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Lymph nodes & spleen, nonlymphoma

Lymph node & spleen-nonlymphoid neoplasms

Metastases

Last author update: 1 June 2006

Last staff update: 3 August 2022

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

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Cite this page: DePond W. Metastases. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/lymphnodesmetastases.html. Accessed December 26th, 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

Signet ring cells may actual be muciphages (Am J Surg Pathol 1998;22:545)

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

Nodal involvement may be initial presentation (Am J Surg Pathol 1990;14:819)

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

Thyroglobulin

Paraganglia

Microscopic (histologic) images

Images hosted on other servers:

Subcapsular invasion
with pleomorphic cells
with abundant granular
eosinophilic cytoplasm

Plexiform fibrohistiocytic tumor

Definition / general

Uncommonly metastasizes to lymph nodes (Am J Surg Pathol 1999;23:662)

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

Nodal metastases may be metastatic ovarian serous borderline tumor (Am J Surg Pathol 2006;30:739)
58 year old woman with high grade urothelial carcinoma of bladder and unknown ovary tumor 33 years prior (Arch Pathol Lab Med 2005;129:537)

Small cell neuroendocrine carcinoma

Definition / general