TUMORS OF THE LYMPH NODES AND SPLEEN

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


Table of Contents

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

Back