PATHOLOGY OF LYMPH NODES

Norman Levy, MD

I. Goals

• A. Review the histology and cytology of the normal lymph node
• B. Review normal lymphopoiesis
• C. Present the major pathologic processes occurring within the lymph nodes
  • 1. Reactive hyperplasias
  • 2. Malignant lymphoma (non-Hodgkin's Lymphoma - NHL)
  • 3. Hodgkin's disease
• D. Relate lymphoid malignancies to their benign counterparts
  
  

II. Objectives

• A. The student should know the anatomic regions of the normal lymph node, and the cytologic populations
• that occupy them
• B. The student should know the relationship between lymph node structure and the immunologic functions of the lymphoid immune system that occur within them
  • 1. The sites of B and T cell homing
  • 2. The sites of B and T cell expansion in response to antigenic stimulation
• C. The student should know the basic features of normal lymphopoiesis
  • 1. The locations and immunologic changes of antigen independent maturation, B and T cell
  • 2. The locations, morphologic changes, associated with antigen stimulated B and T cell maturation and differentiation
• D. The student should be able to relate the cytologic features of lymphoid cells to their physiologic state: resting, activated, cycling.
• E. The student should know the major patterns of lymph node reaction
• F. The student should know the current classification and major histologic subtypes of the non-Hodgkin's lymphomas and
• Hodgkin's disease.
• G. The student should be able to relate the major subtypes of non Hodgkin's lymphomas to their benign counterparts, and understand the biologic and therapeutic significance of these relationships.
• H. The student should know what types of ancillary diagnostic studies are used in the diagnosis and prognosis of these diseases: immunologic, cytogenetic, molecular.
  • 1. Flow cytometry
  • 2. Immunohistochemistry
  • 3. Gene rearrangement studies
  • 4. (The student is expected to know that these techniques exist, and how they are generally used, but is not expected to memorize the antigens / antibodies / molecular probes used in their performance)
• I. The student should know the common and unique clinical presentations of lymphoid malignancies.
• J. The student should know the major staging system for lymphoid malignancies.
• K. The student should know the basic treatment strategies for lymphoid malignancies.

III. Format

• A. 1-3:00 Lecture/Computer demonstration
  
  

IV. Reading:

• A. Robbins Pathologic Basis of Disease, 5th edition
  • 1. Chapter 14: 629-648
    
    

V. Computer assisted learning

• A. This lecture and the microscopic images will be available for review in Hypertext Markup Language (HTML) form over the World Wide Web. It can be viewed through any WWW browser, such as the Netscape World Wide Web browser available through the Dartmouth College network. There are several ways it can be accessed.
  • 1. Through the Medical library Macintosh workstations used for review of other computer assisted programs. Search Levy lecture
  • 2. Through any Macintosh with a color monitor, 8 megs of RAM, and access to Netscape via the Dartmouth college network or any other WWW access, by methods 3, 4 or 5. below
  • 3. The program can be viewed on the WWW at URL HTTP://www.dartmouth.edu/~nlevy/levylecture.html
  • 4 (Or you can take the more humorous route, and get there by my personal homepage at URL: HTTP://www.dartmouth.edu/~nlevy
    • a. Go to "Pathology Resources"
    • b. Double click on "Pathology of lymph nodes, SBM Hematology" lecture)
  • 5. It can also be downloaded by Internet file transfer protocol (ftp) and viewed on your own computer, using Netscape or any other WWW browser such as Microsoft Explorer. (This may speed up the display of images, which can be quite slow over the internet when all US time zones are awake and playing, when they should be working. However, you will need the necessary diskspace.)
    • a. Use Dartmouth College's Fetch program to access ftp:
      • 1). Host: ftplocal.dartmouth.edu
      • 2). User: Anonymous
      • 3). Password: Leave blank
      • 4). Directory: /levy
      • 5). Double mouseclick the lecture, or highlight and click the "Get" button
      • 6). Fetch will ask where to place the file, and then deliver it in compressed form, approximately four megabytes
    • b. Double click file after download to initiate self extraction of compressed files
    • c. Start Netscape, use the FILE menu to access "Open local file.." and then select lecture.html from the decompressed folder on your computer.
• B. The lecture is based on WWW hypertext markup language. All underlined words are linked to other text, graphics, or photomicrographs. All images surrounded by a border are also linked, either to larger versions of the same image, or to related information

C. Enjoy, curse or ignore- feedback appreciated via E-mail

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