Pathology HIM Midterm PDF

**Pathology** **Diseases of Lymph nodes** **Lymphadenopathy refers to a disease of the lymph nodes, in which they are abnormal [in size] or [consistency.]** **Lymphadenopathy or Lymph node enlargement may be inflammatory or neoplastic** **[LYMPH NODE DISTRIBUTION]** **ACUTE...

**Pathology** **Diseases of Lymph nodes** **Lymphadenopathy refers to a disease of the lymph nodes, in which they are abnormal [in size] or [consistency.]** **Lymphadenopathy or Lymph node enlargement may be inflammatory or neoplastic** **[LYMPH NODE DISTRIBUTION]** **ACUTE LYMPHADENITIS** **[*Acute non-specific Lymphadenitis*.]** **It occurs in nodes draining acutely inflamed focus as in acute suppurative tonsilitis** ***[Morphology]*** ***[Gross]:* Acutely inflamed nodes are enlarged & tender** ***[U/M:]* there are large germinal centers , Neutrophilic infiltrate with abscess formation may be seen in severe cases** **[Chronic nonspecific lymphadenitis]** - **Changes in lymph node due to prolonged inflammatory, infective,.... etiology.** - **It is referred to as [reactive hyperplasia ]** - **It is the *[commonest cause]* for lymph node enlargement** ***[Chronic specific lymphadenitis]*** - **TB lymphadenitis** - **Sarcoidosis** - **Cat scratch disease** - **Infectious mononucleosis** - **Syphilis** - **Toxoplasmosis** **[1)Tuberculosis of Lymph Nodes(TB lymphadenitis)]** - **It is a is a [common cause] of lymph node enlargement** - **It is usually a [primary infection] in children** **[The commonest sites are:]** - **Cervical Lymph nodes : infected from [tonsils]** - **Mediastinal LNs : infected with [primary pulmonary TB]** - **Mesenteric LNs; infected due to [ingestion of infected milk] (Tabes mesenterica)** **[Microscopically]** **[Early tuberculous lymphadenitis]: there is infiltration by multiple small, pale tubercles formed of [aggregates of epithelioid cells], few Langhan's giant cells & minimal caseation** **[Caseating tuberculous lymphadenitis:] Most of nodal tissue is replaced by areas of [caseous necrosis] with multiple small tubercles at the periphery** **What is cold abscess ?!** - **It is formed by accumulation & liquefaction of caseous material, surrounded by TB granulation tissue & fibrosis** - **It complicates TB of LN, bone & joints and epididymis** - **It may open to outside \-\--► [multiple sinuses]** **[2)Sarcoidosis]** **Is an inflammatory disease of [unknown cause] that affects multiple organs in the body, but mostly the lungs and lymph nodes. In people with sarcoidosis, abnormal masses [(Non caseating granulomas)] are formed in different organs.** ***[Morphology]*** ***[Microscopically:]* There is [non-caseating] well circumscribed epithelioid granulomata with giant cells surrounded by lymphocytes** - **Two characteristic inclusions are seen inside giant cells** **2)*[Astroid bodies]* (star shaped inclusions)** **[3)Cat scratch disease (CSD)]** **Is an illness caused by the bacterium [Bartonella henselae] Almost half of all cats carry the infection at some point. The infection does not make cats sick. However, [the scratch or bite] of an infected cat can cause symptoms in people, including swollen lymph nodes forming [stellate abscess].** **[4)Infectious mononucleosis]** **It refers to a group of symptoms caused by the [Epstein-Barr virus (EBV)]. It occurs in teenagers but can occur at any age. The virus is spread through saliva, which is why some people refer to it as ["the kissing disease."]** **Symptoms: Pain; Sore throat; Fever; Jaundice** **It presents with reactive lymphadenopathy, characterized by an increased number of lymphocytes and follicular hyperplasia in the lymph nodes.** **[Summary of Key Points for Each Diagnosis]** **1)Tuberculosis (TB): Often presents with caseating granulomas and enlarged lymph nodes, especially in the cervical region. History of exposure to TB or a pulmonary infection may help with diagnosis.** **2)Sarcoidosis: Non-caseating granulomas with elevated ACE levels, commonly affects the lungs and lymph nodes. Bilateral hilar lymphadenopathy is a hallmark finding.** **3)Infectious Mononucleosis (EBV): Causes sore throat, fever, lymphadenopathy, and splenomegaly. A positive Monospot test confirms the diagnosis.** **4)Cat Scratch Disease (Bartonella henselae): Characterized by stellate abscesses in the lymph nodes, often with a history of cat scratch or bite.** **5)Toxoplasmosis: Can cause swollen lymph nodes with a predominance of T lymphocytes, often seen in immunocompromised individuals or with travel to endemic areas.** **[Questions]** **1) A patient with tuberculosis of the lymph nodes presents with enlarged, tender cervical lymph nodes. Which of the following is the most likely source of infection for this lymphadenopathy?** **a) Infected milk (Tabes mesenterica)** **b) Primary pulmonary tuberculosis** **c) Tonsillar infection** **d) Infected wounds** **2) Which of the following lymph node findings is characteristic of Cat Scratch Disease (CSD)?** **a) Non-caseating granulomas with giant cells** **b) Stellate abscesses in the lymph nodes** **c) Reactive hyperplasia with lymphoid follicles** **d) Caseating necrosis with tubercles at the periphery** **3) In sarcoidosis, which of the following is typically seen within the giant cells in granulomas?** **a) Schaumann bodies and Astroid bodies** **b) Caseating necrosis and Langhans giant cells** **c) Abscess formation and neutrophils** **d) Neoplastic cells and lymphocytes** **4) Which of the following is the causative agent of Cat Scratch Disease (CSD)?** **a) Epstein-Barr virus** **b) Bartonella henselae** **c) Mycobacterium tuberculosis** **d) Toxoplasma gondii\ ** **5) Which of the following conditions is associated with \"cold abscesses\" in the lymph nodes?** **a) Sarcoidosis** **b) Infectious mononucleosis** **c) Tuberculosis** **d) Toxoplasmosis** **6) A 30-year-old woman presents with progressive shortness of breath and bilateral hilar lymphadenopathy on chest X-ray. A biopsy of one of the enlarged lymph nodes reveals non-caseating granulomas, and the patient has no history of tuberculosis. What is the most likely diagnosis?** **a) Tuberculosis** **b) Sarcoidosis** **c) Cat Scratch Disease** **d) Lymphoma** **7) A 5-year-old child presents with swollen, tender cervical lymph nodes, fever, and malaise. The child has a history of recurrent tonsillitis. A biopsy of the enlarged lymph node reveals granulomatous inflammation with caseating necrosis. What is the most likely diagnosis?** **a) Sarcoidosis** **b) Cat Scratch Disease** **c) Tuberculosis of the lymph nodes (TB lymphadenitis)** **d) Infectious mononucleosis** **8) A 20-year-old man presents with fever, sore throat, and swollen lymph nodes in the neck. His monospot test is positive, and the Epstein-Barr virus (EBV) is confirmed in the blood. Which of the following is the most likely finding in the enlarged lymph nodes?** **a) Caseating granulomas with Langhans giant cells** **b) Non-caseating granulomas with Schaumann bodies** **c) Reactive lymphoid hyperplasia with predominance of lymphocytes** **d) Multiple small abscesses with neutrophilic infiltration** **\ 9)A Patient has enlarged lymph nodes and suffering from low grade fever and malaise. Lymph node biopsy shows a circular lesion composed of epithelioid cells, giant cells and central area of necrosis. The most likely cause of this lymph node disease is:\ a)Sarcoidosis\ b)Tuberculosis\ c)Cat scratch disease\ d)Reactive lymphoid hyperplasia** **10) A 24-year-old man presents with a persistent sore throat, fever, and enlarged posterior cervical lymph nodes. On physical exam, he has splenomegaly and jaundice. His heterophile antibody test (Monospot) is positive. What is the most likely diagnosis?** **a) Sarcoidosis** **b) Infectious mononucleosis** **c) Toxoplasmosis** **d) Tuberculosis** **11) A 28-year-old woman presents with fever, swollen lymph nodes, and a history of recent travel to an area endemic for malaria. She has multiple enlarged, painful axillary lymph nodes. A biopsy reveals reactive hyperplasia with a predominance of T lymphocytes. Which of the following is the most likely cause of her symptoms?** **a) Sarcoidosis** **b) Toxoplasmosis** **c) Cat Scratch Disease** **d) Infectious mononucleosis** **Answer Key\ 1)C 2) B 3)A 4)B 5)C 6)B 7)C 8)C\ 9)B 10)B**