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University of Manitoba
Biochem. and Medical Genetics
BGEN 3020
Jason Leboe- Mcgowan

Chapter 12 Lymph nodes General Characteristics: 1. Painful vs painless: lymphadenopathy that is painful is not malignant; mean that you have inflammation causing it (does not always mean infection) – you are stretching the capsule, it’s an inflammatory condition (lupus), and that produces pain. When you have non-tender, think malignant, either (1) mets or 2) primary lymphoma originating from it. Always tell if painful/less. 2. Localized vs. generalized lymphadenopathy: Localized (ie exudative tonsillitis goes to local nodes; breast cancer goes to local nodes. Generalized (systemic dz – ie HIV, EBV, Lupus). 3. Examples: (a) Bruton’s agammaglobinemia – germinal follicle absent: B-cell (b) DiGeorge syndrome– paratrabeculae messed up: T-cell country (c) Histiocytes (Han shculler Christian/letterman sieve dz) – involves sinuses (d) SCID (adenine deaminase def) – B and T cell deficiency, therefore no germinal follicle and no paratrabeculae but will have sinuses. (e) Reactive lymphadenopathy: Macrophage takes Ag, and presents to germinal follicles and they spit out a plasma cell, making Ab’s Non-Hodgkin’s lymphoma Follicular lymphoma = MC Non-Hodgkin’s Lymphoma: B-cell; translocation 14,18; and apoptosis gene knocked off, so the cells are immortal. What 2 tissues are resistant to invasion by cancer cells? Cartilage and elastic tissue Example: Burkitts; caused EBV; Translocation 8,14, myc oncogenes, starry sky – normal macrophages looking like sky at night, #3 MCC cancer in kids; can cure; MC lymphoma in kids, usually in the abdomen (ie payers patches, paraortic lymph nodes, also but rarely in the jaw, or testes) Example: plaque like lesions, no teeth, not a fungal infection – actually the inflammatory cells are really neoplastic; so the helper T cell in mycosis fungoides is neoplastic, therefore it’s a T cell malignancy. Involves the skin and lymph nodes vs. Sezary cell syndrome which is seen in peripheral blood (malign helper T cell that is in peripheral blood, in mycosis fungoides) Example: kid with EM of eczematous rash all over – generalized nontender hepatosplenomegaly, , EM of monomorphic cells which were CD 1+ cells – histiocytosis X (letterman sieve dz) (birbeck granules, look like tennis racket – clostridium tetani which has a spore also looks like a tennis racket) Audio day 3: hematology file 6 Painful lymphadenopathy = some type of inflammatory condition, not malignant Painless lymphadenopathy = malignancy: MC malignancy of lymph node = metastasis MC primary cancer of lymph node = non Hodgkin’s lymphoma: follicular B cell lymphoma (translocation: 14, 18. This knocks off apoptosis gene and the cell is immortal). Hodgkin’s Dz– four different types. In Hodgkin’s the cardinal signs are: fever, night sweats, and wt loss (usually TB unless proven otherwise). It is usually localized, nontender lymphadenopathy. On micro: the malignant cell is Reid Steinberg cells, RS cells – owl eyes - common on boards (also giardia, CMV, ashoff nodule in rheumatic fever). Less # = better prognosis; more = wo
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