Lymph Nodes Below Diaphragm: Diagnosis



Lymph Nodes Below Diaphragm: Diagnosis










Metastatic carcinomas should closely resemble the primary carcinoma. This abdominal lymph node shows both metastatic well-differentiated colon carcinoma image and prostate carcinoma image.






Benign inclusions should be considered when epithelioid cells in nodes do not resemble a known primary carcinoma. Endosalpingiosis image, decidual reaction, and mesothelial cells should be considered.


SURGICAL/CLINICAL CONSIDERATIONS


Goal of Consultation



  • Evaluate peritoneal or inguinal lymph nodes for staging of a known carcinoma or to evaluate lymphadenopathy


Change in Patient Management



  • Planned surgical procedure for curative intent may be modified or canceled if metastatic carcinoma is found


Clinical Setting



  • Enlarged nodes may be detected during surgery for a benign condition



    • If malignant, additional surgical exploration and biopsies may be performed to detect primary carcinoma


  • Nodes are routinely sampled for staging of known carcinomas of abdominal cavity prior to definitive surgery


  • For some carcinomas, surgical approach will be altered if metastatic carcinoma is detected


  • For other carcinomas, surgical treatment is indicated even if metastatic carcinoma is present


SPECIMEN EVALUATION


Gross



  • Specimen usually consists of excision of a nodule presumed grossly to be a lymph node


  • If surrounded by adipose tissue, nodule should be separated by palpation and dissection



    • Size and contours (e.g., smooth or irregular) of nodule are recorded


  • Nodule is serially sectioned



    • Focal firm white areas are typical of metastatic carcinoma


    • Diffusely enlarged node with fleshy surface is most likely lymphoma


    • Hard, difficult to cut nodule is most likely an infarcted epiploic appendage


    • Mottled nodes with focal necrosis may be involved by infectious process


Frozen Section



  • If patient has known carcinoma and biopsy is performed for staging prior to performing surgery, it is preferable to submit entire node for frozen section



    • If only a portion of node is frozen, a small metastasis can be missed


  • If patient does not have known carcinoma, specimen should be sampled such that diagnosis will be possible on permanent sections &/or with ancillary studies



    • Nonfrozen tissue for ancillary studies may be helpful


    • Cytologic preparations are preferred if infection or lymphoma are suspected


    • If cytologic preparations do not provide diagnosis, portion of node may be frozen


Cytology



  • Scrape or touch preparations can be made from cut surface(s) of node


MOST COMMON DIAGNOSES


Metastatic Carcinoma



  • Almost always resemble primary carcinoma



    • Location and histologic type of known or suspected primary carcinoma is essential information


    • Seminoma can be associated with granulomas


  • If suspected metastasis does not resemble primary, consider other diagnoses


Endosalpingiosis (Müllerian Inclusions)



  • In women, benign tubular epithelium can be found in lymph nodes



    • May be associated with psammoma body calcifications


    • Very rarely present in males


  • Tubules are lined by single layer of low cuboidal cells



    • Nuclei are small with inconspicuous nuclei


    • Cilia may be present


  • Squamous metaplasia can occur


  • Final classification may require immunohistochemical studies



Ectopic Decidua

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Jul 7, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Lymph Nodes Below Diaphragm: Diagnosis

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