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Lymphadenopathy: Introduction – White Blood Cell Pathology

by Carlo Raj, MD
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    00:01 Our topic here is WBC pathology.

    00:04 The various lymphoid tissue that we shall take a look at in this section include the lymph node.

    00:09 Examples clinically of when and how the lymph node will be affected.

    00:14 It’s important that we walk through the anatomy of it.

    00:18 A few words about the spleen and the thymus, all of this dealing with leukemias and lymphomas in this section in which students tend to confuse quite a bit.

    00:28 But by the time we are done, you’ll be well-organized with the WBC pathology.

    00:36 At first, we’ll take a look at the normal lymph node.

    00:41 Think about the lymph node that we have in our body.

    00:44 Think about spread that might take place within the lymph node depending as to what kind of cancer.

    00:50 For example, I mentioned a few times that if it was breast cancer, a prognostic indicator there would be the axillary lymph node.

    00:57 Whereas if you had a male and there was lymph node involvement with either your testicular cancer or your scrotal cancer.

    01:06 If it’s testicular cancer, then the spread will be to the paraaortic.

    01:10 We’ll mention these types of spreads when the time is right.

    01:13 At this point, it is important for us to identify the following structures.

    01:18 I’d like for us to start in the middle.

    01:20 And by the middle, I mean the germinal center.

    01:23 This germinal center that you’re noticing -- indentify it please – In the middle.

    01:28 Responsible for B-cell type of proliferation.

    01:31 Quite active.

    01:33 Beyond that, you start getting into the cortex, so this will be outer side.

    01:37 And we have paracortex.

    01:39 The paracortex will be the area in which the T-cells are housed.

    01:44 You have the subcapsular sinus and this sinus will become important to us at some point when we talk about a particular WBC pathology known as your Langerhans cell histiocytosis.

    01:57 Remember once again that this is a lymph node and so therefore, just like you would have organization of many organs, the cortex will always be the outer.

    02:06 The medulla will always be the inner.

    02:09 Therefore, in the middle here, we have the medulla.

    02:11 And through here, you might find macrophages and company that might be located as eventually making way through what’s known as the afferent and efferent lymphatics.

    02:23 Our topic at first is benign lymphadenopathy.

    02:27 What does this mean to you? “Hey, doc, it hurts.” Where? In my neck.

    02:34 And upon further examination, you’d find erythema in the back of the neck with oral examination.

    02:41 This to you is a good news.

    02:43 Of course, you’re not going to tell the patient that you’re happy that it’s a painful lymph node.

    02:47 But at least, you know most likely that it can be cured and treated And most likely due to bacterial infection.

    02:55 My topic is benign lymphadenopathy here and the lymph node will be called tender.

    03:00 Acute nonspecific lymphadenitis.

    03:03 Inflammation of lymph node characterized by cortical and/or paracortical hyperplasia.

    03:08 Acute.

    03:11 Usually caused by acute infections and by acute infection, we’ll be having strep or staph being the most common.

    03:18 Maybe perhaps causing pharyngitis.

    03:23 Cat-scratch disease.

    03:25 A cat-scratch disease is rather interesting.

    03:27 If you have an immunocompetent patient and gets scratched by a cat and maybe perhaps passes off a bacteria called Bartonella henselae.

    03:37 I mentioned immunocompetent whereas you have a patient who is immunocompromised, maybe perhaps HIV positive, completely changes the story, doesn’t it? And this patient who is HIV positive, immunocompromised, the introduction of Bartonella in such a patient results in a skin manifestation known as bacillary angiomatosis.

    03:56 It changes a complexion completely.

    04:01 Tularaemia.

    04:03 Tularaemia will be let’s say your patient that goes into the woods, goes for hunting and then ends up developing an acute infection.

    04:11 And so therefore, we talk about rabbits.

    04:17 Most frequent presentation would be tender enlarged lymph nodes, what that means is the fact that it actually hurts.

    04:23 And if the lymph node hurts, this is a good news for you as a clinician.

    04:26 It means that you have quite a bit of arsenal to make sure that you take care of that acute inflammation.

    04:36 Whereas if it’s chronic nonspecific lymphadenitis, this is dangerous.

    04:42 This is not so much benign is it? Usually, case is long-standing and the lymph node here, “Hey, doc." 'I have a lump on my neck.” Does it hurt? "No." This raises red flags.

    04:54 It’s concerning.

    04:55 Nontender lymphadenopathy.

    04:58 Take a look at your differentials.

    05:00 Autoimmune diseases.

    05:02 HIV.

    05:03 Chronic infection.

    05:05 Drugs.

    05:07 And maybe perhaps even cancers.


    About the Lecture

    The lecture Lymphadenopathy: Introduction – White Blood Cell Pathology by Carlo Raj, MD is from the course Lymphadenopathy – White Blood Cell Pathology (WBC).


    Included Quiz Questions

    1. Bacillary angiomatosis
    2. Bacillary peliosis
    3. Botryomycosis (pyoderma vegetans)
    4. Tropical pyomyositis
    5. Leptospirosis
    1. Bartonella henselae
    2. Bartonella rochalimae
    3. Bartonella quintana
    4. Bartonella vinsonii
    5. Bartonella bacilliformis
    1. Pharyngitis
    2. HIV
    3. Autoimmune diseases
    4. Drugs
    5. Cancers

    Author of lecture Lymphadenopathy: Introduction – White Blood Cell Pathology

     Carlo Raj, MD

    Carlo Raj, MD


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