Ansari-Lari M Ali, Westra William H
Department of Pathology, The Weinberg Building, The Johns Hopkins Medical Institutions, Room 2242, 410 N. Broadway, Baltimore, Maryland 21231, USA.
Head Neck. 2003 Oct;25(10):841-7. doi: 10.1002/hed.10304.
Histopathologic scrutiny of surgical pathology specimens can uncover unexpected but important pathologic processes that might not (yet) be clinically apparent. We suspect that cervical lymph nodes removed from patients with known cancers of the head and neck might occasionally harbor clinically unsuspected neoplasms.
We reviewed the pathology reports of all patients who had undergone cervical lymph node dissections at our institution between 1984 and 2001 to determine the prevalence of occult metastatic thyroid cancer and other clinically unsuspected tumors. The medical records were reviewed to obtain follow-up information when histologic examination disclosed some significant finding that was unsuspected on clinical grounds.
Of the 1337 patients who underwent cervical lymphadenectomy during the 17-year period, 27 (2.0%) had at least one lymph node harboring an unanticipated finding that raised the concern of a clinically unsuspected neoplasm. Sixteen (1.2%) of these patients had conclusive histologic evidence of an unexpected neoplasm, including 6 patients (0.4%) with malignant lymphomas (low-grade B cell, n = 5; high-grade B cell, n = 1) and 10 patients (0.7%) with metastatic papillary thyroid carcinomas. An additional 11 patients (0.8%) had lymph nodes harboring "benign" thyroid inclusions or psammoma bodies. Four of these 11 patients underwent thyroidectomy, but thyroid cancer was not detected in the ipsilateral thyroid. Only one patient died as a consequence of the incidentally discovered neoplasm.
To the degree that our study population is reflective of the adult population at large, at least 1% of adults harbor malignant neoplasms in their cervical lymph nodes. Although this statistic seems alarmingly high, most of these neoplasms are indolent and do not undergo unrelenting progression to clinically overt malignancies.
对手术病理标本进行组织病理学检查能够发现一些意外但重要的病理过程，这些过程可能尚未在临床上显现出来。我们怀疑，从已知头颈部癌症患者身上切除的颈部淋巴结偶尔可能会隐藏临床上未被怀疑的肿瘤。
我们回顾了1984年至2001年间在本机构接受颈部淋巴结清扫术的所有患者的病理报告，以确定隐匿性转移性甲状腺癌和其他临床上未被怀疑的肿瘤的患病率。当组织学检查发现一些临床上未被怀疑的重大发现时，查阅病历以获取随访信息。
在这17年期间接受颈部淋巴结切除术的1337例患者中，27例（2.0%）至少有一个淋巴结存在意外发现，这引发了对临床上未被怀疑的肿瘤的担忧。其中16例（1.2%）患者有意外肿瘤的确切组织学证据，包括6例（0.4%）恶性淋巴瘤（低级别B细胞型，n = 5；高级别B细胞型，n = 1）和10例（0.7%）转移性乳头状甲状腺癌。另外11例（0.8%）患者的淋巴结含有“良性”甲状腺包涵体或砂粒体。这11例患者中有4例接受了甲状腺切除术，但同侧甲状腺未检测到甲状腺癌。只有1例患者因偶然发现的肿瘤而死亡。
就我们的研究人群能够反映广大成年人群体的程度而言，至少1%的成年人颈部淋巴结中存在恶性肿瘤。尽管这个统计数据看起来高得惊人，但这些肿瘤大多数生长缓慢，不会持续发展为临床上明显的恶性肿瘤。
