Color Atlas of Hematology - Practical Microscopic and Clinical ...

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180Cytology of Organ Biopsies and ExudatesSarcoidosis and TuberculosisThe material of cell biopsies taken from indolent, nonirritated enlargedlymph nodes in the neck or axilla that have developed with little in theway of clinical symptoms, or from subcutaneous infiltration in various regions,can be quite homogeneous. With their thin, very long, ovoid nucleus(four to five times the size of lymphocytes), delicate reticular chromatinstructure, and extensive layer of cytoplasm that may occasionallyappear confluent with that of other cells, they are reminiscent of theepithelial cells that line the body’s internal cavities and are thereforecalled epithelioid cells. They are known to be the tissue form of transformedmonocytes, and are found in increased numbers in all chronic inflammatoryprocesses—especially toxoplasmosis, autoimmune diseases,and foreign-body reactions—and also in the neighborhood and drainageareas of tumors. They exclusively dominate the cytological picture in aparticular form of chronic “inflammation,” sarcoidosis (Boeck disease). Atypical finding almost always encountered at the pulmonary hilus combinedwith a negative tuberculin test will all but confirm this diagnosis.The appearance of a few multinuclear cells (Langhans giant cells) mayallow confusion with tuberculosis, but clinical findings and a tuberculinskin test will usually make the diagnosis clear.Rapidly developing, usually hard, pressure-sensitive neck lymph nodes,seemingly connected with each other with some fluctuant zones and externalinflammatory redness, suggest the now rare scrofulous form oftuberculosis. A highly positive tuberculin skin test also suggests this diagnosis.If any remaining doubts cannot be dispelled clinically, a very-fineneedlelymph node biopsy may be performed, but only if the skin showsnoninflammatory, pale discoloration.The harvested material can show the potency of the tissue-boundforms of cells in the monocyte/macrophage series. In addition to mononuclearepithelioid cells, there are giant cell conglomerates made up ofpolynuclear epithelioid cells in enormous syncytia with 10, 20, or morenuclei. These are called Langhans giant cells. In scrofuloderma (tuberculosiscolliquativa), there are also lymphocytic and granulocytic cells in theprocess of degradation, which are absent in purely productive tuberculouslymphadenitis.
Epithelioid cells dominate the lymph node biopsy: Boeck diseaseor tuberculosisabFig. 64 Boeck disease and tuberculosis. a Lymph node cytology in Boeck disease:a special form of reactive cell pattern with (often predominating) islandsand trains of epithelioid cells (arrow), which have ovoid nuclei with delicate chromatinstructure and a wide, smoke-gray layer of cytoplasm. b Lymph node cytologyin tuberculous lymphadenitis: in addition to lymphocytes and a few epithelialcells (1), enormous syncytes of epithelioid cell nuclei within one cytoplasm (arrow)may be encountered: the Langhans giant cell.181
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iiiColor Atlas of HematologyPractic
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vPrefaceOur Current EditionAlthough
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viiContentsPhysiology and Pathophys
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ContentsixAcute Lymphoblastic Leuke
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2Physiology and Pathophysiology of
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Normal Cells of the Blood andHemato
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Normally erythropoiesis takes place
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34Normal Cells of the Blood and Hem
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Advancing nuclear contraction and s
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Note the granulations, inclusions,
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Abnormalities of the White Cell Ser
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Predominance of Mononuclear Round t
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During lymphatic reactive states, v
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Extreme transformation of lymphocyt
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Monotonous proliferation of small l
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Atypical lymphocytes are not part o
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Deep nuclear indentation suggests f
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Cytoplasmic processes the main feat
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Plasmacytoma cannot be diagnosed wi
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Atypias and differential diagnoses
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Bone marrow diagnosis is indicated
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Conspicuously large numbers of mono
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Fundamental characteristic of acute
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The diagnosis of acute leukemia is
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Acute leukemias may also derive fro
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New WHO classification: AML with dy
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The cells in acute lymphocytic leuk
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In unexplained anemia and/or leukoc
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The classification of myelodysplasi
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Prevalence of Polynuclear (Segmente
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Predominance of the granulocytic li
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Prevalence of Polynuclear (Segmente
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Left shift as far as myeloblasts, p
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Bone marrow analysis is not obligat
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In the course of chronic myeloid le
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Enlarged spleen and presence of imm
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Eosinophilia and basophilia are usu
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Erythrocyte and ThrombocyteAbnormal
Page 139 and 140: Hypochromic Anemias129Insufficient
Page 141 and 142: Hypochromic Anemias131BSGIron Ferri
Page 143 and 144: Small, hemoglobin-poor erythrocytes
Page 145 and 146: Hypochromic erythrocytes of very va
Page 147 and 148: Hypochromic Anemias137Hypochromic S
Page 149 and 150: Hypochromic anemia without iron def
Page 151 and 152: Consistently elevated “young” e
Page 153 and 154: Distribution pattern and shape of e
Page 155 and 156: Conspicuous erythrocyte morphology
Page 157 and 158: Unexplained decrease in cell counts
Page 159 and 160: Hypochromic Anemias149Differential
Page 161 and 162: Thrombocytopenia with leukocytosis
Page 163 and 164: Conspicuous large erythrocytes sugg
Page 165 and 166: In older patients, myelodysplastic
Page 167 and 168: Small inclusions are usually a sign
Page 169 and 170: PlasmodiumfalciparumPlasmodiumvivax
Page 171 and 172: Conspicuous erythrocyte inclusions
Page 173 and 174: Bone marrow analysis contributes to
Page 175 and 176: Thrombocytes: increases, reductions
Page 177 and 178: Thrombocytes: increases, reductions
Page 179 and 180: Variant forms of thrombocyte and me
Page 181 and 182: Thrombocyte proliferation with larg
Page 183 and 184: Cytology of Organ Biopsiesand Exuda
Page 185 and 186: Lymph Node Cytology175Anamnesis- su
Page 187 and 188: Reactive lymph node hyperplasia and
Page 189: Lymph Node Cytology179Contact witha
Page 193 and 194: In cases of non-Hodgkin lymphoma an
Page 195 and 196: Accessible cysts (e.g., branchial c
Page 197 and 198: Tumor cells can be identified in pl
Page 199 and 200: Viral, bacterial, and malignant men
Page 201 and 202: 191IndexAActinomycosis 179Addison d
Page 203 and 204: Index193Disseminated intravascularc
Page 205 and 206: Index195blast crisis 120-121bone ma
Page 207 and 208: Index197in hemolytic anemia 140orth
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