Salehi Amir H, Omeroglu Gulbeyaz, Kanber Yonca, Omeroglu Atilla
1McGill University Health Center, Montreal, Quebec, Canada.
Int J Surg Pathol. 2013 Dec;21(6):610-2. doi: 10.1177/1066896913502228. Epub 2013 Sep 10.
Intraoperative assessment of sentinel lymph nodes at time of surgical excision of primary breast carcinoma is a crucial step in the determination of cancer extent and the need for further axillary dissection. Benign epithelial inclusions in axillary lymph nodes can mimic metastatic carcinoma and are a well-known pitfall during examination of these nodes in frozen or permanent sections. Most often, these inclusions consists of heterotopic mammary glands and are familiar to the practicing pathologist. Here, however, we present a rare case of endosalpingiosis in the axillary lymph nodes of a breast cancer patient and describe our experience and effort to characterize the lesion. Simulating a metastatic focus of invasive ductal carcinoma, the glandular inclusions lacked myoepithelial cells and failed to stain with myoepithelial markers. However, consistent with a Mullerian origin, the inclusions demonstrated strong staining with PAX-8 and WT-1. Although endosalpingiotic inclusions are not uncommonly encountered in subdiaphragmatic lymph nodes, they are an extremely rare finding above the diaphragm. Pathologists must be aware of these lesions and their ability to imitate metastatic gland-forming carcinoma during frozen section or permanent examination of axillary lymph nodes.
在原发性乳腺癌手术切除时对前哨淋巴结进行术中评估，是确定癌症范围以及是否需要进一步进行腋窝淋巴结清扫的关键步骤。腋窝淋巴结中的良性上皮性包涵体可模仿转移性癌，是在冰冻切片或永久切片检查这些淋巴结时众所周知的陷阱。这些包涵体大多由异位乳腺组织构成，对于执业病理学家来说并不陌生。然而，在此我们报告一例乳腺癌患者腋窝淋巴结发生输卵管内膜异位症的罕见病例，并描述我们对该病变进行特征描述的经验和努力。这些腺性包涵体模拟浸润性导管癌的转移灶，缺乏肌上皮细胞，且不能被肌上皮标记物染色。然而，与苗勒管起源一致，这些包涵体对PAX - 8和WT - 1呈强阳性染色。虽然输卵管内膜异位性包涵体在膈下淋巴结中并不罕见，但在膈上却是极其罕见的发现。病理学家必须了解这些病变及其在腋窝淋巴结冰冻切片或永久检查期间模仿转移性腺形成癌的能力。
