> Signup and view all the answers

    Which of the following lymph nodes is located near the ventral angle of the jaw?

    <p>Mandibular (A)</p> Signup and view all the answers

    What is one of the recommended methods for making a diagnostic smear?

    <p>Impression smears (C)</p> Signup and view all the answers

    Which process is NOT recommended to enhance diagnostic ability when creating smears?

    <p>Creating 'splat' or 'shotgun blast' smears (A)</p> Signup and view all the answers

    Which lymph node is responsible for draining the area distal to the stifle?

    <p>Popliteal (B)</p> Signup and view all the answers

    What is a key factor in evaluating lymph node samples?

    <p>Degree of blood contamination (B)</p> Signup and view all the answers

    Which technique improves the dispersion of cells in diagnostic smears?

    <p>'Squash' Prep Technique (C)</p> Signup and view all the answers

    The prescapular lymph nodes primarily drain which area?

    <p>Thoracic limb and caudal part of the head (C)</p> Signup and view all the answers

    What factor differentiates absolute erythrocytosis from relative erythrocytosis?

    <p>True increase in RBC mass (B)</p> Signup and view all the answers

    Which condition is associated with increased Erythropoietin levels in erythrocytosis?

    <p>Environmental hypoxia (B)</p> Signup and view all the answers

    What is a common cause of relative erythrocytosis?

    <p>Dehydration (C)</p> Signup and view all the answers

    Which option describes appropriate erythrocytosis?

    <p>Hypoxia induced changes (D)</p> Signup and view all the answers

    What does splenic contraction cause in animals?

    <p>Redistribution of RBCs (C)</p> Signup and view all the answers

    Which condition is considered a primary cause of erythrocytosis?

    <p>Polycythemia vera (D)</p> Signup and view all the answers

    In which scenario would you find a normal Erythropoietin level?

    <p>Primary erythrocytosis (D)</p> Signup and view all the answers

    Which factor is NOT associated with absolute erythrocytosis?

    <p>Dehydration (B)</p> Signup and view all the answers

    What is the primary hormonal regulator of RBC production?

    <p>Erythropoietin (EPO) (D)</p> Signup and view all the answers

    Which condition is primarily associated with an absolute increase in RBC mass?

    <p>Polycythemia vera (C)</p> Signup and view all the answers

    What causes erythropoietin production to be upregulated?

    <p>Renal hypoxia (C)</p> Signup and view all the answers

    What is the primary effect of increased blood viscosity due to erythrocytosis?

    <p>Impaired blood flow (D)</p> Signup and view all the answers

    Which of the following breeds is known to have a naturally higher RBC mass?

    <p>Dachshunds (A)</p> Signup and view all the answers

    Which factor is NOT associated with relative erythrocytosis?

    <p>Hypoxia (A)</p> Signup and view all the answers

    Which finding is most indicative of relative erythrocytosis due to dehydration?

    <p>Tacky mucous membranes (D)</p> Signup and view all the answers

    What was identified on the abdominal ultrasound in Sally's case?

    <p>A 6 cm mass on the cranial pole of the left kidney (A)</p> Signup and view all the answers

    What physiological response can lead to transient erythrocytosis in animals?

    <p>Exercise-induced splenic contraction (D)</p> Signup and view all the answers

    What defines absolute erythrocytosis?

    <p>A true increase in RBC mass (D)</p> Signup and view all the answers

    Which of the following scenarios would most likely induce inappropriate erythropoietin production?

    <p>Renal diseases (B)</p> Signup and view all the answers

    What was the finding of the cytology from the fine needle aspiration of the renal mass?

    <p>Atypical mesenchymal cells diagnosed as sarcoma (B)</p> Signup and view all the answers

    The term 'polycythemia' is most strictly used to refer to:

    <p>Neoplastic proliferation of RBCs (A)</p> Signup and view all the answers

    Which condition is NOT a cause of secondary absolute erythrocytosis?

    <p>Dehydration (C)</p> Signup and view all the answers

    What was Sally's packed cell volume (PCV) two weeks post-operation?

    <p>51% (B)</p> Signup and view all the answers

    In which situation would lymph node aspiration generally be indicated?

    <p>When lymph nodes are enlarged with unknown causes (A)</p> Signup and view all the answers

    What condition can cause a redistribution of red blood cells from the spleen?

    <p>Right-to-left cardiac shunts (C)</p> Signup and view all the answers

    Which of the following is NOT a differential for an enlarged lymph node?

    <p>Dehydration (B)</p> Signup and view all the answers

    What characterizes absolute erythrocytosis?

    <p>A true increase in RBC mass (A)</p> Signup and view all the answers

    Which option represents a secondary cause of erythrocytosis?

    <p>Lung disease (C)</p> Signup and view all the answers

    What type of erythrocytosis occurs when EPO is normal or decreased?

    <p>Primary erythrocytosis (D)</p> Signup and view all the answers

    During an epinephrine response, which mechanism accounts for increased RBC counts?

    <p>Splenic contraction (C)</p> Signup and view all the answers

    Inappropriate secondary erythrocytosis is characterized by what?

    <p>Local renal lesions (C)</p> Signup and view all the answers

    What lab finding could indicate dehydration as a cause of relative erythrocytosis?

    <p>Increased protein levels (C)</p> Signup and view all the answers

    Which of the following is considered an appropriate cause of secondary erythrocytosis?

    <p>High altitude acclimatization (D)</p> Signup and view all the answers

    Which of the following conditions would most likely result in compensatory erythrocytosis?

    <p>Exposure to high altitudes (D)</p> Signup and view all the answers

    Which of the following best describes polycythemia vera?

    <p>A neoplastic proliferation of RBCs (C)</p> Signup and view all the answers

    What change in laboratory results might be expected in absolute erythrocytosis?

    <p>Decreased MCV and increased HCT (D)</p> Signup and view all the answers

    Flashcards

    Erythrocytosis

    An increase in the volume of red blood cells in the blood.

    Polycythemia

    A condition characterized by an abnormally high number of red blood cells in the blood.

    Relative Erythrocytosis

    A type of erythrocytosis where the increase in red blood cells is only relative to the decreased plasma volume. There is no actual increase in the total number of red blood cells.

    Absolute Erythrocytosis

    A type of erythrocytosis where the increase in red blood cells is real and there is an actual increase in the total number of red blood cells in the body.

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    Erythropoietin (EPO)

    The primary hormone responsible for stimulating the production of red blood cells. It is produced by the kidneys.

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    Renal Hypoxia

    EPO production is triggered by low oxygen levels in the blood, often due to conditions like anemia or poor renal perfusion.

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    Primary Erythrocytosis

    A condition where the body doesn't produce enough EPO, resulting in a low level of red blood cells.

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    Secondary Erythrocytosis

    A condition where the body produces too much EPO, causing an increase in red blood cells. This can be due to various factors, such as hypoxia or tumors.

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    Polycythemia Vera

    A type of erythrocytosis characterized by a neoplastic proliferation of red blood cells in the bone marrow. It is a rare condition.

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    Blood Viscosity

    A condition where the red blood cells become sluggish and clump together, leading to impaired blood flow and decreased oxygen delivery to tissues.

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    Microcytosis

    This is the name for a type of anemia where the red blood cells are smaller than normal. This is caused by a lack of iron.

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    Macrocytosis

    This is the name for a type of anemia where the red blood cells are larger than normal. This is caused by a lack of vitamin B12.

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    Hypertension

    A condition of high blood pressure.

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    Dehydration

    A reduction in the blood volume caused by loss of fluids. It is often diagnosed based on clinical history and examination and supported by hematology (e.g., high PCV/Hct) and laboratory tests (e.g, High protein concentration in serum or plasma).

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    Azotemia

    An increase of Urea Nitrogen in the blood. This is a common indicator of kidney issues. In dehydrated patients, BUN is often increased due to hemoconcentration.

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    Secondary Erythrocytosis (Appropriate)

    A type of erythrocytosis caused by the body producing more erythropoietin (EPO) due to hypoxia or hypoxemia. This is an appropriate response to low oxygen levels in the blood.

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    Secondary Erythrocytosis (Inappropriate)

    A type of erythrocytosis caused by the body producing more erythropoietin (EPO) without systemic hypoxia or hypoxemia. This is an inappropriate response, as the body is producing EPO without a real need.

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    Relative Erythrocytosis (Dehydration)

    An apparent increase in red blood cell mass, but actually due to a decrease in plasma volume. This is caused by dehydration, which makes the blood thicker.

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    Relative Erythrocytosis (Splenic Contraction)

    An apparent increase in red blood cell mass, but actually due to a redistribution of red blood cells from the spleen. This is caused by nervous excitement, which releases red blood cells from the spleen.

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    Hypoxemia

    A condition where the body is not getting enough oxygen due to problems with the heart or lungs.

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    Pyogranulomatous Lymphadenitis

    Characterized by an increased number of macrophages, neutrophils, and sometimes pyogranulomas.

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    Eosinophilic Lymphadenitis

    Greater than 3% eosinophils in lymph nodes, suggesting an allergic or parasitic reaction.

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    Mixed Cell Lymphadenitis

    The most common type of lymphadenitis, caused by various reasons and often non-specific.

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    Lymphoma

    A type of cancer affecting the lymph nodes, characterized by an abnormal proliferation (>50%) of a single type of lymphocytes.

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    Immunophenotype of Lymphoma

    Lymphoma categorized based on the specific type of lymphocyte involved (B-cell or T-cell), providing crucial information for treatment and prognosis.

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    Right-to-left cardiac shunt

    A condition where blood bypasses the lungs, leading to lower than normal oxygen levels in the blood.

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    Lymph node aspiration

    The procedure of aspirating fluid from a lymph node using a needle and syringe.

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    Lymphocytes

    Cells found in lymph nodes, playing a key role in the immune response.

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    Enlarged lymph node

    An abnormal increase in the size of a lymph node, which could be caused by several factors.

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    Cytology

    The study of cells and their structure, particularly in the context of diseases.

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    Lymphadenomegaly

    Enlarged lymph nodes, detectable via palpation, radiography, or ultrasound.

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    Staging

    The process of determining the stage of a cancer, particularly if it has spread to other parts of the body.

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    Mandibular lymph node

    A common lymph node located at the ventral angle of the jaw, draining most of the head, including the rostral oral cavity.

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    Prescapular lymph node

    A lymph node located cranial to the shoulder, draining the caudal part of the head, most of the thoracic limb, and part of the thoracic wall.

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    Axillary lymph node

    A lymph node located caudal and medial to the shoulder joint, draining most of the thoracic wall, deep structures of the thoracic limb and neck, and cranial mammary glands.

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    Superficial Inguinal Lymph node

    A lymph node located in the furrow between the abdominal wall and medial thigh, draining caudal mammary glands, ventral half of the abdominal wall, penis, prepuce, scrotum, tail, ventral pelvis, medial thigh and stifle.

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    Popliteal Lymph node

    A lymph node located at the back of the stifle joint, draining the area distal to the stifle.

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    Medial Iliac lymph node

    A lymph node located near the caudal vena cava and aorta, draining skin of the pelvic area, pelvic limb, distal intestinal and urogenital system.

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    Study Notes

    Erythrocytosis and Polycythemia

    • Erythrocytosis is an increase in red blood cell (RBC) mass, often measured by hematocrit (HCT/PCV), RBC count, and/or hemoglobin (Hgb).
    • Polycythemia means "many cells in the blood." Most pathologists reserve "polycythemia" for neoplastic conditions affecting RBC production (polycythemia vera), which is a neoplastic proliferation of RBCs.
    • Others use the terms interchangeably, creating confusion.

    Learning Objectives

    • Appreciate breed-specific differences in RBC mass.
    • Identify the primary hormonal regulator of RBC production, where it's produced, and what stimulates it.
    • Understand the underlying causes of erythrocytosis and their mechanisms.

    Why Isn't More Blood Better?

    • Increased blood viscosity leads to RBC sludging in vessels, impairing blood flow.
    • Impaired blood flow decreases tissue oxygenation.
    • Possible consequences: congested mucous membranes, dilated retinal vessels, and seizures.

    Breed Specific Differences

    • Some breeds (e.g., sighthounds, greyhounds, certain dachshunds, racing horses, warm-blooded breeds) have naturally higher RBC masses.

    RBC Production - About EPO

    • Erythropoietin (EPO) is the primary hormonal regulator of RBC production.
    • EPO is produced by the fetal liver and the adult kidney.
    • EPO production is stimulated by renal hypoxia, not directly by RBC mass.
    • Anemia, poor renal perfusion, and poor oxygenation of the blood also trigger increased EPO production.

    Relative Erythrocytosis

    • Not a true increase in RBC mass.
    • Results from factors like dehydration (reduced plasma volume, hemoconcentration), splenic contraction (redistribution of RBCs from the spleen).
    • Certain animals (cats, horses) are more excitable, making splenic contraction a more important consideration.

    Relative Erythrocytosis: Dehydration

    • Most common cause of mild to moderate erythrocytosis in veterinary medicine.
    • Associated with a decrease in plasma volume rather than an increase in RBC mass.
    • Clinical signs often include: dry or tacky mucous membranes, tenting of the skin.
    • Laboratory findings might include increased protein (total protein, albumin), highly concentrated urine (high USG), and increased urea/creatinine (pre-renal azotemia).
    • Treatment involves rehydration and reevaluation.

    Relative Erythrocytosis: Splenic Contraction

    • RBCs have shifted from the spleen into the bloodstream.
    • Associated with excitement, fear, or exercise.
    • More frequent in cats and horses than dogs.
    • Animals have larger splenic RBC reserves.
    • May also see an increase in lymphocytes. (epinephrine induced).

    Absolute Erythrocytosis

    • Refers to a true increase in RBC mass.
    • Rule out causes of relative erythrocytosis.
    • Primary is rare, EPO-independent, and caused by polycythemia vera (neoplastic proliferation of mature RBCs independent of EPO).

    Absolute Erythrocytosis - Secondary

    • EPO-dependent (increased EPO).
    • Appropriate response to hypoxia/hypoxemia (e.g., heart disease, lung disease, high altitudes).
    • Inappropriate response when no systemic hypoxia/hypoxemia exists (e.g., renal lesions, tumors or EPO or EPO-like substances or doping).

    Summary of Classification

    • A table summarizes the key factors and findings correlated with relative and absolute erythrocytosis.

    Case Example: Sally

    • A 7-year-old spayed female mixed-breed dog with anorexia and lethargy showed various abnormal blood test results.
    • Further diagnostics (thoracic radiographs to rule out heart or lung disease, abdominal ultrasound for kidney abnormalities), and blood tests led to a diagnosis.
    • Diagnosis was confirmed by fine needle aspiration of the mass. Sally's mass was determined to be atypical sarcoma; which was the source of increased EPO.
    • Post-surgical recovery was positive.

    Lymph Node Cytology - Learning Objectives

    • Understand how lymphocytes size relative to other blood cells.
    • Understand the normal cellular composition of a lymph node.
    • Identify common cell types in lymph nodes.
    • Diagnose an enlarged lymph node via cytology, understanding differences in cellular composition.

    When to Aspirate a Lymph Node

    • Lymphadenomegaly or enlargement of one or more lymph nodes.
    • Detected by palpation, radiography, or ultrasonography.
    • Evaluate for metastasis.

    Commonly Sampled Lymph Nodes

    • A table categorizes locations and the areas drained by sampled lymph nodes.

    Making a Diagnostic Smear

    • Goal is creating a thin layer of intact cells on a rapidly air-dried slide.
    • Methods for making smears include impression smears, fine-needle aspiration technique, and fine-needle non-aspiration technique.
    • Proper "squashing" techniques improve cell dispersion.

    Sample Evaluation

    • Evaluates cellularity, cell types, morphology, and relative proportions of each type to determine if the sample is from a lymph node.
    • Additional structures, such as salivary epithelium, adipose tissue, and muscle can be differentiated from lymph nodes.

    Sizing of Lymphocytes & Cytomorphology

    • Differentiates small, intermediate, and large lymphocytes based on morphological characteristics.

    Normal Lymph Node

    • 90% small lymphocytes, 10% intermediate and large lymphocytes are typically found.
    • Other cells, including macrophages, plasma cells, mast cells, are less numerous.
    • Lysed cells and lymphoglandular bodies can also be seen.

    Differential Diagnoses for Enlarged Lymph Nodes

    • Reactive (hyperplastic) lymph node.
    • Inflammatory (lymphadenitis)
    • Neoplastic (lymphoma).
    • Metastatic neoplastic process from other sites.

    Reactive Lymph Node

    • Caused by antigenic response to inflammation, infection, immune-mediated disease or neoplasia
    • Characterized by predominance of small lymphocytes (>75%), increased numbers of intermediate & large lymphocytes (up to 25%).
    • Increased plasma cells are seen in variable numbers, along with Mott cells (plasma cells filled with immunoglobulin-containing vacuoles -- also called Russell bodies). Neutrophils might be present.

    Lymphadenitis

    • Inflammation of a lymph node.
    • Many etiologies (neutrophilic, eosinophilic, mixed).
    • Be cautious about blood contamination in the sample.
    • Characterized by the predominant type of inflammatory cell.

    Neutrophilic Lymphadenitis

    • Purulent/suppurative lymphadenitis.

    • 5% neutrophils present. (Must rule out other causes of neutrophils like blood contamination).

    • Non-specific; might be related to bacterial, neoplastic conditions, or immune-mediated disease.
    • Dental disease might be a cause in mandibular lymph nodes.

    (Pyo)Granulomatous Lymphadenitis

    • Macrophagic or histiocytic lymphadenitis.
    • Increased macrophages
    • Increased neutrophils and macrophages.
    • Often related to chronic inflammation from bacteria (e.g., filamentous, acid-fast), fungi (yeast/hyphae).

    Eosinophilic Lymphadenitis

    • 3% eosinophils.

    • Multiple causes: allergies, hypersensitivity, local skin disease (e.g., atopic dermatitis), parasites, fungal infections (e.g., Pythium), paraneoplastic conditions (e.g., lymphoma, MCT).

    Mixed Cell Lymphadenitis

    • Most common type of inflammatory lymphadenitis.
    • Non-specific findings.
    • Due to a combination of factors.

    Lymphoma

    • Predominance (>50%) of monomorphic lymphocyte population.
    • Often characterized by large lymphocytes with atypia (e.g., open chromatin, prominent nucleoli).
    • Potential for a small cell, well-differentiated variant requiring additional tests (e.g., flow cytometry, PARR).
    • Further testing of immunophenotype (B or T cells) is important to determine prognosis and treatment.

    Metastatic Neoplasia

    • Foreign cell population presence.
    • Common sources include epithelial cells (carcinoma), round cell origin (lymphoma, etc), or other tumor types metastasizing to lymph nodes (e.g., melanoma, neuroendocrine tumors, sarcomas; less common).

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