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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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There is Fig. 1 Lymph node in infectious mononucleosis showing follicles widely separated by expanding paracortical tissue, x 20. Infectious and granulornatous conditions of lyrnph nodes 29 a concornitant proliferation of blast cells in the rnedullary cords. Carter and Penrnan (1969) rernarked on the paucity of plasrna cells in infectious rnononucleosis even in the late stages of the disease. The florid blast cell proliferation induced by infectious rnononucleosis rnay extend into the sinuses and partially obliterate the lyrnph node structure giving rise to an appearance resernbling diffuse large cell lyrnphorna.

The virus specifically infects B-lymphocytes, which have receptors for EB virus, and causes lymphoproliferation. The infected B-lymphocytes elicit a vigorous T-lymphocyte response with the production ofkillerT-cells. It is at this stage of T-lymphocyte response that the patient becomes symptomatic. In the early stages of the disease B-lymphoblasts are found in the peripheral blood to be replaced as the disease progresses by 26 Infectious and granulomatous conditions of lymph nodes 27 T-blasts. Various apparently inappropriate antibodies are produced during the disease including autoantibodies and a heterophile antibody to sheep red cells that forms the basis of the diagnostic heterophile antibody test.

20 Biopsy Pathology of the Lymphoreticular System Fig. 25 A frozen section of a reactive lymph node stained with a monoclonal antibody to T-cells using an immunoperoxidase technique. There is positive staining of most cells in the T-zone (T) within which the postcapillary venules stand out as negative staining structures. Within the follicle centre (FC) T-cells are concentrated towards the mantle (M) in the 'light zone', x 80. lymph node. Lymphomas derived from follicle centre cells often themselves form follicles both within and outside lymph nodes and cytologically are composed of mixtures of centroblasts and centrocytes in varying proportions.

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