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Patologi Sistem Retikulo

Endhotelial
Prof. DR. Ambar Mudigdo, Sp.PA(K)
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Lymph Node
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Lymph Node
1. AFF LYMPH. VES.
2. CAPSULE
3. PERI PHER SINUS
4. PARA FOLICULAR
CORTEX/ T CELL
ZONE
5. LYMPHOID FOLICLE/
B CELL ZONE
6. EFF LYMPH VES
7. ARTERI & VEIN
8. MEDULLA
9. MEDULLARY
SINUSES
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ACUTE NON SP LYMPHADENITIS
REACTIVE CHANGES
:
Micro organism
Cell debris
Foreign material

cervical
axillaries
inguinal
mesenteric

Macros : Enlarged, swollen,
grey-red, distendedpain.
Micros : Lymphoid foll
prominent, large germinal
center with mitotic activity,
histiosit, neutrophil infiltration,
sinusis cell hipertropia/plasia
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Acute Non specific Lymp-itis
Reactive changes
Cervical, axillaries, inguinal, mesenteric
Morphology : enlarged, swollen, grey-red,
distended caps tender.
Histopathology : Lymph. Follicles >>,
Large germ C with mitotic activity,
neutrophil infiltration. Sinuses cell hyper
trophi / plasia.


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Chronic Non Specific Lymp.itis
Inguinal, axillaries, not tender.
Morfologi : enlarged, firm, mobil.
Histopathology:
follicular hyperplasia-B cell
dark zone, light zone, plasma cell,
histiosit, PMN, Eosinophyl.
DD: Follicular Lymphoma :
1. Archi. Inter foll. T & Sinus
2. Variation shape & size nod
3. Dark-Light, Phagocytic-macrophages
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I. Follicular hyperplasia
activated B cell, larged, round germinal center.

II. Paracortical lymphoid hyperplasia
Reactive chages T cell
Viral Infection.

III. Sinus histiocytosis.
Distention-prominent sinusoid
Lymph node draining cancer
Chronic Non Specific
Lymphadenitis
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Chronic specific Lymphadenitis
TUBERCULOSA

MACROS :
bergerombol, packed, central caseous.Not tender (cold
abcess)

MICROS :
tubercle, cheese, necrotic, langhans cell,epitheloid cell.

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Morphology : besar, multiple,
bergerombol, tdk nyeri, livide, fistel
Histopatology :tuberc, epiteloid, caseosa,
langhans.
Lokasi : Leher, Supraclav, axilla
Chronic specific Lymphadenitis
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LYMPHOID NEOPLASMA
Limfoma - Leukemia
HD
NHL
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Hodgkin Disease
Chain nodes-spread characteristic
Giant cells, Reed-Stenberg cell induced
RX lymph, histiocyt, granulocyt.
Nodular sclerosis
mixed cellularity
lymph predominant
lymphocyte-depleted
Clin : Multiple limphoadenopatia
single group painless
Kadang-kadang
hepatosplenomegali
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Hodgkin Disease
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Hodgkin disease
100% kel limfe
Tunggal menyebar
20-40 th(30-35 th)
Jenis
Nodular scler. : 65%
Mixed cellularity : 25%
Limfositik predominan 10%
Limfositik depletion
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Clinical staging of HD
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HD & NHL
HD NHL
Local lymph .CER-
ME.ST-P.A
MULTIPHERIPHERAL
Limf. Node enlargement
CONTIQUITY NO
EXTRA NODAL
UNCOMMON
COMMON
WALDEYER &
MESENTERIC
INVOLVED RARE
COMMON
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Reed-Stenberg cell
Microskopis :
Reed-stenberg cell:
besar, binukleus,
berhadap-kaca,
kadang-kadang multi
nuc, single lob,
sekitar halo area
Lacunar cell :
nodular sel
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NODULAR SCLEROSIS
MOST COMMON 65-75%, , YOUNG
PROGNOSA BAIK, LEHER
SUPRACLAVICULA, MEDIASTINUM.
NODULAR, VARIANT R.S., Lacunar cell,
collagen band, divide lymphositis-nodule.

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Non Hodgkin Lymphomas
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Klasifikasi bervariasi
mnrt : Asal :sel B,sel T.
Struktur : FOL,DIF.
Vol.sel : LARGE,SM.
DIFERENSIASI : WORKING FROM.,REAL
CLAS.,RAPPAPORT.

ACUT LIMFOBLASTIC LIMFOMA/LEUKEMIA
di AS : 2500 KASUS BARU/TH
< 15 th, kulit putih 2X
> atau = , balita, < 15 th.
Mic : Str Norm kel lif rusak, sel limfoblas dominan : Besar.
Inti Lobulated, Mitosis >>
Clinn : Anemia, Lemah, Panas acut. Infeksi, Bone pain,
Spleen & liver enlargement, General limfadenopati, dll


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Chronic lymphocitic / small cell limfoma
Sering pada dewasa
Small B cell pd sirkulasi (leukemia)
Micros : str NL rusak, Small limfosit predominan,
inti kecil, kombinasi dgan sel > besar
(prolimfositic)
Clin :
> 50 tahun
< atau = , sering asimptom, BB, lemah, anoreksi,
Lekosit >>, Limfadenopatia, spleen+ Liver

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B-cell lymphoma
Chronic lymphocitic lymphoma
Folicular lymphoma
Diffus large B cell lymphoma
Burkitt lymphoma
Plasma cell neoplasm, etc.

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T cell lymphoma & natural killer cell N
1. Peri T cell L UNSP
2. Adult T cell Lymphoma
3. Mycosis fungoides
4. Hodgkin disease

Precursor B Cell & T cell N
Acut Lymphoblastic L
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NHL : paling sering(45%)
; dewasa
Micros : nodular struktur, small cell irreg.
inti bigger cell chrom >>, nucleoli >
Clinical : Painless limfadenopati general
extra nodul rare, median survival 7-9 th
Tx : Chemoteraphy, radiasi, palliativ Tx

Folicular lymphoma
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Diffus Large B-cell Lymphoma
20% NHL
<, 60 th
Mic :
Diffus patern
Large cell : 4-5x limf kecil
Nuclei : bulat-oval, cleaved-lobulasi
Anak inti : 2-3 atau 1 di tengah
Clin :
pembesaran kel. limf., kadang-kadang extra nodal : Git, bone,
brain, skin.
Px : Jelek
Tx : Intensive mix chemo Txcomplete remission 60-80%, 50% for
several years.
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MULTIPLE MYELOMA
PLASMA CELL bone, skin LN.
> , Ig > , prot Bence Jones, Midle age (50).
Clinic :
Multiple bone destruct
Vert, Ribs, Skull, pelvis, femur, R bulat oval,
batas fract. Patol.
Micros : plasma cell >> pleo morphic, exentric nucleus
plasma blast
spleen, liver, kidney, lungs



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Burkitt limfoma
Endemic-sporadic-agresif (Afrika).
Mic : invasi intermed size sel limfosit, inti
oval-bulat, nucleoli>1 kromatin kasar,
mitosis>> starry sky patern( macrophages,
ingest nuc debris)
Clin :
extra nodal manifes, mandibula, organ intra
Abdomen.
Children, muda.
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SPLEEN
150 GR : 12 x 7 X 3 CM
MACROS : KAPSUL TIPIS, ABU-ABU
TRABEKULA PD. PARENKIM MERAH
DGN BERCAK PUTIH-WHITE PULP.
RED PULP. SINUSSOID DGN KAPILER
DD TIPIS

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SPLEEN
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FUNGSI
1. Pembentukan sel darah (diluar sumsum
tulang).
2. Proses hemolisis
3. Reservoir darah, mobilisasi bila perlu
4. Reaksi pertahanan-kekebalan tubuh,
produksi limfosit dan zat anti


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Gangguan sirkulasi
1. Bendungan akut
2. Bendungan menahun
3. Sindroma banti : splenomegali kongestif
>>, lekopeni, anemi.
4. Infark : Obstr. Emboli cor single/ multiple-
Baji.
Gamna-Gandy bodies : bercak abu2-coklat
(fibrosis+ endapan pigmen) pd Banti
sindrom

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Splenomegali
1. Infeksi : Typ. TBC, Mal syph
2. Congestiv : Cirh, decomp, portalthrom
3. Limfo-hematogen dis.
4. Immunogenic
5. Storage dis : gaucher, niemann-Pick
6. Lain : amyloid, neopl
Neoplasm : Jarang
Benign : Hemangioma, Limfangioma, fibroma