Lymph nodes & spleen, nonlymphoid
Lymph nodes-inclusions, pigment, ectopic cells or tissue
Müllerian
Author: Jayalakshmi Balakrishna, M.D.
Topic Completed: 1 July 2014
Minor changes: 29 July 2020
Revised: 1 February 2019, last major update July 2014
Copyright: 2003-2020, PathologyOutlines.com, Inc.
PubMed Search: Müllerian inclusions and cysts
Table of Contents
Definition / general | Terminology | Sites | Pathophysiology | Clinical features | Case reports | Treatment | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Differential diagnosis | Additional referencesCite this page: Balakrishna J. Müllerian. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/lymphnodesmullerianinclusioncysts.html. Accessed August 6th, 2020.
Definition / general
- Benign glandular inclusions lined by salpingeal or ovarian epithelium with no endometrial stroma or hemosiderophages
Terminology
- Also called endosalpingiosis
Sites
- Predominantly pelvic and paraaortic lymph nodes
- Present in 5 - 41% of intra-abdominal nodes of women (Am J Obstet Gynecol 1978;130:813), 20% of women with gynecologic malignancies in paraaortic / pelvic nodes (Gynecol Oncol 2000;78:242)
Pathophysiology
- Theories include:
- Passage of epithelial cells through the tubal ostium for implantation in the peritoneum following peeling, followed by transportation by the lymphatic route to reach the pelvic lymph node
- Metaplastic origin from the peritoneum
- Foci of endometriosis
- Vestiges of paramesonephricus ducts
- Metastases from ovarian serous borderline tumors (Am J Surg Pathol 2000;24:710)
Clinical features
- Incidental finding / enlarged lymph nodes
Case reports
- 64 year old woman with endosalpingiosis with psammoma bodies within an intramammary lymph node presented as microcalcifications on mammography (Arch Pathol Lab Med 1995;119:841)
- Coexisting with breast metastatic carcinoma in an axillary lymph node (Virchows Arch 2005;446:467)
Treatment
- Benign process, with no clinical significance
Gross description
- Enlarged lymph nodes
Microscopic (histologic) description
- Glandular / cystic inclusions lined by cuboidal / columnar cells with a Müllerian or coelomic appearance commonly found in the capsule
- Psammoma bodies are common
- May undergo squamous metaplasia
- No / rare mitotic figures, no / mild atypia, no desmoplastic stroma, no endometrial stroma
Microscopic (histologic) images
AFIP images
In pelvic lymph node
Differential diagnosis
- Metastasis from borderline / malignant ovarian tumors or uterine carcinomas
Additional references
- J Clin Oncol 2006;24:2013, Ioachim's Lymph Node Pathology, 4th Edition, 2008, Rosai and Ackerman's Surgical Pathology, 10th Edition, 2011, Robboy's Pathology of the Female Reproductive Tract, 2nd Edition, 2008, Dunphy: Frozen Section Library: Lymph Nodes, 2012, Weiss: Lymph Nodes, 1st Edition, 2008, University of Pittsburg - Endometriosis and bland glandular inclusions, Case #375
