48,536
edits
Difference between revisions of "Lymph node metastasis"
Jump to navigation
Jump to search
→See also
| (16 intermediate revisions by the same user not shown) | |||
| Line 7: | Line 7: | ||
| Micro = malignant cells foreign to the lymph node - typically subcapsular sinus; morphology dependent on specific cancer | | Micro = malignant cells foreign to the lymph node - typically subcapsular sinus; morphology dependent on specific cancer | ||
| Subtypes = dependent on primary tumour - macrometastasis, micrometastasis, isolated tumour cells | | Subtypes = dependent on primary tumour - macrometastasis, micrometastasis, isolated tumour cells | ||
| LMDDx = [[endometriosis]], ectopic [[decidua]], [[endosalpingiosis]], melanocytic nevus, [[dermatopathic lymphadenopathy]], [[sinus histiocytosis]], [[tumour deposit]] (dependent on site), pathology of the lymph node - see ''[[lymph node pathology]]'' and ''[[lymphoma]]'' | | LMDDx = [[endometriosis]], ectopic [[decidua]], [[endosalpingiosis]], [[nodal nevus|nodal (melanocytic) nevus]], [[dermatopathic lymphadenopathy]], [[sinus histiocytosis]], [[tumour deposit]] (dependent on site), pathology of the lymph node - see ''[[lymph node pathology]]'' and ''[[lymphoma]]'' | ||
| Stains = dependent on tumour | | Stains = dependent on tumour | ||
| IHC = dependent on tumour | | IHC = dependent on tumour | ||
| Line 71: | Line 71: | ||
#[[Soft_tissue_lesions#Lymph_node_metastases_in_sarcomas|Lymph node metastases in sarcomas]] are uncommon; they are seen in <3% of cases.<ref name=pmid8424704>{{Cite journal | last1 = Fong | first1 = Y. | last2 = Coit | first2 = DG. | last3 = Woodruff | first3 = JM. | last4 = Brennan | first4 = MF. | title = Lymph node metastasis from soft tissue sarcoma in adults. Analysis of data from a prospective database of 1772 sarcoma patients. | journal = Ann Surg | volume = 217 | issue = 1 | pages = 72-7 | month = Jan | year = 1993 | doi = | PMID = 8424704 | PMC = 1242736}}</ref> | #[[Soft_tissue_lesions#Lymph_node_metastases_in_sarcomas|Lymph node metastases in sarcomas]] are uncommon; they are seen in <3% of cases.<ref name=pmid8424704>{{Cite journal | last1 = Fong | first1 = Y. | last2 = Coit | first2 = DG. | last3 = Woodruff | first3 = JM. | last4 = Brennan | first4 = MF. | title = Lymph node metastasis from soft tissue sarcoma in adults. Analysis of data from a prospective database of 1772 sarcoma patients. | journal = Ann Surg | volume = 217 | issue = 1 | pages = 72-7 | month = Jan | year = 1993 | doi = | PMID = 8424704 | PMC = 1242736}}</ref> | ||
#Fatty lymph nodes (esp. fatty hilus<ref name=pmid18337039>{{Cite journal | last1 = Mack | first1 = MG. | last2 = Rieger | first2 = J. | last3 = Baghi | first3 = M. | last4 = Bisdas | first4 = S. | last5 = Vogl | first5 = TJ. | title = Cervical lymph nodes. | journal = Eur J Radiol | volume = 66 | issue = 3 | pages = 493-500 | month = Jun | year = 2008 | doi = 10.1016/j.ejrad.2008.01.019 | PMID = 18337039 }}</ref>) are less likely to harbor metastases.<ref name=pmid21972135>{{Cite journal | last1 = Korteweg | first1 = MA. | last2 = Veldhuis | first2 = WB. | last3 = Mali | first3 = WP. | last4 = Diepstraten | first4 = SC. | last5 = Luijten | first5 = PR. | last6 = van den Bosch | first6 = MA. | last7 = Eijkemans | first7 = RM. | last8 = van Diest | first8 = PJ. | last9 = Klomp | first9 = DW. | title = Investigation of lipid composition of dissected sentinel lymph nodes of breast cancer patients by 7T proton MR spectroscopy. | journal = J Magn Reson Imaging | volume = 35 | issue = 2 | pages = 387-92 | month = Feb | year = 2012 | doi = 10.1002/jmri.22820 | PMID = 21972135 }}</ref> | #Fatty lymph nodes (esp. fatty hilus<ref name=pmid18337039>{{Cite journal | last1 = Mack | first1 = MG. | last2 = Rieger | first2 = J. | last3 = Baghi | first3 = M. | last4 = Bisdas | first4 = S. | last5 = Vogl | first5 = TJ. | title = Cervical lymph nodes. | journal = Eur J Radiol | volume = 66 | issue = 3 | pages = 493-500 | month = Jun | year = 2008 | doi = 10.1016/j.ejrad.2008.01.019 | PMID = 18337039 }}</ref>) are less likely to harbor metastases.<ref name=pmid21972135>{{Cite journal | last1 = Korteweg | first1 = MA. | last2 = Veldhuis | first2 = WB. | last3 = Mali | first3 = WP. | last4 = Diepstraten | first4 = SC. | last5 = Luijten | first5 = PR. | last6 = van den Bosch | first6 = MA. | last7 = Eijkemans | first7 = RM. | last8 = van Diest | first8 = PJ. | last9 = Klomp | first9 = DW. | title = Investigation of lipid composition of dissected sentinel lymph nodes of breast cancer patients by 7T proton MR spectroscopy. | journal = J Magn Reson Imaging | volume = 35 | issue = 2 | pages = 387-92 | month = Feb | year = 2012 | doi = 10.1002/jmri.22820 | PMID = 21972135 }}</ref> | ||
# Cancer within adipose tissue may be classified as a ''lymph node metastasis''. | |||
#* In the context of breast cancer: breast cancer in axillary adipose tissue in the absence of normal breast tissue, absence of in situ breast carcinoma and absence of residual lymphoid tissue is classified as a lymph node metastasis/micrometastasis/isolated tumour cells in lymph node.<ref name=cap_breast_inv_ver4p5p0p0>College of American Pathologists. Cancer Protocol Templates - Breast Invasive, Resection. Version 4.5.0.0. Available at: [https://documents.cap.org/protocols/Breast.Invasive_4.5.0.0.REL_CAPCP.docx https://documents.cap.org/protocols/Breast.Invasive_4.5.0.0.REL_CAPCP.docx]. Accessed on: August 8, 2021.</ref> | |||
DDx - mimics of metastatic disease: | DDx - mimics of metastatic disease: | ||
| Line 76: | Line 78: | ||
*Ectopic [[decidua]].<ref name=pmid15859655>{{Cite journal | last1 = Wu | first1 = DC. | last2 = Hirschowitz | first2 = S. | last3 = Natarajan | first3 = S. | title = Ectopic decidua of pelvic lymph nodes: a potential diagnostic pitfall. | journal = Arch Pathol Lab Med | volume = 129 | issue = 5 | pages = e117-20 | month = May | year = 2005 | doi = 10.1043/1543-2165(2005)129e117:EDOPLN2.0.CO;2 | PMID = 15859655 }}</ref> | *Ectopic [[decidua]].<ref name=pmid15859655>{{Cite journal | last1 = Wu | first1 = DC. | last2 = Hirschowitz | first2 = S. | last3 = Natarajan | first3 = S. | title = Ectopic decidua of pelvic lymph nodes: a potential diagnostic pitfall. | journal = Arch Pathol Lab Med | volume = 129 | issue = 5 | pages = e117-20 | month = May | year = 2005 | doi = 10.1043/1543-2165(2005)129e117:EDOPLN2.0.CO;2 | PMID = 15859655 }}</ref> | ||
*[[Endosalpingiosis]].<ref name=pmid20631604>{{Cite journal | last1 = Corben | first1 = AD. | last2 = Nehhozina | first2 = T. | last3 = Garg | first3 = K. | last4 = Vallejo | first4 = CE. | last5 = Brogi | first5 = E. | title = Endosalpingiosis in axillary lymph nodes: a possible pitfall in the staging of patients with breast carcinoma. | journal = Am J Surg Pathol | volume = 34 | issue = 8 | pages = 1211-6 | month = Aug | year = 2010 | doi = 10.1097/PAS.0b013e3181e5e03e | PMID = 20631604 }}</ref> | *[[Endosalpingiosis]].<ref name=pmid20631604>{{Cite journal | last1 = Corben | first1 = AD. | last2 = Nehhozina | first2 = T. | last3 = Garg | first3 = K. | last4 = Vallejo | first4 = CE. | last5 = Brogi | first5 = E. | title = Endosalpingiosis in axillary lymph nodes: a possible pitfall in the staging of patients with breast carcinoma. | journal = Am J Surg Pathol | volume = 34 | issue = 8 | pages = 1211-6 | month = Aug | year = 2010 | doi = 10.1097/PAS.0b013e3181e5e03e | PMID = 20631604 }}</ref> | ||
* | *[[Nodal nevus|Nodal (melanocytic) nevus]] - intracapsular or within the trabeculae.<ref name=pmid12717252>{{Cite journal | last1 = Biddle | first1 = DA. | last2 = Evans | first2 = HL. | last3 = Kemp | first3 = BL. | last4 = El-Naggar | first4 = AK. | last5 = Harvell | first5 = JD. | last6 = White | first6 = WL. | last7 = Iskandar | first7 = SS. | last8 = Prieto | first8 = VG. | title = Intraparenchymal nevus cell aggregates in lymph nodes: a possible diagnostic pitfall with malignant melanoma and carcinoma. | journal = Am J Surg Pathol | volume = 27 | issue = 5 | pages = 673-81 | month = May | year = 2003 | doi = | PMID = 12717252 }}</ref> | ||
**Incidence estimated at ~ 0.5% in axillary lymph nodes.<ref name=pmid8037154>{{cite journal |author=Bautista NC, Cohen S, Anders KH |title=Benign melanocytic nevus cells in axillary lymph nodes. A prospective incidence and immunohistochemical study with literature review |journal=Am. J. Clin. Pathol. |volume=102 |issue=1 |pages=102–8 |year=1994 |month=July |pmid=8037154 |doi= |url=}}</ref> | **Incidence estimated at ~ 0.5% in axillary lymph nodes.<ref name=pmid8037154>{{cite journal |author=Bautista NC, Cohen S, Anders KH |title=Benign melanocytic nevus cells in axillary lymph nodes. A prospective incidence and immunohistochemical study with literature review |journal=Am. J. Clin. Pathol. |volume=102 |issue=1 |pages=102–8 |year=1994 |month=July |pmid=8037154 |doi= |url=}}</ref> | ||
*[[Dermatopathic lymphadenopathy]].{{fact}} | *[[Dermatopathic lymphadenopathy]].{{fact}} | ||
*[[Sinus histiocytosis]] - especially for the junior resident. | *[[Sinus histiocytosis]] - especially for the junior resident. | ||
*[[Tumour deposit]] (discoutinuous extramural extension) - definition dependent on primary tumour | *[[Tumour deposit]] (discoutinuous extramural extension) - definition dependent on primary tumour. | ||
**In the head & neck they are generally considered tumour replaced lymph nodes - though this appears to be evolving.<ref name=pmid25546631>{{Cite journal | last1 = Sarioglu | first1 = S. | last2 = Akbulut | first2 = N. | last3 = Iplikci | first3 = S. | last4 = Aydin | first4 = B. | last5 = Dogan | first5 = E. | last6 = Unlu | first6 = M. | last7 = Ellidokuz | first7 = H. | last8 = Ada | first8 = E. | last9 = Akman | first9 = F. | title = Tumor deposits in head and neck carcinomas. | journal = Head Neck | volume = 38 Suppl 1 | issue = | pages = E256-60 | month = Apr | year = 2016 | doi = 10.1002/hed.23981 | PMID = 25546631 }}</ref> | |||
**In the colon and rectum tumour deposits are considered separately and not counted as lymph nodes. | |||
*Benign thyroid inclusion - somewhat controversial, see ''[[aberrant thyroid tissue]]''.<ref name=pmid15744160 >{{Cite journal | last1 = León | first1 = X. | last2 = Sancho | first2 = FJ. | last3 = García | first3 = J. | last4 = Sañudo | first4 = JR. | last5 = Orús | first5 = C. | last6 = Quer | first6 = M. | title = Incidence and significance of clinically unsuspected thyroid tissue in lymph nodes found during neck dissection in head and neck carcinoma patients. | journal = Laryngoscope | volume = 115 | issue = 3 | pages = 470-4 | month = Mar | year = 2005 | doi = 10.1097/01.mlg.0000157841.63283.87 | PMID = 15744160 }}</ref> | |||
===Images=== | ===Images=== | ||
| Line 100: | Line 105: | ||
==Staging== | ==Staging== | ||
It is customary to record: | It is customary to record: | ||
# The size of the largest lymph node metastasis.‡ | # The size of the largest lymph node metastasis. ‡ | ||
#* It is a dictum of the ''Association of Directors of Anatomic and Surgical pathology''<ref name=pmid11007046>{{Cite journal | title = Recommendations for the reporting of specimens containing oral cavity and oropharynx neoplasms. | journal = Mod Pathol | volume = 13 | issue = 9 | pages = 1038-41 | month = Sep | year = 2000 | doi = 10.1038/modpathol.3880188 | PMID = 11007046 }}</ref> that masses >3 cm are matted lymph nodes/confluent lymph nodes ''or'' a tumour mass. | #* It is a dictum of the ''Association of Directors of Anatomic and Surgical pathology''<ref name=pmid11007046>{{Cite journal | title = Recommendations for the reporting of specimens containing oral cavity and oropharynx neoplasms. | journal = Mod Pathol | volume = 13 | issue = 9 | pages = 1038-41 | month = Sep | year = 2000 | doi = 10.1038/modpathol.3880188 | PMID = 11007046 }}</ref> that masses >3 cm are matted lymph nodes/confluent lymph nodes ''or'' a tumour mass. | ||
# The presence/absence of extranodal extension. | # The presence/absence of extranodal extension. | ||
| Line 106: | Line 111: | ||
Note: | Note: | ||
*‡ Large size is considered significant at some anatomical [[site]]s, e.g. pharynx. It may | *‡ Large size is considered significant at some anatomical [[site]]s, e.g. pharynx. It may change the N stage. | ||
===Number of lymph nodes=== | ===Number of lymph nodes=== | ||
| Line 121: | Line 126: | ||
#Number of tissue fragments with definite lymph node. | #Number of tissue fragments with definite lymph node. | ||
#*Lymph node = lymphoid tissue + capsule. | #*Lymph node = lymphoid tissue + capsule. | ||
#Whether tumour | #Whether tumour nodules without lymphoid tissue are classified as lymph nodes or [[tumour deposits]] - dependent somewhat on the anatomical [[site]]. | ||
Notes: | Notes: | ||
*Generally, the number of lymph nodes in a block should not exceed the number seen at gross. | *Generally, the number of lymph nodes in a block should not exceed the number of possible lymph nodes seen at gross. | ||
==Sign out== | ==Sign out== | ||
<pre> | |||
Lymph Nodes, Left Axilla, Radical Lymph Node Dissection: | |||
- Three lymph nodes with METASTATIC MALIGNANT MELANOMA | |||
of twenty lymph nodes (3/20). | |||
-- Largest focus of melanoma: 2.1 cm. | |||
-- Extranodal extension: ABSENT. | |||
- Benign skin. | |||
</pre> | |||
===Matted lymph nodes - comment=== | ===Matted lymph nodes - comment=== | ||
<pre> | <pre> | ||
| Line 137: | Line 151: | ||
*[[Cancer]]. | *[[Cancer]]. | ||
*[[Cancer staging]]. | *[[Cancer staging]]. | ||
*[[Lateral aberrant thyroid tissue]]. | |||
*[[Sentinel lymph node]]. | |||
*[[Extranodal extension]]. | |||
==References== | ==References== | ||