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F O U R T H
E D I T I O N
IOACHIM’S
Lymph Node
Pathology
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F O U R T H
E D I T I O N
IOACHIM’S
Lymph Node
Pathology
Harry L. Ioachim, M.D.
ProfessorofPathology
NewYorkUniversity
AdjunctProfessorofPathology
CollegeofPhysiciansandSurgeonsofColumbiaUniversity
AdjunctProfessorofPathology
CornellUniversityMedicalCollege
ChairEmeritus
DepartmentofPathology
LenoxHillHospital
NewYork,NewYork
L. Jeffrey Medeiros, M.D.
ChairmanandProfessor
DepartmentofHematopathology
TheUniversityofTexasM.D.AndersonCancerCenter
Houston,Texas
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SeniorExecutiveEditor:JonathanPine
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FourthEdition
(cid:2)c 2009byLippincottWilliams&Wilkins,aWoltersKluwerbusiness
530WalnutStreet
Philadelphia,PA19106
LWW.com
ThirdEdition(cid:2)c 2002byLippincottWilliams&Wilkins.SecondEdition(cid:2)c 1994by
Lippincott-Raven.FirstEdition(cid:2)c 1982byJ.B.LippincottCompany.
Allrightsreserved.Thisbookisprotectedbycopyright.Nopartofthisbookmaybereproduced
inanyformorbyanymeans,includingphotocopying,orutilizingbyanyinformationstorageand
retrievalsystemwithoutwrittenpermissionfromthecopyrightowner,exceptforbriefquotations
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PrintedinChina
LibraryofCongressCataloging-in-PublicationData
Ioachim’slymphnodepathology/editors,HarryL.Ioachim,L.JeffreyMedeiros.–4thed.
p.;cm.
Rev.ed.of:Ioachim’slymphnodepathology/HarryL.Ioachim.3rded.(cid:2)c 2002.
Includesbibliographicalreferencesandindex.
ISBN-13:978-0-7817-7596-0(alk.paper)
ISBN-10:0-7817-7596-5(alk.paper)
1.Lymphnodes–Biopsy. 2.Lymphnodes–Diseases–Diagnosis.
3.Lymphomas–Diagnosis. I.Ioachim,HarryL.,1924- II.Medeiros,L.Jeffrey.
III.Ioachim,HarryL.,1924-Ioachim’slymphnodepathology. IV.Title:
Lymphnodepathology.
[DNLM:1.LymphNodes–pathology. 2.LymphaticDiseases–diagnosis.
WH700I6382008]
RC646.I582008
616.4(cid:2)207–dc22
2008021300
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This book is dedicated to the memory
of my parents.
The strongest support and encouragement for this effort as always came from my
family, Noemi, Laura, Jackie, Martin, and Kenneth.
—H.L.I.
To the teachers who helped me get started, in particular, my parents, Ms. Rosemary
Quinn, the late Reverend Thomas M. Coskren, O.P., and Drs. Dinah Yu, Guido Majno,
Walter H. (Sunny) Dzik, and Charles F. Arkin.
—L.J.M.
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■
C O N T E N T S
Preface xiii
PrefacetotheFirstEdition xv
Acknowledgments xvii
P A R T O N E ■ T H E N O R M A L LY M P H N O D E
Chapter1 TheNormalLymphNode 2
P A R T T W O ■ D I A G N O S T I C M E T H O D S
Chapter2 TheLymphNodeBiopsy 16
Chapter3 Cytopathology 21
Chapter4 ElectronMicroscopy 31
Chapter5 Cytochemistry 35
Chapter6 Immunohistochemistry 38
Chapter7 FlowCytometry 48
Chapter8 MolecularDiagnosis 59
P A R T T H R E E ■ LY M P H A D E N I T I D E S
SECTION I ■ VIRAL LYMPHADENITIDES
Chapter9 InfectiousMononucleosisLymphadenitis 76
Chapter10 CytomegalovirusLymphadenitis 83
Chapter11 HerpesSimplexVirusLymphadenitis 87
Chapter12 Varicella-HerpesZosterLymphadenitis 92
Chapter13 VacciniaLymphadenitis 95
Chapter14 MeaslesLymphadenitis 97
Chapter15 HumanImmunodeficiencyVirusLymphadenitis 99
SECTION II ■ BACTERIAL LYMPHADENITIDES
Chapter16 OrdinaryBacterialLymphadenitis 106
Chapter17 Cat-ScratchLymphadenitis 110
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viii Contents
Chapter18 BacillaryAngiomatosisofLymphNodes 115
Chapter19 LymphogranulomaVenereumLymphadenitis 119
Chapter20 SyphiliticLymphadenitis 123
Chapter21 LymphadenitisofWhippleDisease 127
SECTION III ■ MYCOBACTERIAL LYMPHADENITIDES
Chapter22 MycobacteriumtuberculosisLymphadenitis 130
Chapter23 NontuberculousMycobacterialLymphadenitis 137
A.AtypicalMycobacterialLymphadenitides 137
B.Mycobacteriumavium-intracellulareLymphadenitis 138
Chapter24 MycobacteriumlepraeLymphadenitis 144
SECTION IV ■ FUNGAL LYMPHADENITIDES
Chapter25 CryptococcusLymphadenitis 147
Chapter26 HistoplasmaLymphadenitis 150
Chapter27 CoccidioidomycosisLymphadenitis 153
Chapter28 PneumocystisLymphadenitis 156
SECTION V ■ PROTOZOAL LYMPHADENITIDES
Chapter29 ToxoplasmaLymphadenitis 159
Chapter30 LeishmaniaLymphadenitis 165
Chapter31 FilariaLymphadenitis 168
P A R T F O U R ■ LY M P H A D E N O P A T H I E S
SECTION I ■ REACTIVE LYMPHADENOPATHIES
Chapter32 ReactiveLymphoidHyperplasia 172
Chapter33 AtypicalLymphoidHyperplasia 181
Chapter34 ProgressiveTransformationofGerminalCenters 186
SECTION II ■ LYMPHADENOPATHIES ASSOCIATED
WITH CLINICAL SYNDROMES
Chapter35 KimuraLymphadenopathy 190
Chapter36 SinusHistiocytosiswithMassive
Lymphadenopathy 193
Chapter37 KikuchiLymphadenopathy 199
Chapter38 SarcoidosisLymphadenopathy 203
Chapter39 SystemicLupusLymphadenopathy 213
Chapter40 RheumatoidLymphadenopahty 218
Chapter41 DermatopathicLymphadenopathy 223
Chapter42 CastlemanLymphadenopathy 227
Chapter43 LymphadenopathiesofSalivaryGlands 238
Chapter44 Tumor-ReactiveLymphadenopathy 243
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Contents ix
SECTION III ■ IATROGENIC LYMPHADENOPATHIES
Chapter45 Drug-InducedLymphadenopathy:Methotrexate 248
Chapter46 Drug-InducedLymphadenopathy 255
SECTION IV ■ VASCULAR LYMPHADENOPATHIES
Chapter47 LymphNodeInfarction 259
Chapter48 VascularTransformationofSinuses 263
SECTION V ■ FOREIGN BODY LYMPHADENOPATHIES
Chapter49 ProteinaceousLymphadenopathy 266
Chapter50 LipidLymphadenopathy 270
Chapter51 SiliconeLymphadenopathy 275
Chapter52 LymphadenopathyofMetalDebrisAssociated
withJointProstheses 279
Chapter53 GoldLymphadenopathy 281
SECTION VI ■ LYMPH NODE INCLUSIONS
Chapter54 EpithelialCellInclusionsinLymphNodes 283
Chapter55 NevusCellInclusionsinLymphNodes 289
P A R T F I V E ■ LY M P H O M A S
SECTION I ■ NOMENCLATURE AND CLASSIFICATION
OF LYMPHOMAS
Chapter56 NomenclatureandClassficationofLymphomas 294
SECTION II ■ HODGKIN LYMPHOMA
Chapter57 HodgkinLymphoma:Classical 306
Chapter58 HodgkinLymphoma:NodularLymphocytePredominant 325
SECTION III ■ PRECURSOR B-CELL AND T-CELL NEOPLASMS
Chapter59 LymphoblasticLeukemia/Lymphoma 334
SECTION IV ■ MATURE B-CELL NEOPLASMS
Chapter60 ChronicLymphocyticLeukemia/SmallLymphocytic
Lymphoma 352
Chapter61 LymphoplasmacyticLymphoma 362
Chapter62 HairyCellLeukemia 374
Chapter63 NodalMarginalZoneB-CellLymphoma 383
Chapter64 FollicularLymphoma 391
Chapter65 DiffuseFollicleCenterCellLymphoma 401
Chapter66 MantleCellLymphoma 407
Chapter67 DiffuseLargeB-CellLymphoma 423
Chapter68 MediastinalLargeB-CellLymphoma 432
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x Contents
Chapter69 BurkittLymphoma 436
Chapter70A LymphomasofSalivaryGlands 447
Chapter70 CompositeLymphoma 452
SECTION V ■ MATURE T-CELL NEOPLASMS
Chapter71 AdultT-CellLeukemia/Lymphoma 460
Chapter72 MycosisFungoides 468
Chapter73 PeripheralT-CellLymphoma,Unspecified 482
Chapter74 AngioimmunoblasticT-CellLymphoma 491
Chapter75 AnaplasticLarge-CellLymphoma 504
P A R T S I X ■ G R A N U L O C Y T I C , H I S T I O C Y T I C , A N D
D E N D R I T I C C E L L N E O P L A S M S
Chapter76 MyeloidSarcoma 518
Chapter77 HistiocyticSarcoma 526
Chapter78 DendriticCellNeoplasms 531
P A R T S E V E N ■ LY M P H O P R O L I F E R A T I V E D I S O R D E R S
A S S O C I A T E D W I T H I M M U N E D E F I C I E N C Y
Chapter79 LymphoproliferativeDisordersAssociatedwith
CongenitalImmuneDeficiencies 546
Chapter80 Post-TransplantLymphoproliferativeDisorders 553
Chapter81 LymphomasAssociatedwithAcquiredImmunodeficiency
Syndrome(AIDS) 563
P A R T E I G H T ■ S P I N D L E C E L L N E O P L A S M S O F
LY M P H N O D E S
Chapter82 PalisadedMyofibroblastoma 570
Chapter83 InflammatoryPseudotumorofLymphNodes 573
P A R T N I N E ■ VA S C U L A R N E O P L A S M S O F LY M P H N O D E S
Chapter84 Hemangiomas/Hemangioendotheliomas 578
Chapter85 KaposiSarcoma 581
P A R T T E N ■ M E T A S T A T I C T U M O R S I N LY M P H N O D E S
Chapter86 TumorMetastasesinLymphNodes 590
Chapter87 MetastaticMelanoma 599
Chapter88 MetastaticBreastCarcinoma 606
Chapter89 MetastaticNasopharyngealCarcinoma 615
