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Small neuroendocrine lesions in intrathoracic lymph nodes of patients with primary lung adenocarcinoma: real metastasis?

Publication ,  Journal Article
Li, F; Wang, X; Xu, H; Roggli, VL
Published in: Am J Surg Pathol
November 2010

The presence of individual neuroendocrine cells in rare peripancreatic lymph nodes (LNs) suggests that neuroendocrine tumor or nested neuroendocrine cell proliferation can arise in situ from neuroendocrine cells native to any LN. However, it is very difficult to ascertain whether any neuroendocrine lesion in LNs is a primary tumor or a metastasis from adjacent organs. We encountered 4 cases of neuroendocrine proliferation in intrathoracic LNs (ILNs) of patients with primary lung adenocarcinoma. All patients had a single lung mass without mediastinal lymphadenopathy based on computed tomography and positron emission tomography imaging. Mediastinal staging was done by either mediastinoscopy or thoracotomy and none of them had metastasis from adenocarcinoma in any LN. One patient had three ILNs positive for neuroendocrine proliferation measuring 1.7, 1.8, and 4.0 mm, respectively and a minute tumorlet less than 1.0 mm in the lung. Three other patients had small areas of neuroendocrine proliferation no more than 1 mm in single ILN without any lung neuroendocrine lesion. Neuroendocrine cells in ILNs often formed nests of varying size with similar morphology to carcinoid tumorlet in the lung. Small clusters of neuroendocrine cells without any particular pattern were often seen together with these nests. These cells were positive for neuroendocrine markers: synaptophysin, chromogranin, and CD56. They were also positive for CK7 and TTF-1. It is interesting to note, single cells positive for neuroendocrine markers and TTF-1 were identified near or away from these neuroendocrine nests or clusters. These findings suggest that neuroendocrine lesion can be incidentally identified in ILNs. Close clinical follow-up is warranted as metastasis from or synchronous lesions in adjacent organs cannot be excluded.

Duke Scholars

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Published In

Am J Surg Pathol

DOI

EISSN

1532-0979

Publication Date

November 2010

Volume

34

Issue

11

Start / End Page

1701 / 1707

Location

United States

Related Subject Headings

  • Thoracotomy
  • Thoracic Cavity
  • Pathology
  • Neuroendocrine Cells
  • Neoplasm Staging
  • Middle Aged
  • Mediastinoscopy
  • Male
  • Lymphatic Metastasis
  • Lymph Nodes
 

Citation

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Li, F., Wang, X., Xu, H., & Roggli, V. L. (2010). Small neuroendocrine lesions in intrathoracic lymph nodes of patients with primary lung adenocarcinoma: real metastasis? Am J Surg Pathol, 34(11), 1701–1707. https://doi.org/10.1097/PAS.0b013e3181f207c0
Li, Faqian, Xi Wang, Haodong Xu, and Victor L. Roggli. “Small neuroendocrine lesions in intrathoracic lymph nodes of patients with primary lung adenocarcinoma: real metastasis?Am J Surg Pathol 34, no. 11 (November 2010): 1701–7. https://doi.org/10.1097/PAS.0b013e3181f207c0.
Li, Faqian, et al. “Small neuroendocrine lesions in intrathoracic lymph nodes of patients with primary lung adenocarcinoma: real metastasis?Am J Surg Pathol, vol. 34, no. 11, Nov. 2010, pp. 1701–07. Pubmed, doi:10.1097/PAS.0b013e3181f207c0.

Published In

Am J Surg Pathol

DOI

EISSN

1532-0979

Publication Date

November 2010

Volume

34

Issue

11

Start / End Page

1701 / 1707

Location

United States

Related Subject Headings

  • Thoracotomy
  • Thoracic Cavity
  • Pathology
  • Neuroendocrine Cells
  • Neoplasm Staging
  • Middle Aged
  • Mediastinoscopy
  • Male
  • Lymphatic Metastasis
  • Lymph Nodes