by
ROGER A. WARNKE, M.D.
Professor of Pathology
Co-Director, Immunodiagnosis Laboratory
Stanford University Medical Center
Stanford, California 94305
LAWRENCE M. WEISS, M.D.
Director, Surgical Pathology
Division of Pathology
City of Hope National Medical Center
Duarte, California 91010
JOHN K. C. CHAN, M.B.B.S., M.R.C.Path
Consultant Pathologist
Department of Pathology
Queen Elizabeth Hospital
Kowloon, Hong Kong
MICHAEL L. CLEARY, M.D.
Associate Professor of Pathology
Director, Molecular Diagnostics Laboratory
Stanford University Medical Center
Stanford, California 94305
RONALD F. DORFMAN, M.B.B.Ch., F.R.C.Path
Professor of Pathology
Stanford University Medical Center
Stanford, California 94305
1 Introduction
2 Normal Anatomy and Function of Lymph Nodes and Spleen
2.1 Lymph Nodes
2.1.1 Gross Anatomy
2.1.2 Microscopic Anatomy
2.2 Spleen
2.2.1 Gross Anatomy
2.2.2 Microscopic Anatomy
3 Evaluation of Lymphoid Lesions
3.1 Handling the Fresh Specimen
3.1.1 Clinical Correlation
3.1.2 Technical Considerations in the Choice of Ancillary Studies
3.1.3 Role of Frozen Section Diagnosis
3.1.4 Specimen Transport
3.1.5 Optimal Freezing for Immunologic Studies
3.2 Fixation and Processing
3.2.1 Fixation
3.2.2 Artifacts of Fixation and Processing
3.2.3 Routine and Histochemical Stains
3.3 Pattern Recognition in Morphologic Differential Diagnosis
3.4 Immunohistochemical Studies
3.4.1 Markers Used on Fixed Paraffin-Embedded Tissues
3.4.2 Markers Used on Fresh Cells or Frozen Tissues
3.4.3 Differential Diagnosis with Panels of Markers
3.5 Antigen Receptor Genes and Analysis of Their Rearrangements
3.5.1 Theoretical Background
3.5.2 Technical Aspects
3.5.3 Applications
3.5.4 Interpretation
3.6 Common Chromosomal Abnormalities
3.7 Electron Microscopy
3.8 Aspiration Cytology
4 Nomenclature and Classification of Lymphoid Tumors
4.1 Classification Based on Histologic Features
4.2 Classification Based on Immunologic Features
4.3 Classification Based on Molecular Features
4.4 Classification in the Context of Lymphoid Ontogeny
4.4.1 Precursor Cell Lymphomas and Leukemias
4.5 Lymphomas and Leukemias Reflective of Antigen-Dependent Stages of
Lymphocyte Differentiation
5 Malignant Lymphomas Other Than Hodgkin's Disease (Non-Hodgkin's
Lymphomas): An Overview
5.1 Epidemiology
5.2 Grading
5.3 Staging and Spread
6 Malignant Lymphoma, Follicular (Small Cleaved, Mixed, and Large Cell;
Centroblastic-Centrocytic and Centroblastic)
7 Malignant Lymphoma, Small Lymphocytic and Diffuse Small Cleaved Cell
(Centrocytic)
7.1 Small Lymphocytic Lymphoma
7.2 Small Lymphocytic Lymphoma with Plasmacytoid Features
(Lymphoplasmacytoid/Lymphoplasmacytic Immunocytoma)
7.3 Mantle Cell (Intermediate Lymphocytic/Mantle Zone/Centrocytic/
Diffuse Small Cleaved Cell) Lymphoma
7.4 Monocytoid (B-Cell) Lymphoma
7.5 Low Grade Lymphoma of Mucosa-Associated Lymphoid Tissue
8 Malignant Lymphoma, Diffuse, Mixed Small and Large Cell
9 Malignant Lymphoma, Diffuse, Large Cell and Variants
9.1 Diffuse Large Cell Lymphoma
9.2 Unusual Morphologic Variants of Diffuse Large Cell Lymphoma
9.3 Large Cell Lymphoma Variants with Distinctive Clinicopathologic
Features
9.3.1 Intravascular Lymphomatosis
9.3.2 Anaplastic Large Cell Lymphoma
9.3.3 Variants of Anaplastic Large Cell Lymphoma
9.3.4 T-Cell-Rich Large B-Cell Lymphoma
9.3.5 Mediastinal Large B-Cell Lymphoma
10 Malignant Lymphoma, Small Noncleaved Cell
11 Malignant Lymphoma, Lymphoblastic
12 Mycosis Fungoides
13 Post-Thymic T-Cell Lymphoma
14 Classic Hodgkin's Disease
15 Nodular Lymphocyte Predominance (L&H) Hodgkin's Disease (Nodular
Paragranuloma)
16 Plasma Cell Neoplasms and Amyloidosis
16.1 Plasmacytoma
16.2 Amyloid Deposits in Lymph Node
16.3 Amyloid Deposits in Spleen
17 Histologic Combinations and Evolution in Tumors of the Lymphoid System
17.1 Histologic Combinations as Evidence of Tumor Progression
17.1.1 Transformation of Low-Grade B-Cell Lymphoma
17.1.2 Transformation of Low-Grade T-Cell Lymphoma
17.2 Histologic Combinations as Evidence of Differentiation
17.3 Combinations of Hodgkin's Disease and Non-Hodgkin's Lymphomas
17.3.1 Nodular Lymphocyte Predominance Hodgkin's Disease and Another
Lymphoma
17.3.2 Classic Hodgkin's Disease and B-Cell Lymphoma and Leukemia
17.3.3 Classic Hodgkin's Disease and T-Cell Lymphoma
17.4 Histologic Combinations as Evidence of Immunodeficiency
18 Histiocytic and Dendritic Cell Proliferations
18.1 Langerhans' Cell Histiocytosis
18.2 Sinus Histiocytosis with Massive Lymphadenopathy (Rosai-Dorfman
Disease)
18.3 Follicular Dendritic Cell Sarcoma
18.4 Interdigitating Dendritic Cell Sarcoma
18.5 Indeterminate Cell Tumors (Precursor Langerhans'
Cell Histiocytosis)
18.6 True Histiocytic Lymphomas (True Histiocytic Sarcomas)
18.7 So-Called Malignant Histiocytosis
18.8 Plasmacytoid Monocytic Lymphoma (So-Called Plasmacytoid T-Cell
Lymphoma)
19 Extramedullary Leukemia and Mastocytosis
19.1 Leukemic Infiltration
19.2 Granulocytic Sarcoma
19.3 Hairy Cell Leukemia
19.4 Systemic Mastocytosis (Systemic Mast Cell Disease)
20 Lymphomas of the Spleen
20.1 Primary Splenic Lymphoma
20.2 Splenic Involvement by Lymphoma
20.2.1 Hodgkin's Disease
20.2.2 Non-Hodgkin's Lymphoma
20.2.3 Follicular Lymphoma
20.2.4 Small Lymphocytic, Lymphoplasmacytoid, and Mantle Cell
Lymphomas
20.2.5 Monocytoid B-Cell Lymphoma
20.2.6 Diffuse Large Cell Lymphoma
20.2.7 Post-Thymic T-Cell Lymphoma
20.2.8 Other Lymphoma Types
20.3 Lymphoma Presenting with Prominent Splenomegaly
20.3.1 Hepatosplenic T-Cell Lymphoma
20.3.2 Lymphoplasmacytoid Lymphoma (Immunocytoma) of the Spleen
20.3.3 Splenic B-Cell Lymphoma with Circulating Villous Lymphocytes
20.3.4 Malignant Lymphoma of Marginal Zone Cells
21 Nonhematolymphoid Tumors and Tumor-Like Lesions of Lymph Node and
Spleen
21.1 Classification
21.2 Hemorrhagic Spindle Cell Tumor with Amianthoid Fibers (Palisaded
Myofibroblastoma)
21.3 Smooth Muscle Proliferations in Lymph Nodes
21.3.1 Smooth Muscle Proliferation in Nodal Hilum
21.3.2 Angiomyolipoma
21.3.3 Lymphangiomyomatosis
21.3.4 Leiomyomatosis of Lymph Node
21.3.5 Angiomyomatous Hamartoma
21.3.6 Intranodal Leiomyoma
21.4 Inflammatory Pseudotumor of Lymph Node
21.5 Mycobacterial Spindle Cell Pseudotumor of Lymph Node and Spleen
21.6 Deciduosis of Lymph Node
21.7 "Lipomatosis" of Lymph Node
21.8 Kaposi's Sarcoma of Lymph Node
21.9 Vascular Tumors of Lymph Node
21.9.1 Nodal Hemangioma
21.9.2 Epithelioid Vascular Tumors
21.9.3 Polymorphous Hemangioendothelioma
21.9.4 Lymphangioma
21.10 Vascular Neoplasm Arising in Localized Form of Castleman's
Disease
21.11 Vascular Transformation of Lymph Node Sinuses
21.12 Angiolipomatous Hamartoma in Association with Castleman's Disease
21.13 Bacillary Angiomatosis
21.14 Glandular Inclusions in Lymph Node
21.14.1 Müllerian Inclusions
21.14.2 Endometriosis
21.14.3 Salivary Gland Inclusions
21.14.4 Thyroid Inclusions
21.14.5 Mammary Inclusions
21.14.6 Other Epithelial Inclusions
21.15 Nevus Cells in Lymph Node
21.15.1 Nevus Cell Aggregates
21.15.2 Blue Nevi of Lymph Node
21.16 Rare Lesions of Lymph Node
21.17 Lymph Node Metastasis
21.17.1 Staging of Cancer or Documentation of Recurrence
21.17.2 Metastatic Cancer Versus Malignant Lymphoma
("Undifferentiated Malignant Tumor")
21.17.3 Prediction of Origin of a Metastatic Carcinoma
21.18 Splenic Hemangioma, Lymphangioma, Hemangioendothelioma, and
Hemangiopericytoma
21.18.1 Splenic Hemangioma
21.18.2 Littoral Cell Angioma
21.18.3 Splenic Lymphangioma
21.18.4 Hemangioendothelioma
21.18.5 Hemangiopericytoma
21.19 Angiosarcoma of Spleen
21.20 Nonvascular Sarcomas of Spleen
21.21 Inflammatory Pseudotumor of Spleen
21.22 Splenic Hamartoma
21.23 Splenic Cysts
21.23.1 Epithelial Cysts
21.23.2 Parasitic Cysts
21.23.3 False Cysts
21.24 Rare Lesions of Spleen
21.25 Splenic Metastases
22 Immunodeficiency-Associated Lymphoproliferative Disorders
22.1 Lymphoproliferations Associated with Congenital Immunodeficiencies
22.2 Lymphoproliferations Associated with Secondary Immunodeficiencies
22.2.1 Acquired Immunodeficiency Syndrome
22.2.2 Non-Hodgkin's Lymphoma
22.2.3 Hodgkin's Disease
22.3 Post-Transplantation Lymphoproliferative Disorders
22.4 Immunosuppressive Agents Outside of the Setting of Transplantation
23 References of Chapter 6
24 Index