Intrapulmonary lymph nodes. Clinical, radiologic, and pathologic features

Our plain-English summary of Intrapulmonary lymph nodes. Clinical, radiologic, and pathologic features, by R.L. Kradin, P.W. Spirn, E.J. Mark (Chest, 1985).

The study

• Authors: R.L. Kradin, P.W. Spirn, E.J. Mark
• Journal: Chest
• Published: 1985;87(5):662-7
• Cited by: 60 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The clinical, radiographic, and pathologic material from ten patients with intrapulmonary lymph nodes was analyzed, along with information from all previously reported cases. In our series the median age was 56 years, and 80 percent (eight) of the patients were men. All patients are or were cigarette smokers. Sixty percent (six) had a history of exposure to either asbestos, nonfibrous silicates, or both. There were no characteristic symptoms attributable to the intrapulmonary lymph nodes. Forty percent (four) had an unexplained pulmonary nodule or nodules on the chest roentgenogram, which prompted further diagnostic studies, including thoracotomy, to rule out a malignant neoplasm. Radiographically, in our cases and in the literature, almost all cases of intrapulmonary lymph nodes are subpleural, inferior to the level of the carina, and less than 2.0 cm in diameter. Thirty-five percent are multiple. Pathologically, in our cases, all intrapulmonary lymph nodes were markedly anthracotic, and 60 percent were additionally silicotic. Although their histogenesis is uncertain, intrapulmonary lymph nodes are probably hyperplastic lymphoid nodules related to inhalation of irritant dusts and attendant distortion of local lymphatic vessels. Precise clinical and radiographic analysis correlated carefully with cytologic and histologic material obtained by percutaneous needle biopsy should obviate exploratory thoracotomy in most instances.

In plain English

This article from Massachusetts General Hospital described ten patients with intrapulmonary lymph nodes (lymph nodes within the lung tissue) seen over two years, and reviewed 13 earlier reported cases. The patients were aged 36 to 73. Eight were men, all smoked, and at least six had workplace exposure to asbestos or other silicates. In four patients the nodes appeared as spots on chest images and led to investigations, including surgery, to rule out cancer. In six they were found in lung removed for other conditions. In one patient, a former acoustic ceiling installer, a needle biopsy was read as small-cell carcinoma, but surgery found lymph nodes, with lung changes consistent with asbestosis. All nodes contained anthracotic pigment, and in six patients they held crystals of silica or silicates. Combining this series with earlier reports (34 nodules, 23 patients), 97 percent lay at or below the carina and 97 percent measured under 2.0 cm. The authors concluded most such nodes are acquired, and that imaging plus needle biopsy may allow diagnosis without surgery.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case series of ten patients from one hospital, combined with a review of previously reported cases
• Who was studied: Ten patients with intrapulmonary lymph nodes seen at Massachusetts General Hospital, Boston, over a two-year period (exact years not given), aged 36 to 73 (median 56), eight men and two women, all cigarette smokers. Also 13 cases previously reported in the literature.
• Exposure: Cigarette smoking in all ten patients. Workplace exposure to asbestos or other silicates in at least six. No fiber type was named. One patient (case 2) had been exposed to asbestos 30 years earlier while installing acoustic ceilings.
• Main results:
  • In four of the ten patients, the nodes were detected on chest imaging and led to a diagnostic investigation. In the other six, the nodes were found in lung specimens removed for other conditions.
  • In case 2, a needle aspiration biopsy of a nodule was interpreted as small-cell undifferentiated carcinoma. After surgery, both nodules proved to be intrapulmonary lymph nodes.
  • In case 2 (the acoustic ceiling installer exposed to asbestos), the resected lung showed interstitial fibrosis and numerous ferruginous bodies, which the authors described as consistent with asbestosis.
  • Macrophages bearing anthracotic pigment were present in all nodes from the ten patients.
  • In six of the ten cases, the nodes contained moderate or large numbers of crystals of silica or silicates. Four had silicotic nodules as well.
  • In the authors' series, 93 percent of the nodes were in the middle or lower lung zones, and 81 percent were within 1 cm of a pleural surface.
  • Combining earlier reports with this series (34 nodules in 23 patients), 97 percent were at or below the level of the carina and 97 percent were less than 2.0 cm in diameter.
• The authors' conclusion: The authors considered at least most intrapulmonary lymph nodes to be acquired lymphoid nodules formed along lymphatic drainage routes. They stated that the characteristic imaging and clinical features, together with adequate material from a percutaneous needle aspiration biopsy, may permit diagnosis without thoracotomy.

Topics

Medical terms in this study, explained in our Lexicon: Silicate, Thoracotomy, Neoplasm, Needle Biopsy.

Related studies

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• Pleural mesothelioma in a woman whose documented past exposure to asbestos was from smoking asbestos-containing filtered cigarettes: the comparative value of analytical transmission electron microscopic analysis of lung and lymph-node tissue — R.F. Dodson, S.P. Hammar (2006)
• Clinical and pathological characteristic of metastatic malignant mesothelioma initially diagnosed by lymph node biopsy — X.L. Zhu, L.M. Gao, et al. (2017)
• Asbestos content of lung tissue, lymph nodes, and pleural plaques from former shipyard workers — R.F. Dodson, M.G. Williams, et al. (1990)
• A comparison of asbestos burden in lung parenchyma, lymph nodes, and plaques — R.F. Dodson, M.G. Williams, et al. (1991)
• Characteristics of asbestos concentration in lung as compared to asbestos concentration in various levels of lymph nodes that collect drainage from the lung — R.F. Dodson, S. Shepherd, et al. (2007)

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