Nevus cells in axillary lymph nodes from radical mastectomy specimens

From 1977 to 1983, 44 cases with nevus cells in the capsule and trabeculae of axillary lymph node specimens from about 7000 mastectomies performed for primary breast cancer were found. This finding was therefore less than 1%. In 3 cases, the nevus cells were present in 2 nodes, whereas in 41 cases solitary nodes were involved. In 13 cases, nevus cells were present in nodes that also contained metastatic carcinoma. Silver impregnation of reticulin fibers is very useful for the differential diagnosis of nodal metastases of breast carcinoma.     

Benign nevus cells in the lymph nodes. An immunohistochemical study

Aggregates of nevus cells in the axillary lymph nodes may give rise to a suspicion of metastatic breast cancer. Usually the nevus cells are confined to the capsule or the trabeculae, but in the present case, clusters of nevus cells were also observed in the peripheral sinus. Immunohistochemical analysis for S-100 protein and epithelial membrane antigen established the true nature of the cells.     

A case of spitzoid melanoma with lymph node metastasis in a child

The distinction of a spitz nevus from a melanoma can be difficult and in some cases, impossible. A misdiagnosed spitz nevus can metastasize and lead to fatal outcomes, especially in children. A 5-yr-old girl presented with a 1-yr history of a solitary pinkish nodule on her left hand. On physical examination, she had a palpable left axillary lymph node. We performed biopsy and checked 3 sentinel lymph nodes (SLN) on her axillary area. The biopsy specimen showed multiple variably sized and shaped nests with large spindle or polygonal cells and SLN biopsy showed 3 of 3 lymph nodes that were metastasized. Under the diagnosis of spitzoid melanoma, she was treated with excision biopsy and complete left axillary lymph nodes were dissected. She received interferon-α2b subcutaneously at a dose of 8 MIU per day, 3 times weekly for 12 months, and shows no recurrence.     

Benign salivary gland tissue inclusion in a pulmonary hilar lymph node from a patient with invasive well-differentiated adenocarcinoma of the lung: a potential misinterpretation for the staging of carcinoma

Benign epithelial and nonepithelial inclusions have been found in lymph nodes in multiple body sites. These inclusions have been seen in cervical, axillary, mediastinal, abdominal, and pelvic lymph nodes. They appear as benign epithelial, parathyroid, decidual, mesothelial, angiolipomatous, nevus cells, or Tamm-Horsfall protein. Although heterotopic salivary gland tissue is not infrequent in paraparotid lymph nodes, it has only been described in lymph nodes of the pulmonary hilum once. A 68-year-old woman with gastric lymphoma now in remission presented for routine follow-up and was found to have a lung mass. After a fine needle aspiration biopsy diagnosis of adenocarcinoma, lobectomy and lymph node dissection were performed. Histological sections of lung demonstrated a well-differentiated adenocarcinoma and one lymph node, which displayed a subcapsular nest of well-formed salivary glands occupying approximately one third of the nodal tissue. The inclusion was composed of acinar cells of both serous and mucinous types, but ductal type of cells were not seen. Identification of heterotopic tissue in lymph nodes is of great importance for patient management. Misdiagnosing benign glandular inclusions for metastasis could potentially lead to incorrect tumor staging. Benign salivary gland tissue inclusions should be considered in the differential diagnosis when evaluating for metastatic adenocarcinoma. The salivary gland inclusion in pulmonary hilar lymph node may be histogenetically related to the minor salivary glands, which are located within the bronchial submucosa.     

Begnin naevus cell inclusions in two patients treated for cancer

In 1897, Reis was the first to describe benign nevus inclusions in the lymph node of patients undergoing surgery for genital neoplasia. These inclusions are very rarely encountered and can be misleading in the absence of careful analysis. We report on two cases of nevus cell inclusions in axillary and inguinal lymph nodes dissected in the context of breast cancer and thigh sarcoma respectively. Cautious morphological analysis should be compared with histochemistry and immunohistochemistry data to avoid erroneous diagnosis of metastasis. We also should bare in mind the possible occurrance of primitive lymph node melanoma.     

Megakaryocytes mimicking metastatic breast carcinoma

False-positive diagnosis of lymph nodes occurs when a benign element in a lymph node, or in its capsule, is interpreted as metastatic carcinoma. This report describes a patient with breast carcinoma who had megakaryocytes in axillary sentinel lymph nodes mimicking metastatic carcinoma. The patient had no history of a hematologic disease, and we found no evidence of a concurrent hematopoietic disorder. The megakaryocytes were reactive for CD31, CD61, and von Willebrand factor, but not for cytokeratin (AE1/AE3). Megakaryocytes should be added to the list of benign histologic abnormalities that may simulate metastatic carcinoma in a sentinel lymph node.     

Benign nevus cell aggregates in the thymus: a case report.

Aggregates of benign nevus cells occurring in lymph nodes are a well-described incidental finding. Nevus cell aggregates (NCAs) can mimic foci of metastatic carcinoma or other disease processes, so the surgical pathologist should be familiar with this lesion. The purpose of this report is to describe the potential diagnostic difficulties created by benign NCAs within the thymus of a 32-year-old man with dysplastic nevus syndrome and malignant melanoma involving mediastinal lymph nodes and the right lung. Morphologically, the NCAs in this case elicited the differential diagnoses of metastatic melanoma and thymoma. Immunohistochemical studies helped to establish the correct diagnosis by demonstrating reactivity for S-100 protein and negative staining for keratin and HMB-45. Unlike malignant melanomas, NCAs show no p53 protein immunoreactivity, and low proliferative activity was detected by Ki-67 antigen immunostaining. Although melanocytic cells were rarely reported in thymic neoplasms, we are not aware of any previous reports of NCAs occurring in the normal thymus.     

Intralymphatic nevus cells in benign nevi

The histogenesis of nevus cell aggregates in lymph nodes lesion is controversial, and various hypotheses have been used to explain their origin. One of them is the transport of cells from cutaneous nevi or lesions to lymph nodes, called mechanical transport theory. We investigated in our cases of benign nevi to obtain evidence to substantiate this theory. A total of 369 benign cutaneous nevi were prospectively evaluated in excisional biopsy samples. Immunohistochemical stainings for CD31 and podoplanin (D2-40) were performed in the cases with intralymphatic nevus cell aggregate (ILNA), suspected for ILNA, and/or intralymphatic nevus cell protrusion. A total of 13 ILNAs were found in 10 patients. Six ILNA were verified with their histology as well as immunohistochemically with D2-40 and CD31. Protrusions of nevus cells inside the lymphatics (intralymphatic nevus cell protrusion) were seen in all cases of ILNA and also in 27 nevi where an ILNA was not observed. In most nevi, the perilymphatic orientation of nevus cells and their affinity to the lymphatics were observed. We suggested that ILNAs can be dislodged with local minor trauma and be carried inside the lymphatic vessel to the draining lymph node. Besides, whether ILNA or not, nevus cells could also move toward lymphatic spaces with mechanical effects due to their affinity to lymphatics and their localizations that are very close to the endothelium. Our findings might support the mechanical transport theory.     

Nevus cell aggregates associated with lymph nodes. Immunohistochemical observations

Nevus cell aggregates occurring in association with axillary lymph nodes can be difficult to recognize and differentiate from a metastatic breast carcinoma. We believe S100-protein immunoreactivity, along with negative staining for keratin and epithelial membrane antigen, and typical geographic distribution of nevus cell aggregates in lymph nodes are helpful in providing an accurate diagnosis.     

Paracortical axillary sentinel lymph node ectopic breast tissue

Benign glandular inclusions in axillary lymph nodes are uncommon, and their presence in axillary sentinel lymph nodes is exceptionally rare. The possibility of over-staging due to misinterpretation of glandular inclusions as metastatic carcinoma is a concerning issue. We present a 54-year-old female with high grade ductal carcinoma in-situ undergoing simple mastectomy with sentinel lymph node biopsy. Permanent sections of the sentinel lymph node revealed scarce naked small glands without surrounding stroma scattered in the paracortex in the superficial level. Deeper levels showed glands spanning a much larger area (2 mm), with bland ducts and tubules separated by abundant stroma. The myoepithelial layer was visible and was immunohistochemically confirmed. A final diagnosis of benign ectopic breast tissue within an axillary sentinel lymph node was rendered. Previous studies described axillary sentinel lymph nodes with glandular inclusions separated by stroma or subcapsular in location. It has been suggested that paracortical location and absence of stroma are characteristics of metastasis. As demonstrated in our report, benign inclusions may be paracortical and lack surrounding stroma. We recommend that glandular inclusions should be a diagnostic consideration for cases in which paracortically located naked glands do not histologically resemble the corresponding primary tumor.     

Benign lymph node inclusions mimicking metastatic carcinoma.

AIMS--To draw attention to non-neoplastic inclusions in axillary lymph nodes removed from women with primary breast cancer which may be mistaken for metastases. METHODS--Five examples of non-malignant inclusions were detected in axillary lymph nodes removed from women with mammary carcinoma. Immunohistochemical staining for CAM 5.2 and S100 markers, as well as morphological assessment were performed. RESULTS--Three of the five cases comprised naevus cells and two heterotopic epithelial elements. One of each was initially mistaken for metastatic carcinoma. Naevus cells in the capsule of axillary nodes are often arranged as lines of small, round cells and may readily be misinterpreted as metastatic lobular carcinoma. Heterotopic epithelial elements, in the form of tubules, can easily be mistaken for metastasis from an infiltrating ductal carcinoma. CONCLUSIONS--Awareness of the occasional occurrence of non-neoplastic nodal inclusions will help avoid misdiagnosis. If immunohistochemical markers for epithelial cells are used to screen lymph nodes for metastasis, such lesions could be detected more frequently. It is important to combine immunohistochemistry with morphological assessment and the use of a panel of antibodies in histological diagnosis.     

Benign heterotopic epithelial inclusions in axillary lymph nodes. Histological and immunohistochemical patterns

Benign heterotopic epithelial inclusions in axillary lymph nodes are an extremely rare condition that must be differentiated from metastatic carcinoma. We describe 2 histologically different examples of benign epithelial inclusions in nonsentinel axillary lymph nodes, each with an unusual clinical presentation.     

Frequency of perilymphadenitis in regional lymph nodes in carcinoma

Intensity, frequency and extension of an inflammatory reaction of the lymph node capsule (perilymphadenitis) were investigated in nodes draining invasive ductal breast cancer and infiltrating adenocarcinoma of the large bowel. Occurrence of chronic perilymphadenitis was significantly higher in paracolic lymph nodes than in the axillary ones (p less than 0.05). Both paracolic and axillary lymph nodes developed perilymphadenitis more frequently when they were infiltrated by carcinoma (p less than 0.001). Frequency and extension of the inflammatory reaction of the capsule depended on the degree of carcinomatous infiltration.     

A Case of Dysplastic Nevus of the External Auditory Canal Presenting with Conductive Hearing Loss

A nevus which is a benign melanocytic neoplasm rarely occurs within the external auditory canal (EAC). A dysplastic nevus presents atypical features both clinically and histologically, and is important as a potential precursor for melanoma. We present a case of a 33-year-old female patient with a dysplastic nevus in her EAC. Physical examination revealed a protruding mass arising from the posterior wall of the left cartilaginous EAC. The mass showed clinically characteristic findings of a melanocytic nevus. The patient underwent excisional biopsy via a transcanal approach under local anesthesia. Histopathological examination revealed an intradermal nevus with atypical melanocytes without pleomorphism. There was no evidence of recurrence two years after surgical excision.     

Fine-needle aspiration biopsy and intraoperative cytologic smear findings in a case of benign mesothelial-cell inclusions involving a lymph node: case report and review of the literature

Although first described over a decade ago, the rare entity of mesothelial lymph node inclusions (nonneoplastic mesothelial cells involving lymph node sinuses) is not well-known among pathologists. Unlike most lymph node inclusions such as Müllerian inclusions or nevus cells, which usually occur in the capsule of the lymph node, mesothelial cells involve the lymph node sinus, mimicking metastatic carcinoma or metastatic mesothelioma. The spectrum of histologic findings ranges from a few mesothelial cells, perhaps only detectable by immunohistochemical stains, to a massive distention of the lymph node sinus with abundant mesothelial cells. Mesothelial-cell inclusions in lymph nodes are usually found in mediastinal lymph nodes of patients with pleural and/or pericardial effusions. It is hypothesized that the effusion, due to whatever cause, allows for mesothelial-cell migration into the submesothelial lymphatics and regional lymph nodes. To our knowledge, cytologic findings on aspiration biopsy and intraoperative smear preparations of a lymph node with mesothelial-cell inclusions have never been described. Familiarity with this entity is important in preventing misdiagnosis of malignancy.     

Sclerosing adenosis in sentinel axillary lymph nodes from a patient with invasive ductal carcinoma: an unusual variant of benign glandular inclusions

Benign glandular inclusions in axillary lymph nodes are very rare events that have to be distinguished from metastatic carcinoma. We report an exceptional instance in which a patient with invasive ductal carcinoma had benign glandular inclusions in the form of sclerosing adenosis in 2 sentinel lymph nodes. The lymph nodes did not contain metastatic carcinoma. Immunohistochemical studies facilitated the correct diagnosis.     

Mast cell types and cell-to-cell interactions in lymph nodes of the opossum Didelphis albiventris

Previous light-microscopic studies have shown a unique population of mast cells in lymphatic sinuses of lymph nodes located in the head, neck, axillary fossa and inguinal region of the opossum. In the present work, scanning and transmission electron-microscopic studies in the opossum mandibular and superficial axillary lymph nodes have strengthened the differences between connective-tissue mast cells (CTMC) and the lymphatic-sinus mast cells (LSMC). Further, close appositions of mast cells to other cells were described. At the nodal capsule, CTMC contacted fibroblast and granulocytes. In the lymphatic sinuses a few CTMC contacted LSMC, macrophages and reticular cells. The LSMC contacted macrophages, reticular cells and other LSMC. A few LSMC could be located in the medullary cord in close contact with plasma cells or other lymphoid cells, keeping the same ultrastructural features of those found in the lymphatic sinuses. An important new finding was provided by light-microscopic studies in nine abdominal lymph nodes. Most of them (para-aortic, common iliac, cardial, cecocolic and those of the body and tail of the pancreas) displayed numerous LSMC with the same distribution and histological features described herein. However, the mesenteric, pyloric and head-of-pancreas lymph nodes were virtually devoid of LSMC. Instead, their mast cells occurred mainly at the medullary cords and were very similar to the CTMC. Ultrastructural studies at the mesenteric lymph nodes confirmed the CTMC character of the mast cells located at both medullary cords and sinuses, and disclosed interactions with macrophages and lymphoid cells. Accepted: 8 September 1999     

The relationship between cytotoxicity and prognostically significant histologic changes in lymph nodes from patients with cancer of the breast.

Axillary lymph nodes obtained from 37 patients with cancer of the breast were used in a microcytotoxicity assay against a human mammary cancer cell line, ALAB. Cell suspensions made from 60 individual lymph nodes and 51 lymph node pools were tested. Each lymph node was graded for the extent of the histologic changes of sinus histiocytosis (SH), paracortical hyperplasia (PCH), and germinal center hyperplasia (GCH). High levels of cytotoxicity correlated significantly with the presence of SH and PCH. When multiple lymph nodes of individual patients were pooled and tested, a high intensity of GCH correlated with a low degree of cytototoxicity. The cytotoxic activity of pooled lymph nodes from different axillary regions was studied in 20 patients. In 7 of these patients, low axillary lymph node cells were more cytotoxic than high axillary node cells. The reverse was found for 7 patients, and there was no difference in cytotoxicity between axillary regions in 6. Cytotoxic lymph node pools had high SH and low GCH whether they were obtained from the low or high region. Noncytotoxic lymph node pools from the high axillary region had a low intensity of all three histologic reactions. In contrast, noncytotoxic lymph node pools from the low axillary regions had high intensities of SH, PCH, and GCH. These results suggest that germinal center hyperplasia in the lymph nodes nearest an advancing tumor is associated with a local suppression of cytotoxic cell activity.     

Nevus-cell aggregates in lymph nodes: fine-needle aspiration cytologic findings and resulting diagnostic difficulties

We report a case of nodal nevus present in enlarged lymph nodes with changes of dermatopathic lymphadenopathy sampled by fine-needle aspiration (FNA) cytology prior to clinical evaluation of the patient. This lymph node pathology was established later by lymph node excisional biopsy, by which along with a skin biopsy the dermatopathic lymphadenopathy was tentatively attributed to early mycosis fungoides. The FNA revealed fairly atypical melanotic tissue from the dermatopathic lymphadenopathy along with nodules of uniform melanocytic nevoid cells, the presence of which in combination with the dermatopathic atypical tissue provided a tentative diagnosis of metastatic melanoma of unknown primary, with the diagnosis of nodal nevus presented as a less likely possibility. This is to our knowledge the first cytologic report on FNA of nodal nevus, which besides presenting cytologic findings of this entity highlights some of the problems related to providing an accurate diagnosis, if this exceptionally unusual pathologic entity is encountered in lymph nodes sampled for enlargement from pathologies unrelated to this entity. The subject of nevus changes in lymph nodes is briefly discussed.     

Reactive murine lymph nodes uniquely permit parenchymal access for T cells that enter via the afferent lymphatics

Whereas naïve T cells access the lymph nodes predominantly via the high endothelial venules, their effector counterparts can also enter via the afferent lymphatics. It is unclear if such cells are confined to the lymphatic spaces during their transit through the lymph node or whether they can access the lymphocyte‐ and dendritic cell‐rich parenchyma with its potentially stimulatory environment. We used a flank HSV inoculation model that featured neuronal‐mediated movement of virus to distinct areas of skin to study the lymphatic‐mediated transit of activated T cells between different skin‐draining lymph nodes. These experiments showed that activated T cells released from the brachial lymph node, draining the primary site of inoculation, entered the downstream axillary lymph node. These activated T cells accessed the subcapsular areas of the axillary lymph node via lymphatic vessels exiting the upstream brachial node regardless of whether the former drained skin that was associated with active infection. However, T cells remained within the sinusoidal network of the axillary lymph node unless it was directly associated with peripheral infection. Thus, activated T cells that enter a given lymph node using the afferent lymphatics do not have automatic access to the parenchyma unless it is a reactive node involved with peripheral inflammation or infection. Copyright © 2012 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.