Roberto N. Miranda Joseph D. Khoury L. Jeff rey Medeiros Atlas of Lymph Node Pathology 123 Atlas of Anatomic Pathology Series Editor Liang Cheng For further volumes: http://www.springer.com/series/10144 Roberto N. Miranda (cid:129) Joseph D. Khoury L. Jeffrey Medeiros Atlas of Lymph Node Pathology Roberto N. Miranda, MD L. Jeffrey Medeiros, MD Department of Hematopathology Department of Hematopathology The University of Texas The University of Texas M.D. Anderson Cancer Center M.D. Anderson Cancer Center Houston Houston Texas Texas USA USA Joseph D. Khoury, MD Department of Hematopathology The University of Texas M.D. Anderson Cancer Center Houston Texas USA ISBN 978-1-4614-7958-1 ISBN 978-1-4614-7959-8 (eBook) DOI 10.1007/978-1-4614-7959-8 Springer New York Heidelberg Dordrecht London Library of Congress Control Number: 2013945180 © Springer Science+Business Media New York 2013 This work is subject to copyright. 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Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) To my wife Norma; my children Alonso and Andrea; my mother Milly and my late father Hernan; my sisters Elena and Carina; my brothers Hernan and Aaron. Roberto N. Miranda, MD To my wife Leah; my children Gabriel and Sophie; my parents David and Jacqueline; my sister Christiane and my brother Claude. Joseph D. Khoury, MD To my father, Leonard Luiz Medeiros (1919–2010); he was a good man. L. Jeffrey Medeiros, MD Series Preface One Picture is Worth Ten Thousand Words – Frederick Barnard, 1927 Remarkable progress has been made in anatomic and surgical pathology during the last 10 years. The ability of surgical pathologists to reach a defi nite diagnosis is now enhanced by immunohistochemical and molecular techniques. Many new clinically important histopatho- logic entities and variants have been described using these techniques. Established diagnostic entities are more fully defi ned for virtually every organ system. The emergence of personalized medicine has also created a paradigm shift in surgical pathology. Both promptness and preci- sion are required of modern pathologists. Newer diagnostic tests in anatomic pathology, how- ever, cannot benefi t the patient unless the pathologist recognizes the lesion and requests the necessary special studies. An up-to-date Atlas encompassing the full spectrum of benign and malignant lesions, their variants, and evidence-based diagnostic criteria for each organ system is needed. This Atlas is not intended as a comprehensive source of detailed clinical information concerning the entities shown. Clinical and therapeutic guidelines are served admirably by a large number of excellent textbooks. This Atlas, however, is intended as a “fi rst knowledge base” in the quest for defi nitive and effi cient diagnosis of both usual and unusual diseases. The Atlas of Anatomic Pathology is presented to the reader as a quick reference guide for diagnosis and classifi cation of benign, congenital, infl ammatory, nonneoplastic, and neoplastic lesions organized by organ systems. Normal and variations of “normal” histology are illus- trated for each organ. The Atlas focuses on visual diagnostic criteria and differential diagnosis. The organization is intended to provide quick access to images and confi rmatory tests for each specifi c organ or site. The Atlas adopts the well-known and widely accepted terminology, nomenclature, classifi cation schemes, and staging algorithms. This book Series is intended chiefl y for use by pathologists in training and practicing surgi- cal pathologists in their daily practice. It is also a useful resource for medical students, cyto- technologists, pathologist assistants, and other medical professionals with special interest in anatomic pathology. We hope that our trainees, students, and readers at all levels of expertise will learn, understand, and gain insight into the pathophysiology of disease processes through this comprehensive resource. Macroscopic and histological images are aesthetically pleasing in many ways. We hope that the new Series will serve as a virtual pathology museum for the edifi cation of our readers. Indianapolis, IN, USA Liang Cheng, MD vii Preface This Atlas represents a concise yet broad review of diseases and disorders that affect lymph nodes. It is intended to serve as a quick reference to pathologists and pathologists-in-training, medical oncologists, primary care physicians, and students interested in diagnostic non- neoplastic and neoplastic lymph node pathology. The Atlas is organized in parts and chapters that sequentially progress from infectious lymphadenitides to reactive lymphadenopathies and ultimately to neoplastic processes classifi ed by cell of origin or differentiation. For neoplastic disorders of lymphoid or hematopoietic cells, we have followed the diagnostic categories of the 2008 World Health Organization classifi cation and illustrated characteristic as well as vari- ant features. Despite best intentions, the cell-of-origin paradigm that forms the basis of the present clas- sifi cation of hematolymphoid neoplasms cannot be applied systematically to all disorders. In addition, current classifi cation schemes have become more sophisticated, often necessitating the use of ancillary techniques and incorporating clinical features including the patient’s genetic background, immune status, history of or underlying disorders, and geographical dis- tribution. With this in mind, we contend that understanding the basic disease pathogenesis and emphasizing careful morphologic evaluation form a solid foundation for lymph node pathol- ogy in clinical practice. In no way do we wish to underemphasize the necessity and value of ancillary techniques for diagnosis, such as immunohistochemistry, fl ow cytometry immuno- phenotyping, conventional cytogenetics, fl uorescence in situ hybridization, and molecular diagnostics. We only wish to remind the reader that the springboard from which these tech- niques are deployed in a judicious manner remains tissue morphology. It is our hope that readers will fi nd this Atlas practical and helpful. We have enjoyed the process of preparing it and sincerely hope it meets the reader’s needs. Roberto N. Miranda, MD Joseph D. Khoury, MD L. Jeffrey Medeiros, MD ix