Weeks D A, Beckwith J B, Mierau G W
Department of Pathology, Children's Hospital, Denver, CO 80218.
Hum Pathol. 1990 Dec;21(12):1239-44. doi: 10.1016/s0046-8177(06)80037-7.
Regional lymph node status is a key factor in the staging of pediatric renal tumors on the National Wilms' Tumor Study (NWTS). A review of cases entered on the NWTS has uncovered a number of cases where benign lymph node findings were mistaken for metastases. Most frequently, this was due to the presence of complexes of epithelial cells and Tamm-Horsfall protein within nodal sinuses. The epithelial cells were derived from damaged nephrons, usually resulting from obstruction by tumor. Another epithelial pseudometastic lesion, intranodal squamous epithelial cells, was found to originate from metaplastic calyceal urothelium. Benign mesothelial or coelomic inclusions similar to those previously described in pelvic and periaortic lymph nodes of adult females were found in nodes of four patients, including two boys, who are, to our knowledge, the first to be described with this finding. Other sources of confusion included protrusion of lymphoid follicles or germinal centers into nodal sinuses, thick endothelial cells of postcapillary venules mimicking epithelial tubules, nodal megakaryocytes resembling anaplastic nuclear changes, and histiocytic granulomas. Immunocytochemical methods were useful in evaluating some of these phenomena. Recognition of these pseudometastatic lesions is essential in order to avoid unnecessary and potentially hazardous therapeutic intensification.
区域淋巴结状态是国家肾母细胞瘤研究（NWTS）中儿童肾肿瘤分期的关键因素。对NWTS登记病例的回顾发现了一些病例，其中良性淋巴结表现被误诊为转移。最常见的原因是淋巴结窦内存在上皮细胞和Tamm-Horsfall蛋白复合物。上皮细胞来源于受损的肾单位，通常是由肿瘤阻塞所致。另一种上皮性假转移病变，即结内鳞状上皮细胞，被发现起源于化生的肾盂尿路上皮。在4例患者的淋巴结中发现了良性间皮或体腔包涵物，类似于先前在成年女性盆腔和腹主动脉旁淋巴结中描述的情况，其中包括2名男孩，据我们所知，这是首次报道有此发现。其他造成混淆的来源包括淋巴滤泡或生发中心突入淋巴结窦、毛细血管后小静脉的厚内皮细胞类似上皮小管、淋巴结巨核细胞类似间变核改变以及组织细胞肉芽肿。免疫细胞化学方法有助于评估其中一些现象。识别这些假转移病变对于避免不必要的和潜在有害的治疗强化至关重要。
