Biopsy Pathology of the Lymphoreticular System by Dennis H. Wright B.Sc, M.D., F.R.C.Path., Peter G. Isaacson

By Dennis H. Wright B.Sc, M.D., F.R.C.Path., Peter G. Isaacson D.M., M.R.C.Path. (auth.)

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34 Biopsy Pathology of the Lymphoreticular System ( . ; . , Fig. 9 Sarcoidosis of lymph node. The tightly packed non-caseating granulomas tend not to fuse as they do in tuberculosis, x 25. necrosis is an important distinguishing feature of this disease, it is by no means always present and tuberculosis should be considered when granulomas of any description are found in a lymph node. The granulomas of sarcoidosis (Fig. 2. 9) are usually small and multiple and whilst they efface much of the normal nodal tissue, tend to remain discrete, not fusing into larger lesions as occurs in tuberculosis; multinucleated giant cells are also not as frequent and there is often considerable fibrosis araund the granulomas.

1 Biopsy Pathology of the Lymphoreticular System Differentialdiagnosis Just as the possibility of tuberculosis must always be kept in mind whenever there is granulomatous inflammation of a lymph node so must the possibility of a granulomatous reaction occurring within a malignant lymphoma. Epithelioid histiocytes are frequently present in Hodgkin' s disease where they may be distributed in much the same pattern as is seen in toxoplasmosis except that they do not encroach on any residual follicles that may be present.

The histiocytes are stuffed with acid fast Iepra bacilli, X 300. 1 Biopsy Pathology of the Lymphoreticular System Differentialdiagnosis Just as the possibility of tuberculosis must always be kept in mind whenever there is granulomatous inflammation of a lymph node so must the possibility of a granulomatous reaction occurring within a malignant lymphoma. Epithelioid histiocytes are frequently present in Hodgkin' s disease where they may be distributed in much the same pattern as is seen in toxoplasmosis except that they do not encroach on any residual follicles that may be present.

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