Hashimoto Hirotsugu, Miura Sakiko, Kamei Kentaro, Masuda Yoshio, Sakuma Jun, Momiyama Masashi, Noie Tamaki, Morikawa Teppei
NTT Medical Center Tokyo, Tokyo, Japan.
Tokyo Healthcare University, Tokyo, Japan.
Int J Surg Pathol. 2021 Oct;29(7):804-807. doi: 10.1177/10668969211003959. Epub 2021 Mar 18.
Nodal metastatic foci of colorectal carcinoma are usually solid nodules. Serous inclusions are occasionally found in lymph nodes, particularly in female patients, and they occasionally form cysts. An 86-year-old woman was treated with laparoscopic low anterior resection and D3 lymph node dissection for advanced rectal carcinoma. A cyst with serous fluid and no necrotic debris was found within one of the dissected pararectal lymph nodes. Histologically, the cyst was lined by low columnar-to-cuboid epithelium with mild nuclear atypia, mimicking a serous inclusion cyst. Immunohistochemically, the epithelial cells were positive for caudal type homeobox 2 and negative for Wilms' tumor suppressor gene1. Immunohistochemistry for p53 showed a diffuse strong positivity, indicating a mutant as seen in primary rectal carcinoma. Thus, the nodal cystic lesion was confirmed to be a metastatic lesion. It is important to carefully assess a nodal cystic lesion to confirm whether it is benign or malignant.
结直肠癌的淋巴结转移灶通常为实性结节。浆液性包涵体偶尔可见于淋巴结，尤其在女性患者中，且偶尔会形成囊肿。一名86岁女性因晚期直肠癌接受了腹腔镜低位前切除术及D3淋巴结清扫术。在清扫的直肠旁淋巴结之一中发现了一个含有浆液且无坏死碎屑的囊肿。组织学上，囊肿内衬低柱状至立方形上皮，伴有轻度核异型性，类似浆液性包涵体囊肿。免疫组化显示，上皮细胞尾型同源盒2阳性，肾母细胞瘤抑制基因1阴性。p53免疫组化显示弥漫性强阳性，表明为原发性直肠癌中所见的突变型。因此，该淋巴结囊性病变被确认为转移瘤。仔细评估淋巴结囊性病变以确认其为良性还是恶性很重要。
