limfadenitis limfoma hodgkins

Textbook ReadingLYMPHADENITIS DAN HODGKIN LYMPHOMA

Oleh Chyntia Giska Aryunisari, S. Ked (0818011012)

M. Dzikrifishofa, S. Ked (0818011073)Ricky Pebriansyah, S. Ked (0818011091)

Pembimbing : dr. Wien Wiratmoko, Sp. PA

dr. Resti Arania, Sp. PAdr. Muhartono, Sp. PA

KEPANITERAAN KLINIK PATOLOGI ANATOMIRUMAH SAKIT UMUM DAERAH Dr. Hi. ABDUL MOELOEK

BANDAR LAMPUNG15 Maret 2013

I. LYMPHADENITIS

Definition

Radang yang terjadi pada kelenjar limfa karena infeksi, merupakan suatu reaksi mikroorganisme yg terbawa oleh limfa dari daerah yg infeksi ke kelenjar limfa regional.

Peradangan pada satu atau beberapa kelenjar getah bening hiperplasia kelenjar getah bening hingga terasa membesar secara klinik.

Classification

1. Spesific Lymphadenitis

Kronis (TBC).

2. Non-Spesific Lymphadenitis

Akut, Kronis.

SPECIFIC LYMPHADENITIS

TB Lymphadenitis

ACUTE NONSPECIFIC LYMPHADENITIS

Lymph nodes undergo reactive changes whenever they are challenged by microbiologic agents, cell debris, or foreign matter introduced into wounds or into the circulation.

Cervical region -teeth or tonsilsAxillary regionInguinal region - secondary to infections in the

extremities. Mesenteric lymph nodes draining acute

appendicitis.

Morphology

SwollenGray red and engorgedHistologically

Lymphoid follicles with large germinal centres and numerous mitotic figures.

Macrophages with particulate debrisNeutrophilic infiltrationSuppurative

CHRONIC NONSPECIFIC LYMPHADENITIS

Follicular HyperplasiaParacortical HyperplasiaSinus Histiocytosis

Follicular Hyperplasia

Humoral immune responses (sel B)Two distinct regions :

A dark zone : proliferating blast-like B cells (centroblasts).

A light zone : B cells with irregular or cleaved nuclear contours (centrocytes).

Tingible body macrophages.Causes : RA, Toxo, Early HIV.

Features reactive follicular hyperplasia: (1) Preservation of the lymph node architecture, include interfollicular T-cell zones and sinusoid, ; (2) Variation in shape and size of lymphoid nodules; (3) Frequent mitotic figures, phagocytic macrophages, and recognizable light and dark zones.

Sometimes accompanied by marginal zone B-cell hiperplasia.

Paracortical Lymphoid Hyperplasia

Cellular immune response.Reactive changes within the T cell regions.Activated T cells (immunoblasts) three to

four times the size of resting lymphocytes, have round nuclei, chromatin, prominent nucleoli, moderate of pale cytoplasm.

Immunologic reactions induced by drugs (Dilantin), acute viral, mononucleosis, and vaccination against certain viral diseases.

Sinus Histiocytosis (Reticular Hyperplasia)

The lining lymphatic endothelial cells are hypertrophied, and macrophages are greatly increased in number Distension and prominence of the lymphatic sinusoids.

May be particularly prominent in lymph nodes draining cancer, such as Ca of breast.

II. HODGKIN LYMPHOMA

HODGKINS DISEASE

Klinis

Clinical Stage of Hodgkin’s and Non Hodgkin’s Lymphomas (Ann Arbor Classification)

STAGE DISTRIBUTOR OF DISEASE

I Involvement of a single lymph node region (I) or involvement of a single extralymphatic organ or site (IE).

II Involvement of two or more lymph node regions on the same side of the diaphragm alone (II) or with involvement of limited contiguous extralymphatic organ or tissue (IIE).

STAGE DISTRIBUTOR OF DISEASE

III Involvement of lymph node regions on both sides of the diaphragma (III), which may include the spleen (IIIS) and/or limited contiguous extralyphatic organ or site (IIIE, IIIES).

IV Multiple or disseminated foci of involvement of one or more extralymphatic organs or tissues with or without lymphatic involvement.

Perbedaan Klinis

Nodular Sclerosis

Lymphocyte-Rich Type

Karakteristik Banyak terdapat limfosit reaktif

limfanodus tidak terlihat menyebar, tetapi kadang dapat ditemui

Berhubungan dengan infeksi EBV pada 40% kasus

Prognosis baik

Lymphocyte Depletion Type

Prevalensi 5% dari kasusDewasa > muda, HIV positif, Infeksi HBV

menigkatkan resiko

Karakteristik Sedikit limfosit dan banyak sel Reed-Stenberg (RS)

Prognosis : Kurang baik dibanding tipe limfoma hodgkin yang

lain

Lymphocyte Depletion Type

Lymphocyte Predominan Type

Prevalensi 5% kasus

KarakteristikSebagian besar limfosit kecil yang matur dan

Histiosit (L&H) Popcorn cell

Prognosis : Sangat baik

Lymphocyte Predominan Type

Etiologi Limfoma Hodgkin

Sel asal tumor = Belum pastiPenelitian Sel limfosit b centrum germinativum

EtiologiEBVPeningkatan NF-kB

Patogenesis Limfoma Hodgkin

Prognosis = BaikAngka kesembuhan stadium 1 dan 2 = 90%5 years dissease free stadium 3 dan 4 = 60-70%

New ProblemTerapi meningkatkan resiko terjadinya secondary

cancer

DAFTAR PUSTAKA

Cotran RS, Kumar V, Robbins SL: Robbins Pathologic Basis of Disease. 7th ed. Philadelphia, W.B. Saunders, 2007.

Journal modern pathology @2013 United States and Canadian Academy of Pathology.

Webphatology.com@2003-2011 Dharam M. Ramnani, M.D.