LYMPH NODE PATHOLOGY DIFFERENTIAL DIAGNOSIS

LYMPH NODES NON-NEOPLASTIC

Ectopic tissue / inclusions:

  • Adipose tissue
  • Decidual reaction
  • Epithelial inclusions
  • Mesothelial components
  • Müllerian components
  • Salivary gland components
  • Smooth muscle components
  • Ectopic tissue
  • Other inclusions

Pigment:

  • Anthracosis
  • Iron
  • Lipofuscin
  • Melanosis

Foreign material

  • Particles from joint prothesis
  • Silicone

Lymph nodes-infectious / parasitic disorders:

  • Actinomyces
  • Bacillary angiomatosis 
  • Bacille Calmette-Guerin (bCG) vaccine infection 
  • Brucellosis
  • Coccidioides
  • Cat scratch disease
  • Epstein Barr virus
  • Herpes simplex
  • Histoplasmosis
  • HIV
  • Leishmania
  • Leprosy
  • Lymphogranuloma venereum
  • Measles
  • Microfilaria
  • Mycobacteria
  • Mycobacterial spindle cell pseudotumor
  • Parvovirus B19
  • Syphilis
  • Toxoplasmosis
  • Tuberculosis
  • Tularemia
  • Whipple disease
  • Yersinia pestis
  • Yersinia pseudotuberculosis

Lymph nodes-inflammatory / reactive disorders:

  • Acute nonspecific lymphadenitis
  • Allergic granulomatosis
  • Castleman disease
  • Dermatopathic lymphadenitis
  • Drug hypersensitivity
  • Indolent T lymphoblastic proliferations
  • Kawasaki disease
  • Kikuchi disease
  • Kimura disease
  • Progressive transformation of germinal centers
  • Rheumatoid arthritis
  • Rosai-Dorfman disease (RDD)
  • Systemic lupus erythematosus

Lymph node-nonspecific findings:

  • Adult onset Still disease
  • Angiolymphoid hyperplasia with eosinophilia
  • Chronic lymphadenitis
  • Erythrophagocytosis
  • Follicular hyperplasia
  • Granulomatous inflammation
  • Hemophagocytic lymphohistiocytosis
  • Hyaline deposits
  • Inflammatory pseudotumor
  • Plasmacytosis
  • Reactive lymphadenopathy other nonspecific findings

LYMPH NODES NEOPLASTIC

Lymph nodes-vascular lesions:

  • Angiolipomatous hamartoma
  • Angiomyolipoma
  • Angiomyomatous
  • Hamartoma
  • Hemangioma
  • Lymphangioma
  • Lymphangiomyomatosis
  • Vascular transformation of sinuses

Lymph node nonlymphoid neoplasms:

  • Acute lymphoblastic leukemia lymphoma
  • Amyloid
  • Extramedullary chronic myeloid leukemia
  • Erdheim-Chester disease
  • Fibroblastic reticulum cell sarcoma
  • Follicular dendritic cell sarcoma (FDCS)
  • Histiocytic sarcoma
  • Indeterminate cell histiocytosis / indeterminate dendritic cell tumor
  • Interdigitating dendritic cell / reticulum cell sarcoma
  • Langerhans cell histiocytosis
  • Leiomyoma
  • Metastases
  • Myofibroblastoma
  • Plasmacytoma

LYMPHOMAS AND RELATED DISORDERS

WHO Classification – Lymphoid Neoplasms

General Characterization of Lymphomas: Hodgkin vs. Non Hodgkin

Hodgkin: Variants include Classical (Nodular sclerosis classic HL, lymphocyte-rich classic HL, mixed cellularity classic HL, lymphocyte-depleted classic HL) and NON-classical (nodular lymphocyte predominant Hodgkin lymphoma).

Non-Hodgkin Lymphoma: mantle cell lymphoma, marginal zone lymphoma, follicular lymphoma, diffuse large B-cell lymphoma.

Hodgkin lymphoma:

  • Classic HL
  • Nodular sclerosis CHL
  • Lymphocyte rich CHL
  • Lymphocyte rich mixed cellularity CHL
  • Lymphocyte depleted CHL
  • Nodular lymphocyte predominant NON-classical HL

Mature B cell neoplasms

Small B cell lymphomas with a circulating component:
  • CLL / SLL
  • Richter syndrome
  • B cell monoclonal lymphocytosis
  • Prolymphocytic leukemia
  • Hairy cell leukemia
  • Hairy cell leukemia variant
  • Splenic B cell leukemia / lymphoma, unclassifiable
  • Splenic diffuse red pulp
Small B cell lymphomas with lymphoplasmacytic differentiation / marginal zone lymphomas:
  • Lymphoplasmacytic lymphoma
  • Marginal zone-general
  • MALT-marginal zone
  • Marginal zone-nodal
  • Splenic marginal zone
  • Splenic lymphoma with villous lymphocytes
  • Pediatric nodal marginal zone lymphoma
Follicular lymphoma:
  • Follicular-usual
  • Follicular neoplasia in situ
  • Follicular lymphoma pediatric type
Mantle cell lymphoma:
  • Classic Mantle cell lymphoma (MCL)
  • In situ mantle cell neoplasia
  • MCL-leukemic nonnodal
  • MCL-aggressive variants
Diffuse Large B-Cell (DLBCL) and large B cell lymphomas with high grade features:
  • DLBCL-NOS
  • Burkitt lymphoma
  • Burkitt-like lymphoma with 11q aberration
  • HGBL with MYC and BCL2 or BCL6
  • High grade B cell lymphoma, NOS
Large B cell lymphomas-special subtypes:
  • ALK positive LBCL
  • DLBCL-primary testicular
  • EBV positive DLBCL
  • EBV positive mucocutaneous ulcer
  • LBCL with IRF4
  • Fibrin associated large B cell lymphoma
  • Intravascular
  • Lymphomatoid granulomatosis
  • Plasmablastic lymphoma of oral mucosa type
  • Primary effusion lymphoma
  • Primary mediastinal
  • Pyothorax associated
  • T cell / histiocyte rich

Extranodal organ specific lymphoma:

  • Follicular lymphoma-duodenal type
  • Primary follicular lymphoma-testis
  • Primary CNS lymphoma

Posttransplant lymphoproliferative disorders (PTLD):

  • PTLD-nondestructive
  • PTLD-florid follicular hyperplasia
  • PTLD-infectious mononucleosis
  • PTLD-polymorphic
  • PTLD-monomorphic
  • PTLD-classic Hodgkin
  • Graft versus host disease

Other immunosuppression related:

  • Common variable immunodeficiency (CVID)
  • HIV associated
  • Immunogobulin A deficiency
  • Warts, hypogammaglobulinemia, infections and myelokathexis (WHIM)
  • X linked agammaglobulinemia (XLA)

HHV8 associated lymphoproliferative disorders:

  • HHV8 related DLBCL
  • HHV8 related germinotropic lymphoproliferative disorder

Mature T/NK cell disorders:

T/NK cell disorders with a leukemic component:
  • T cell prolymphocytic leukemia
  • T cell large granular lymphocytic leukemia
  • Chronic lymphoproliferative disorders of NK cells
  • Aggressive NK cell leukemia
  • Adult T-cell leukemia/lymphoma (ATLL)
  • Sézary syndrome
Intestinal:
  • Enteropathy associated
  • Intestinal T cell lymphoma, NOS
  • Monomorphic epitheliotropic intestinal
  • Indolent T lymphoproliferative disease of the GI tract
Aggressive NK/T cell disorders:
  • Extranodal NK / T cell lymphoma, nasal type
  • Hepatosplenic T cell lymphoma
  • Peripheral T cell lymphoma, NOS
Anaplastic large cell lymphoma:
  • Anaplastic large cell lymphoma, ALK positive
  • Anaplastic large cell lymphoma, ALK negative
  • Breast implant associated anaplastic large cell lymphoma
T follicular helper phenotype:
  • Angioimmunoblastic
  • Follicular peripheral T cell lymphoma (F-PTCL)
  • Nodal PTCL with a TFH phenotype
Cutaneous / soft tissue involvement:
  • Lymphomatoid papulosis
  • Mycosis fungoides
  • Mycosis fungoides variants
  • Primary cutaneous acral CD8+
  • Primary cutaneous anaplastic large cell lymphoma
  • Primary cutaneous CD4+ small / medium
  • Primary cutaneous CD8+ aggressive epidermotropic T cell lymphoma
  • Primary cutaneous DLBCL-leg type
  • Primary cutaneous follicle center lymphoma
  • Primary cutaneous gamma delta
  • Primary cutaneous PTCL, NOS
  • Subcutaneous panniculitis-like
Systemic T cell lymphomas presenting in the skin:
  • Anaplastic large cell lymphoma ALK positive
  • Angioimmunoblastic T cell lymphoma
  • Adult T-cell leukemia/lymphoma
  • Extranodal NK / T cell lymphoma nasal type
  • T cell prolymphocytic leukemia
Pediatric NK/T cell disorders:
  • Systemic EBV+ of childhood
  • Hydroa vacciniforme-like lymphoma
Other conditions to consider:
  • Acute lymphoblastic leukemia / lymphoma early T cell precursor lymphoblastic leukemia
  • NK lymphoblastic leukemia/lymphoma
  • T lymphoblastic lymphoma / leukemia