Lymph nodes & spleen, nonlymphoma

Lymph node & spleen-nonlymphoid neoplasms

Metastases



Last author update: 1 June 2006
Last staff update: 3 August 2022

Copyright: 2003-2024, PathologyOutlines.com, Inc.

PubMed Search: Lymph node metastasis[TI] pathology[TIAB] full text[sb]

Page views in 2024 to date: 1,410
Cite this page: DePond W. Metastases. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/lymphnodesmetastases.html. Accessed March 19th, 2024.
Definition / general
  • Lymph nodes are common site of metastatic disease
  • Presence of metastases is important for TNM staging
  • Must determine when examining lymph nodes: tumor present or not; tumor primary or metastatic; possible sites of primary; number of metastatic nodes; size of largest metastatic deposit often helpful; presence of extranodal or vascular involvement
  • Nodal metastases are common with carcinoma, melanoma or germ cell tumors; rare with CNS tumors and sarcoma (except for angiosarcoma, clear cell sarcoma, epithelioid sarcoma, MFH, rhabdomyosarcoma or synovial sarcoma)
  • Must also rule out lymphoma; compared to metastatic disease, lymphomas are more likely multifocal with diffuse penetration of vessel wall, minimal necrosis, no nesting, not limited to sinuses, not limited to intravascular invasion; differentiate based on special stains / immunostains (see below), touch preparations (clumping favors carcinoma), EM for epithelial features
  • Rarely, there is passive transport of benign neoplastic cells to lymph nodes (Arch Pathol Lab Med 2005;129:1317)
  • Carcinomas usually have cohesive tumor cells, sinus involvement, clearly defined margins with lymphoid tissue; may resemble Hodgkin lymphoma due to prominent nucleoli and mixed inflammatory infiltrate
  • Tumors misinterpreted as lymphoma: nasopharyngeal carcinoma - undifferentiated (tumor cells mix with lymphocytes and tumor does not appear cohesive), melanoma (tumor cells separate from each other within clusters), breast lobular carcinoma (may appear noncohesive), seminoma (inguinal and abdominal nodes)
  • Recommended stains (by Rosai) - first round: CD45 / LCA, pankeratin, S100; second round: (as necessary) CD3 (T cells), CD20 (B cell), EMA, CEA, vimentin, possibly GCDFP15 or lactalbumin (for breast), chromogranin (for neuroendocrine), PSA / PAP (for prostate)
  • Note: TdT+ lymphoid precursors are present in benign pediatric lymph nodes (Am J Clin Pathol 2002;118:248) and tonsils (Am J Clin Pathol 2001;116:12), causing possible confusion in ALL patients
  • Site of metastases:
    • Upper cervical nodes: associated with upper aerodigestive tract
    • Midcervical nodes: thyroid carcinoma, salivary gland, upper aerodigestive tract; also thymus or ovary
    • Supraclavicular nodes: breast or lung, also stomach, pancreas, prostate, testis
    • Axillary nodes: breast (women), melanoma, lung
    • Inguinal nodes: external genitalia, melanoma
    • Undetectable primaries with nodal metastases: nasopharynx, retrotonsillar pillars
  • Posttreatment changes: foamy histiocytes, fibrosis, mucin, atypical residual tumor cells
Microscopic (histologic) images

AFIP images

Metastatic Merkel cell carcinoma from skin

Metastatic Merkel cell carcinoma

Metastatic neuroblastoma

Metastatic seminoma

Metastatic carcinoma
simulating Hodgkin
lymphoma

Adenocarcinoma
Definition / general

Gross images

Contributed by Dr. Mark R. Wick

Adenocarcinoma of
lung, mediastinal
lymph node biopsy



Microscopic (histologic) images

Contributed by Dr. Mark R. Wick, Marino Leon, M.D. and AFIP images

EMA stain

Mucicarmine stain

PAS stain

GEJ primary with signet ring features

Metastatic prostatic adenocarcinoma



Cytology images

AFIP images

Cytology of metastatic adenocarcinoma

Breast adenocarcinoma
Definition / general
  • Lobular carcinoma may resemble lymphoma, particularly if signet ring cells are present

Microscopic (histologic) description
  • Ductal: large apocrine-like pleomorphic cells with pink, granular cytoplasm, large nuclei and prominent nucleoli
  • Often cytoplasmic mucin
  • Comedo, trabecular and papillary patterns

Microscopic (histologic) images

Contributed by Dr. Mark R. Wick, Case #4 and AFIP images

CK stain

Micropapillary carcinoma

Metastatic lobular carcinoma of breast

Metastatic
mammary carcinoma
in axillary
lymph node

Metastatic mammary carcinoma


Images hosted on other servers:

Micropapillary carcinoma

Hepatocellular carcinoma
Microscopic (histologic) description
  • May produce bile

Microscopic (histologic) images

AFIP images

Metastatic hepatocellular carcinoma

Melanoma
Gross images

Images hosted on other servers:

Black staining tissue



Microscopic (histologic) description
  • Often melanin pigment in some tumor cells
  • Balloon cell variant resembles histiocytes, although nuclei are atypical

Microscopic (histologic) images

AFIP images

Metastatic melanoma in lymph node



Cytology images

AFIP images

Metastatic melanoma

Mesothelioma
Definition / general

Microscopic (histologic) description
  • May expand sinuses
  • Cuboidal cells with eosinophilic cytoplasm and central nucleus

Cytology description
  • Large dyscohesive cells with abundant pale cytoplasm, ruffled cytoplasmic borders, prominent central nucleoli (Am J Clin Pathol 1992;97:493)
Nasopharyngeal carcinoma
Definition / general
  • Also called lymphoepithelial carcinoma

Microscopic (histologic) description
  • Syncytium of cells with ill defined cytoplasm, vesicular nuclei and prominent nucleoli

Microscopic (histologic) images

AFIP images

Metastatic nasopharyngeal carcinoma

Metastatic undifferentiated nasopharyngeal carcinoma

Metastatic undifferentiated carcinoma from nasopharynx


Metastatic nasopharyngeal carcinoma

EBV+



Cytology images

AFIP images

Cytology of metastatic
undifferentiated carcinoma
from nasopharynx

Pancreatic adenocarcinoma
Microscopic (histologic) images

Images hosted on other servers:

Ductal adenocarcinoma

Papillary thyroid carcinoma
Microscopic (histologic) description
  • May appear as unilocular or multilocular cyst with attenuated lining cells and lack of distinct nuclear features of papillary carcinoma

Microscopic (histologic) images

Contributed by Dr. Marino Leon and AFIP images

Enlarged upper mediastinal node

Cystic metastatic papillary thyroid carcinoma



Positive stains
Paraganglia
Microscopic (histologic) images

Images hosted on other servers:

Subcapsular invasion
with pleomorphic cells
with abundant granular
eosinophilic cytoplasm

Plexiform fibrohistiocytic tumor
Definition / general

Microscopic (histologic) description
  • Multiple plexiform nodules within and external to node
  • Nodules composed of plump fibrohistiocytic cells with multinucleated giant cells
Rhabdomyosarcoma
Definition / general
  • Alveolar subtype may first present with nodal involvement

Microscopic (histologic) description
  • Alveolar subtype: large packets of cells with central dehiscence, cells have moderate eosinophilic cytoplasm, with some rhabdomyoblasts present

Microscopic (histologic) images

AFIP images

Metastatic alveolar rhabdomyosarcoma

Serous borderline tumor
Case reports
Small cell neuroendocrine carcinoma
Definition / general
  • May resemble lymphoma

Microscopic (histologic) description
  • Minimal cytoplasm, dense chromatin with nuclear molding
  • Often focal necrosis and crush artifact
  • Azzopardi phenomena (dense hematoxylin staining of vessel walls)

Microscopic (histologic) images

Contributed by Dr. Mark R. Wick and AFIP images

Metastatic neuroendocrine lung carcinoma

Synaptophysin

Chromogranin

Metastatic small cell carcinoma from lung

Squamous cell carcinoma
Definition / general
  • Squamous cyst within cervical lymph node should be considered metastatic carcinoma until proven otherwise

Microscopic (histologic) description
  • Cystic change is common, particularly from head and neck region
  • Often bland looking squamous cells with only focal atypia

Microscopic (histologic) images

Contributed by Dr. Mark R. Wick and AFIP images

Squamous carcinoma
of lung, mediastinal
lymph node biopsy

Cystic metastatic squamous cell carcinoma

Back to top
Image 01 Image 02