Synchronous lymph node involvement by metastatic carcinoma and lymphoma (original) (raw)
Related papers
2013
Rare presentation of two concomitant malingancies Background: Lymphatic mapping of axillary breast cancer metastases in the presence of concomitant lymphoproliferative disease is still a controversial topic. Previous reports have postulated that tumor collision in the lymph nodes could lead to false-negative results of sentinel lymph node biopsy, leading to erroneous staging. Case Report: We present the case of a 66-year-old woman with infiltrating ductal breast carcinoma and small lymphocytic lymphoma in whom we performed a lumpectomy and sentinel lymph node biopsy with Technetium-99 and 1% methylene blue, followed by axillary lymph node dissection regardless of the intraoperative status, which was negative. Final pathology confirmed the absence of lymph node metastases. Conclusions: Previously published cases reported correct assessment of SLNB in patients with concomitant small lymphocytic lymphoma and breast carcinoma. We postulate a possible pathological explanation for this: lymphoid cell clusters with pseudofollicles or proliferative centers of small lymphocytic lymphoma are localized outside the nodal sinuses of the lymph node, maintaining its capability of draining, and thus, the feasibility of SLNB in these patients, as in the presented case.
Spectrum of Lesions in Lymph Nodes-A Cytological Study
https://www.ijhsr.org/IJHSR\_Vol.8\_Issue.11\_Nov2018/IJHSR\_Abstract.011.html, 2018
Introduction: Lymph nodes are common sites of clinical presentation of many of the manifestations non-neoplastic and neoplastic diseases. Fine needle aspiration cytology (FNAC) a simple relatively non-invasive procedure which can be employed in diagnosis of superficial lesions of the body. Aim: To study cytomorphological features of various lymph node lesions-non-neoplastic and neoplastic-by fine needle aspiration of enlarged lymph nodes. Methods: The present prospective study to analyse the cytomorphological features of pathological lesions lymph nodes by FNAC is conducted over a period of one year. The study included all the patients of both sexes with age ranging from one to 70 years who presented with clinical features of lymphadenopathy. Results: Out of a total 330 patients with lymphadenopathy subjected to FNAC, the most common site was cervical group of lymph nodes (74.24%) which showed female preponderance (62.42%).Cytomorphology was diagnostic of tuberculous lymphadenitis (32.12%), followed by reactive lymphadenitis(25.45%), granulomatous lymphadenitis (23.33%) and acute suppurative lymphadenitis(3.63%) and metastatic malignant lesions (3.33%) with lymphoproliferative lesions of undetermined significance (0.90%) while neoplastic lesions such as non-Hodgkin's lymphoma (0.30%). Conclusion: FNAC is a simple, safe, reliable, and inexpensive method that could be employed in cytological study and early detection of inflammatory, reactive and neoplastic conditions leading to clinical lymphadenopathy.
Problematic 'high grade' lesions in lymphoproliferative pathology
Materia Medica, 2012
High error rate in primary lymphoma diagnosis by generalist pathologists has imposed a requirement for a redesign of diagnostic services in this subspecialty. 1 In all developed countries and in most of the countries in transition, diagnosis of lymphoid proliferations has become centralised, relying on regional panels of experts and dedicated specialised laboratories. However, the initial steps in the management and subspecialist referral of patients with suspected lymphoma still rely on diagnostic skills of general histopathologists. Their detailed awareness of classification changes, diagnostic requirements and standards is essential for the success of the diagnostic pathway. Here a range of scenarios are highlighted where the outcome of the initial pathological assessment, before any specialist investigations have been carried out, could "sidetrack" the referral process and adversely affect management. The term "High Grade" in this context is used for lesions histologically characterised by high pleomorphism and "blastic" appearance and also for processes with an aggressive clinical behaviour. Over the past two decades the wealth of accumulated knowledge on the biology of lymphoid cells and lymphomas culminated in a series of classifications which emphasised the need for extensive immunophenotypic and genetic interrogation of lymphoid proliferation in the course of pathological diagnosis. 2 as a consequence gone past are the days when treatment of lymphomas could commence after morphological assessment alone. On morphological grounds so many different aggressive lymphomas may show striking similarity. Burkitt lymphoma (BL), blastoid variant of mantle cell lymphoma, lymphomas of the "grey zone" between BL and diffuse large B-cell lymphoma (dLBCL), lymphoblastic lymphoma, plasmacytoid dendritic cell neoplasm and many others may show very similar morphology. This morphological mimicry is further complicated by similarities aggressive lymphoid malignancies may in certain circumstances show with non-haematological malignancies and reactive, inflammatory conditions. Examples of this contentious spectrum are provided together with an update of the most recent classification changes and the impact this has made on the practicalities of pathological diagnosis and management. Abundant reactive lymphoid infiltrate is seen in a range of different tumours: Follicular dendritic cell tumour / sarcoma is an example of this category. This is an uncommon entity displaying a spectrum of biological behaviour involving lymph nodes and a range of extranodal sites. The tumour cells amongst the abundant reactive lymphoid infiltrate could show spindle cell morphology, epithelioid or reed-sternberg-cell features. accurate diagnosis relies on the recognition of the specific immunophenotype (Cd21, Cd23, Cd35, clusterin). 2-4 This is of benefit only if this tumour is included in the initial differential diagnosis which should also consider tumours such as classical Hodgkin lymphoma, T-cell rich B-cell lymphoma, "lymphoepithelioma-like" carcinoma, inflammatory myofibroblastic tumour, metastatic germ cell tumour, medullary carcinoma of breast, "B-type" thymomas, inflammatory pleomorphic sarcoma or interdigitating dendritic cell sarcoma. Aggressive lymphomas may be negative for commonly used lymphoid lineage markers: ALK positive large B-cell lymphoma is a rare entity characterised by a high degree of pleomorphism and epithelioid morphology. 5 This aggressive lymphoma in addition displays an aberrant phenotype, lacking expression of Cd45 and other lineage markers. The initial use of broad immunocytochemical screens may classify this lymphoma as undifferentiated malignancy. a range of haematolymphoid neoplasms may display loss of expression or are by definition characterised by the absence of markers generally considered to be robust lineage discriminators. such tumours are myeloma, plasmablastic lymphomas, anaplastic large cell lymphoma and classical Hodgkin lymphoma which may all pose a difficult differential diagnosis with non-haematological malignancies. Plasma cell myeloma as well as other haematological malignancies may also aberrantly express cytokeratins, which in the context of paucity of expression of other B-cell lineage markers could be highly confusing. 6 In addition, a common tumour such as small cell carcinoma of lung on occasions expresses
Histopathological and immunohistochemical study of lymphnodal biopsies
IP innovative publication pvt. ltd, 2020
Introduction: Diseases affecting lymph nodes form a wide range of spectrum, from simple infection to malignant pathology. A panel of IHC markers is decided based on morphologic differential diagnosis. Aims and Objectives: To study the incidence of lymph nodal lesions with respect to age and sex and their different histopathological patterns. To use Immunohistochemistry (IHC) for sub typing of neoplastic lesions. Materials and Methods: This study was done for a period of two and a half years in the Department o f Pathology, from Jan 2017 to June 2019. All the specimens received were fixed in 10% formalin and routinely processed and stained with Hematoxylin and Eosin (H&E.) Results: A total of 230 lymph node biopsies were studied. Age distribution varied from 3 to 83 years with female preponderance. Non – Neoplastic lesions were common comprising of 120 cases (52%) while neoplastic lesions were 110 (48%). Among non neoplastic lesions reactive lymphadenitis (23%) was common followed by tuberculous lymphadenitis (21%). In neoplastic lesions, metastatic diseases (20%) predominated. IHC was done wherever necessary for subtyping of lymphomas and also to differentiate lymphoma from carcinoma. Conclusion: Lymph node biopsy with IHC plays an important role in establishing the cause for lymphadenopathy and thus aids in therapy.
Proteinaceous precipitate in nodular (follicular) lymphomas
Cancer, 1973
A heretofore undescribed proteinaceous material was observed within the neoplastic nodules of malignant lymphomas with nodular patterns. The amount of this precipitate varied from case to case and from nodule to nodule. Malignant lymphoma, poorly differentiated lymphocytic type, was diagnosed in five patients, and malignant lymphoma, mixed cell type (lymphocytic-histiocytic) was seen in the remaining eight cases. No correlation was found between the amount of the proteinaceous precipitate and the clinical behavior. Of 13 patients in this study, 9 were alive, with or without clinical evidence of lymphoma from 5 to 58 months after onset of symptoms. The remaining four patients died 12, 28, 42, and 48 months after clinical onset, with clinical evidence of disseminated disease at the time of their death. Eight patients were women and five were men. Their ages ranged from 34 to 76 years. Special histochemical procedures failed to reveal the nature of the precipitate, and electron micrographs prepared from one patient showed extracellular clusters of a fine fibrillar material of unknown nature. ALIGNANT L Y R I P H O M A S LVITH A NODULAR M (follicular) pattern have been the subject of a number of publications since their original description. They were first regarded as non-neoplastic processes1~9J2 but are now well accepted as malignant lymphoma^.^^^^^^* 1~x 2 3-2 5 T o date, there is good evidence that patients with malignant lymphomas i n whom a nodular (follicular) pattern is observed have a much better prognosis than cases in which this pattern is lacking.4-10~20 Although the differential morphological criteria between reactive follicular hyperplasia and nodular
Where do these guests come from? A diagnostic approach for metastatic lymph nodes
Turkish Journal of Surgery, 2018
In cases presenting with lymphadenopathies (LAP) without a primary focus detected by simple radiological methods, the primary tumor can be diagnosed by a histopathological evaluation of the metastatic lymph nodes. We aimed to discuss the nonhematological malignancies presenting with lymphadenopathies and the histopathological results for primary tumors. Material and Methods: In this retrospective study, cases diagnosed with metastasis in excisional lymph nodes between January 2013 and June 2016 were assessed for a histopathological diagnostic approach Results: Among 632 lymph node biopsies, a total of 21 cases, involving 12 male and 9 female patients with a mean age of 57.23 y (range, 33-92 y), of nonhematological solid tumors were included. The most common localizations of the involved lymph nodes were inguinal (n=8), axillary (n=6), cervical (n=4), and supraclavicular (n=3) region. The most common primary tumors were malignant melanoma (n=6), breast carcinoma (n=4), ovarian carcinoma (n=2), squamous cell carcinoma (n=2), and germ cell tumor (n=2). Others were papillary thyroid carcinoma, renal cell carcinoma, urothelial carcinoma, prostate adenocarcinoma, and endometrial adenocarcinoma. Conclusion: Nonhematological malignancies presenting with lymphadenopathies are one of the most complicated cases for clinicians. The histopathological evaluation of the excisional metastatic lymph node biopsies is an important method because of cost effectiveness and easy applicability.
Benign Inclusions in Lymph Nodes
International Journal of Morphology, 2007
Criteria Item Inclusions Adenocarcinoma Histological criteria Distribution Around lymphoid follicle, or Not close to lymphoid follicle Epithelium type Pseudostratified Numerous cell layers with Epithelium resembling uterine tube Present Absent Lymph node or vascular involvement May occur Present Psammomatous bodies Present Present Cytological criteria Mitoses Extremely rare Present Cells with neoplastic appearance Absent Present Heterotopic inclusions Lymph nodes commonly involved Breast tissue Axillary Aggregate of nevus cells Axillary Blue nevus Axillary Squamous epithelium Cervical and peripancreatic Salivary gland tissue Cervical Thyroid follicles Cervical Decidual tissue Pelvic Epithelium of paramesonephricus type Pelvic Intestinal glands Mesenteric Mesothelial cells Mediastinal and retroperitoneal