Benign epithelial inclusion consisting of squamous metaplasia and small glandular elements in regional lymph node of a patient with tongue cancer : a case report and literature review
Benign epithelial inclusion consisting of squamous metaplasia and small glandular elements in regional lymph node of a patient with tongue cancer : a case report and literature review
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发表时间：
2016
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通讯作者：
T. Maruyama;T. Nakasone;M. Saio;K. Nishihara;A. Matayoshi;T. Goto;N. Yoshimi;A. Arasaki
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作者：
T. Maruyama;T. Nakasone;M. Saio;K. Nishihara;A. Matayoshi;T. Goto;N. Yoshimi;A. Arasaki
在颈淋巴结清扫术期间，偶尔会报告非预期的病理学发现，包括颈部淋巴结中的良性夹杂物（BI），包括鳞状上皮细胞、腺细胞、甲状腺细胞、痣细胞和间皮细胞。BI可模拟区域淋巴结转移，因此，病理诊断很重要。然而，免疫组化诊断BI的标准尚未建立。我们报告一位73岁女性舌癌合并鳞状上皮化生及区域淋巴结内的腺性BI。病变的临床和放射学评估导致舌鳞状细胞癌（T3N2bM0，IVa期）的诊断。病人接受了右侧全颈淋巴结清扫术和舌肿瘤的广泛局部切除术。所有淋巴结的解剖标本病理学阴性。相比之下，偶然在III级淋巴结中发现1个BI。由于缺乏免疫组化诊断标准，我们无法通过常规病理检查明确诊断此病变。据我们所知，尚未报告头颈癌患者局部淋巴结中存在包括鳞状化生和小腺体成分的BI。我们在组织学上预测病变为BI，并通过额外的细胞角蛋白13和17免疫组化染色证实。临床医生应避免转移的误诊，这可能导致不正确的肿瘤分期和淋巴结BI患者的辅助治疗不足。为了明确区分BI和转移瘤，我们建议在鳞状细胞癌患者的区域淋巴结常规染色切片中进行额外的细胞角蛋白13和17免疫组化染色。
There are occasional reports of unexpected pathological findings during neck dissection, including benign inclusions (BIs) in cervical lymph nodes, comprising squamous epithelial, glandular, thyroid, neval and mesothelial cells. BIs can mimic regional lymph node metastases, therefore, pathological diagnosis is important. However, criteria for immunohistochemical diagnosis of BIs are not established. We report a 73-year-old woman with tongue cancer with squamous metaplasia and a glandular BI in a regional lymph node. Clinical and radiographic assessment of the lesion led to diagnosis of tongue squamous cell carcinoma (T3N2bM0, Stage IVa). The patient underwent right-side total neck dissection with wide local excision of the tongue tumor. All the lymph nodes in the dissection specimen were pathologically negative. In contrast, one BI in a level III lymph node was found incidentally. We could not diagnose this lesion clearly by routine pathological examination because of the lack of criteria for immunohistochemical diagnosis of BIs. To the best of our knowledge, BIs comprising squamous metaplasia and small glandular elements in the regional lymph nodes of patients with head and neck cancer have not been reported. We histologically predicted the lesion as BI, which was confirmed by additional immunohistochemical staining for cytokeratin 13 and 17. Clinicians should avoid misdiagnosis of metastases, which could lead to incorrect tumor staging and inadequate adjuvant therapy for patients with lymph node BIs. To distinguish BIs from metastases clearly, we recommend additional immunohistochemical staining for cytokeratin 13 and 17 in routinely stained sections of regional lymph nodes in patients with squamous cell carcinoma.