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Lymph Node REAL Classification of Lymphoid Neoplasm

Posted Sept. 5, 2016. Pathology Pathology - Lymph node

REAL classification is Revised European – American classification of lymphoid neoplasm.

It includes :

  1. Lymphocytic leukemia
  2. Non – Hodgkin’s lymphoma
  3. Plasma cell tumors.

REAL classification is into 4 broad categories based on the immunophenotype.

  1. Precursor B – cell neoplasm (Neoplasm of mature B – lymphocytes).
  2. Peripheral B – lymphocyte neoplasm (Neoplasm of mature B – lymphocytes).
  3. Precursor T – lymphocyte neoplasm (Neoplasm of immature T – lymphocyte).
  4. Peripheral T – lymphocyte neoplasm (Neoplasm of mature T – lymphocyte)

Precursor B – lymphocyte = Precursor B – cell lymphoblastic leukemia/lymphoma.

Precursor T – lymphocyte = Precursor T – cell lymphoblastic leukemia/lymphoma.

Peripheral B – lymphocyte gives rise to:

  1. Chronic lymphocytic leukemia / small lymphocytic lymphoma.
  2. Lymphoplasmacytic lymphoma.
  3. Mantle cell lymphoma.
  4. Follicular lymphoma.
  5. Marginal zone lymphoma.
  6. Hairy cell leukemia.
  7. Plasmacytoma/plasma cell myeloma.
  8. Diffuse large cell (B) lymphoma.
  9. Burkitt’s lymphoma.

Peripheral T – cell and NK –  neoplasm give rise to:

  1. T cell chronic lymphocytic leukemia.
  2. Large granular lymphocytic leukemia.
  3. Angioimmunoblastic T – Cell lymphoma.
  4. Angiocentric lymphoma (NK – T – cell lymphoma).
  5. Intestinal T – cell lymphoma.
  6. Adult T – cell leukemia/lymphoma.
  7. Anaplastic large cell lymphoma.


Lymphoma, Clinical differences in Non Hodgkin's and Hodgkin's lymphoma

Posted Sept. 4, 2016. Pathology Pathology - Lymph node

Non-Hodgkin’s and Hodgkin’s lymphoma can be differentiated and is shown in the tabulated form.

Sign and Symptom Non-Hodgkin’s lymphoma  Hodgkin’s lymphoma
Age  Common at extreme of age Peak at 18 to 38 years. rare at puberty
General condition Often effected Usually excellent
Pruritus usually absent mostly common
Fever Rare in early stage May be present in early stage
Lesion in respiratory and GIT Common Rare
Lymph Nodes  Often symmetrical Often unilateral
Cervical lymph nodes Often bilateral and upper group Often unilateral and lower group
Contiguous spread Rare Common
Response to radiation Immediate Delayed
Epitrochlear lymph nodes  Maybe positive Practically never
Sternal lymph node Practically never Sometimes positive
Leukemic phase May be seen Absent
Extranodal involvement Common Uncommon


Spleen Tumors

Posted Sept. 4, 2016. Pathology Pathology - Lymph node

Tumors of the spleen may be benign and malignant.

Benign tumors :

  1. Benign cyst of Echinococcus.
  2. Mesothelium lined inclusion cyst.
  3. The false cyst which has no lining and this may be encapsulated hematoma.
  4. Rarely may be a hemangioma.

Malignant tumors:

Primaries are Non-Hodgkin’ lymphoma (NHL) and Hodgkin’s lymphoma (HD)>.

Secondary involvement is by the NHL and HD.



Spleen, Hypersplenism , Splenomegaly

Posted Sept. 3, 2016. Pathology Pathology - Lymph node

Hypersplenism is characterized by a triad of :

  1. Splenomegaly
  2. There is a decreased number of RBCs, WBCs, Platelets or combination of these three elements.
  3. Above deficiency of the cells can be corrected by splenectomy.

Mechanism of hypersplenism:

  1. This is uncertain but there are postulates.
  2. This may be due to increased sequestration.
  3. This may be due to lysis of the cells by macrophagic cells.


Etiological classification

1. Infections: There is enlargement of the spleen in acute pyogenic infection. In septicemia, the spleen is enlarged and called septic spleen.

While non-pyogenic bacteria are Tuberculosis, Typhoid, Brucellosis, and Sarcoidosis.


B = Brucellosis       E = Echinococcus      S = Syphilis and Subacute bacterial endocarditis         T 4 = T.B, Typhoid, Toxoplasmosis and Trypanosomiasis

C = CMvirus M = Malaria   H = Histoplasmosis           K = Kala-azar  I = Infectious mononucleosis.

2. Circulatory disturbance: Persistent or chronic venous congestion leads to congestive splenomegaly. This is due to the portal or splenic vein hypertension.

  • Right heart causes are a chronic congestive failure, Rarely the weight is more than 500 gram.
  • Cirrhosis will lead to increased portal vein pressure due to fibrosis. Massive enlargement 1000 to 5000 grams.
  • Portal vein or splenic vein thrombosis may be seen in pylephlebitis or in carcinoma of stomach and pancreas.

3. Storage diseases: This  may be due to :

  1. Amyloidosis and it gives rise to Sago's spleen.
  2. Lipid storage diseases are Familial hyperlipidemia like: 
    1. Deficiency of alpha-lipoprotein.
    2.  Poorly controlled diabetes.
    3. Hypothyroidism.
    4. Prolonged obstructive jaundice.

Hereditary causes are :

  • Gaucher's disease.
  • Niemann Pick disease.
  • Glycogen storage disease.

4. Neoplasm :

  1. Primary causes are rare benign tumors like Fibroma, Osteoma, Chondroma, and cyst.
  2. Primary malignant tumors are Non-Hodgkin's lymphoma and Hodgkin's lymphoma.
  3. Secondary tumors are lymphomas and rarely carcinoma and sarcoma.

5. Blood disorders :

  1. Primary causes lead to anemia, thrombocytopenia, and leucopenia.
  2. Secondary causes are hemolytic anemia, Idiopathic thrombocytopenia (ITP), leukemia and lymphoma infiltrate, chronic marrow failure like myeloid metaplasia.

6. Immunological conditions like Rheumatoid arthritis and systemic lupus erythematosus (SLE).

7. Splenic infarct in early-stage leads enlargement of the spleen. Later on, fibrosis may bring it back to normal size.

Causes are :

  1. Occlusion of a major splenic artery or branch due to emboli from the heart.
  2. Septic infarct in infective endocarditis.
  3. The Less common cause is local thrombosis in myeloproliferative disorders and sickle cell anemia.


Spleen Part 1

Posted Sept. 2, 2016. Pathology


  1. Its weight is 150 grams and measuring 12×7×3 cms.
  2. It has thin capsules which consists of connective tissues.
  3. There are no smooth muscles in the capsules. So spleen has no contractile function.
  4. There are grey specks areas  called splenic or malpighian follicles. This is called white pulp.
  5. While mononuclear phagocytic system and sinusoid is called Red pulp.
  6. There are two circuits of circulation :
  7. Open circuit is slow. There are thin sinusoids called cords of Billroth. These are part of Red pulp. These splenic cords consists of net work of macrophagic cells and this functional and physical filter.
  8. Closed circuit is fast. It has afferent artery converting into vein.

Functions of spleen

  1. Filtration : 1/120 RBC dies every day. This death takes place in 50% in the spleen.
  2. Culling : This destruction and removal of abnormal RBCs and antibody coated cells.
  3. Pitting : This is removal of inclusion like siderotic granules, Heinz bodies, and Howell Jowel bodies.
  4. Phagocytosis : Other particulate material like bacteria, viruses, carcinoma cells, macromolecule of Gaucher's and Niemann Pick disease are removed by phagocytosis.
  5. Major secondary organ : In immune system it's role is both in humoral and cellular immunity.
  6. Source of lymphoid cells : There may be extramedullary hematopoiesis, called myeloid metaplasia.
  7. Storage site : It stores platelets 30 to 40%. In case of enlargement of spleen, this may reach to 80 to 90%.
    1. There are 30 to 40 ml of RBCs and it increases in case of splenomegaly.