HEPATIC LYPHOMA: TWO CASES REPORT

Introduction: Hepatic lymphoma is defined as primary when there is an attack on the liver without affecting the spleen, the bone marrow or another lymphatic organ. The primary hepatic attack is a very rare variant estimated at 1% of all extra lymphomas. Case report: We report two cases, the first concerning a patient aged 65 years, without pathological history, admitted for chronic abdominal pain associated with a febrile syndrome, the initial diagnosis revealed a liver tumor at the level of segment I. The patient was operated, the pathological examination of an extemporaneous biopsy concluded to a primitive lymphoma of the liver. The patient was referred to oncology for chemotherapy. Her evolution was satisfactory with a 2-year follow-up. The second patient, 50 years old, without notable pathological history, admitted for generalized jaundice, the physical examination reports a palpable mass in the right hypochondrium. The initial diagnosis revealed the presence of a process involving segment I of the liver, an echo endoscopy showed several mesenteric celiomentaladenopathies and a main biliary tract with stenosis, a sphincterotomy was scheduled, an anatomopathological examination with complementary immunohistochemical study showed a diffuse large cell B lymphoma and the patient was referred to the oncology department. Discussion: Lymphomas of the liver is a rare condition. They predominate in middle- aged adults and males. Clinical presentations are diverse. Radiological aspects and biological disturbances are variable. Treatment modalities are variable, combining surgery, chemotherapy and radiotherapy. Conclusion: The diagnosis of lymphomas of the liver is difficult. The therapeutic decision must take into account the extent of the disease, the general condition of the patient. Chemotherapy remains the cornerstone of treatment.

Mucosal Immunology

Approximately 80% of the pathogens that lead to deadly infections in humans choose mucosal tissue as the first site of infection. The mucosal surfaces of the body include the gastrointestinal tract, airways, oral cavity, and urogenital mucosa, which provide a large area conducive to the invasion and accumulation of many microorganisms and are of great importance in this regard. The large extent of mucus, as well as the accumulation of bacteria and countless foreign antigens in these areas, are the most important reasons for the importance of mucosal tissues. In addition to the myriad of symbiotic bacteria, large amounts of oral antigens (both pathogenic and non-pathogenic) enter a person’s body daily and human mucosal tissues are exposed to these antigens. The function of the mucosal immune system is to distinguish pathogenic antigens from non-pathogenic ones. In this way, against a large number of oral antigens or co-tolerant microorganisms, and pathogenic antigens, a favorable (and even non-inflammatory, possible) immune response is produced. Mucosal tissue, as the largest lymphatic organ in the body, is home to 75% of the lymphocyte population and produces the highest amount of immunoglobulin. The amount of secreted IgA (slgA) produced daily by mucosal surfaces is much higher than the IgG produced in the bloodstream. A 70 kg person produces more than 3 grams of IgA per day, which is about 70–60% of the total antibodies produced in the body. The first embryonic organ in which immune system cells are located in the intestine. Some researchers consider this organ (and specifically mucosal lymph nodes) to be the source of the human immune system.

Revisiting the Spleen—An Imaging Review of the Common and Uncommon Splenic Pathology

The spleen is the largest lymphatic organ and is responsible for both hematological and immunological functions. Several common etiologies such as trauma, developmental variants, infectious/inflammatory conditions, and benign and malignant lesions can occur in the spleen. The role of imaging modalities such as ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) in diagnosing these conditions continues to evolve. The main objective of this review article is to illustrate the role of imaging in identifying the common and uncommon pathology of the spleen.

The Role of Lymphatics in Cholestasis: A Comprehensive Review

Cholestatic liver disease affects millions of people worldwide and stems from a plethora of causes such as immune dysfunction, genetics, cancerous growths, and lifestyle choices. While not considered a classical lymphatic organ, the liver plays a vital role in the lymph system producing up to half of the body's lymph per day. The lymphatic system is critical to the health of an organism with its networks of vessels that provide drainage for lymphatic fluid and routes for surveilling immune cells. Cholestasis results in an increase of inflammatory cytokines, growth factors, and inflammatory infiltrate. Left unchecked, further disease progression will include collagen deposition which impedes both the hepatic and lymphatic ducts, eventually resulting in an increase in hepatic decompensation, increasing portal pressures, and accumulation of fluid within the abdominal cavity (ascites). Despite the documented interplay between these vital systems, little is known about the effect of liver disease on the lymph system and its biological response. This review looks at the current cholestatic literature from the perspective of the lymphatic system and summarizes what is known about the role of the lymph system in liver pathogenesis during hepatic injury and remodeling, immune-modulating events, or variations in interstitial pressures.

From "Leaky Gut" to Impaired Glia-neuron Communication in Depression

In the last three decades, the robust scientific data emerged, demonstrating that the immune-inflammatory response is a fundamental component of the pathophysiology of major depressive disorder (MDD). Psychological stress and various inflammatory comorbidities contribute to such immune activation. Still, this is not uncommon that patients with depression do not have defined inflammatory comorbidities, and alternative mechanisms of immune activation need to take place. The gastrointestinal (GI) tract, along with gut-associated lymphoid tissue (GALT), constitutes the largest lymphatic organ in the human body and forms the biggest surface of contact with the external environment. It is also the most significant source of bacterial and food-derived antigenic material. There is a broad range of reciprocal interactions between the GI tract, intestinal microbiota, increased intestinal permeability, activation of immune-inflammatory response, and the CNS that has crucial implications in brain function and mental health. This intercommunication takes place within the microbiota-gut-immune-glia (MGIG) axis, and glial cells are the main orchestrator of this communication. A broad range of factors, including psychological stress, inflammation, dysbiosis and other, may compromise the permeability of this barrier. This leads to excessive bacterial translocation and the excessive influx of food-derived antigenic material that contributes to activation of the immune-inflammatory response and depressive psychopathology. This chapter summarizes the role of increased intestinal permeability in MDD and mechanisms of how the "leaky gut" may contribute to immune-inflammatory response in this disorder.

Indications for Surgery in Non-Traumatic Spleen Disease

The spleen is the largest lymphatic organ that acts as a site for filtration of foreign particles from the blood, erythropoiesis and hematopoiesis. Splenectomy represents the first line of treatment for spontaneous splenic rupture, abscesses, cysts, tumours. It is also used to control hereditary, autoimmune, and myeloproliferative disorders alternatively. Numerous diseases have been indicated for surgery in non-traumatic spleen diseases such as non-traumatic spleen rupture, immune thrombocytopenic purpura (ITP), haemolytic anaemias, Felty's syndrome, Hodgkin's and non-Hodgkin's lymphoma among others. This result because the spleen is the most affected lymphoid organ following its overactivity that occurs during sequestration of dead or disrupted RBCs and lymphocytes. Abdominal pain is one of the major manifestations of splenomegaly, and can also designate other associated complications such as liver cirrhosis or bacterial endocarditis. As a secondary lymphoid organ, the spleen is more often an organ for lymphomas. Although splenectomy is a curative alternative in a few diseases, it is a complementary means of treating several other diseases. Splenectomy is a salvage therapy used when other therapeutic alternatives fail. Despite its indication in numerous diseases, controversies are still inbound of its use.

Anatomical and histological changes in the spleen of post hatching indigenous chicken in Iraq

The structure of the indigenous chickens spleen during the post-hatching period was determined by gross and light microscopical examination by using Hematoxylin and eosin and Massons Trichrome staining techniques. At one day old chicks the spleen was rounded in shape, pink in color. At two weeks old chicks the spleen was triangular in shape. At the progress of the aged the color of spleen became red-brown. In all ages the spleen consisted of white pulp and red pulp which were fused together. The spleen was encapsulated by thin connective tissue capsule contain few smooth muscles, the trabiculi were rare and thin. The red pulp consisted of venous sinuses surrounded by lymphatic cords. The white pulp consisted of peri-artery lymphoid sheath, peri-venous lymphoid sheath, peri ellipsoid lymphoid sheath, and Lymphatic follicles. The appearance of these elements was age dependant. At the first week of age the peri-artery lymphoid sheath and peri-venous lymphoid sheath were developed. At the third week, the peri ellipsoid lymphoid sheath, Lymphatic follicles were noticed and the plasma cells were scattered in the white pulp in addition to the lymphocytes. At one month of age, the germinal center appeared in some lymphatic follicle. The present study revealed that the spleen was well developed lymphatic organ at the age of three weeks.

The Spleen

This review focuses on the normal anatomy and physiology of the spleen. The spleen functions as a hematologic organ, filtering blood, metabolizing iron, and acting as a reservoir for blood cells. The spleen, the largest lymphatic organ, also plays a key role in adaptive and innate immunity. This review contains 7 figures of highly rendered artwork and 26 references. Key words: immune system, spleen, spleen anatomy, spleen physiology, splenectomy vaccine guidelines

Histogenesis of Human Fetal Spleen

Background and Aims: Spleen is the largest secondary lymphatic organ. It acts as a graveyard for RBCs, is essential for immune responses, performs lymphopoiesis in adults and haemopoiesis in fetuses. The present study was conducted to assess the histogenesis of spleen in human fetuses in view of existing literature. Material and Methods: The study was carried out on 34 formalin preserved human fetuses procured from Dr Sushila Tiwari Government Hospital, Haldwani with due clearance from ethical committee. The 6 pm sections of the spleen were stained with Haematoxylin and Eosin and observed under light microscope. Results: At 14 tol5 weeks, spleen had extensive sinusoids filled with RBCs and few lymphocytes. At 16-18 weeks, trabecular arteries were noticed more towards centre along with extensive haemopoietic cells in the venous sinusoids. By 20th week lymphocytic aggregation had started around arterioles. By 24 weeks periarteriolar lymphatic sheath was clearly observed. At term (37-40 weeks), classical primary lymphoid follicle was present but germinal centers were not observed. Conclusion: During earlier differentiation, spleen symbolizes the function of haemopoietic activities and gradually during subsequent gestation; it establishes its identity as a principle lymphoid tissue.