Mesothelial cell inclusions mimicking adenocarcinoma in cervical lymph nodes in association with chylous effusion

Our plain-English summary of Mesothelial cell inclusions mimicking adenocarcinoma in cervical lymph nodes in association with chylous effusion, by M. Goyal, S. Kodandapani, S.N. Sharanabasappa, et al (Indian Journal of Medical and Paediatric Oncology, 2010).

The study

• Authors: M. Goyal, S. Kodandapani, S.N. Sharanabasappa, S.D. Palanki
• Journal: Indian Journal of Medical and Paediatric Oncology
• Published: 2010;31(2):62-4
• Type of article: Case report
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Mesothelial cell inclusions in lymph nodes are of rare occurrence and can be mistaken as metastatic adenocarcinomas, mesothelioma or sinus histiocytosis. These are usually found in mediastinal and abdominal lymph nodes and are associated with effusions. We report a case of benign mesothelial cell inclusions in cervical lymph nodes, which was associated with chylous effusion, and immunohistochemistry revealed unusual weak cytoplasmic epithelial membrane antigen positivity in the cells.

In plain English

This was a case report of a single patient. A 16-year-old boy came to a cancer institute in Hyderabad, India, with severe breathlessness, fluid around both lungs and the heart, fluid in the abdomen, and enlarged lymph nodes in the chest and neck that suggested lymphoma. Tests showed the fluids were chylous, meaning milky fluid rich in fat. No cancer cells were found in the fluids. Four lymph nodes from the left neck were removed and examined. They contained small clusters of bland cells inside the node channels. These cells showed no cell division and did not spread into the node tissue. Staining showed a pattern the authors judged to be mesothelial, along with unusually weak EMA staining. No lymphoma was found. The patient's breathing worsened and he died of cardiorespiratory arrest, and the cause of death was not established. The authors considered the cells benign and an incidental finding. They concluded that such inclusions can be mistaken for adenocarcinoma or mesothelioma. The article does not mention asbestos.

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 report (single patient)
• Who was studied: One 16-year-old boy seen at the Indo-American Cancer Institute and Research Centre, Hyderabad, India, with breathlessness, bilateral pleural effusion, ascites and enlarged mediastinal, left supraclavicular and cervical lymph nodes
• Main results:
  • The pleural and ascitic fluids were chylous, shown by chylomicrons, markedly raised triglycerides and normal cholesterol.
  • Cytology of the fluids showed only benign lymphocytes and mesothelial cells and was negative for malignancy.
  • In the biopsied left cervical lymph nodes (four nodes), the clustered cells lay in the subcapsular and interfollicular sinuses. They showed no mitotic activity and no extranodal or parenchymal infiltration.
  • The cells stained strongly for cytokeratin AE1/AE3 and CK7, stained for calretinin, and were negative for CK20, CD68, CEA and TTF-1. EMA staining was very weak and cytoplasmic.
  • Ki-67 staining showed no proliferation in the cells, and no lymphoproliferative disorder (such as lymphoma) was found in the nodes.
  • The patient's breathlessness progressed and he died of cardiorespiratory arrest. The cause of death was not established.
• The authors' conclusion: The authors considered the cells benign mesothelial inclusions and presumed they were an incidental finding linked to some other undiagnosed condition. They concluded that the cells' features and staining pattern should be evaluated carefully so that such inclusions are not mistaken for adenocarcinoma or mesothelioma, even in unusual sites.
• Limitations the authors state:
  • The cause of the patient's death could not be established, and the underlying condition behind the inclusions was presumed but not diagnosed.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelial Cells, Adenocarcinoma, Mesothelioma, Immunohistochemistry, Epithelial Membrane Antigen (EMA).

Related studies

• Diagnosis of malignant mesothelioma by fine needle aspiration of a cervical lymph node. A case report — N.A. Ansari, N.W. Derias (2000)
• Malignant pleural mesothelioma initially diagnosed on cervical lymph node biopsy — S. Ogata, S. Hiroi, et al. (2009)
• Hyperplastic mesothelial cells in lymph nodes: report of six cases of a benign process that can stimulate metastatic involvement by mesothelioma or carcinoma — P. Argani, J. Rosai (1998)
• Cytological differential diagnosis among adenocarcinoma, epithelial mesothelioma, and reactive mesothelial cells in serous effusions by immunocytochemistry — X.Y. Su, G.D. Li, et al. (2011)
• Ber-EP4 for differentiating adenocarcinoma from reactive and neoplastic mesothelial cells in serous effusions. Comparison with carcinoembryonic antigen, B72.3 and Leu-M1 — M.E. Bailey, R.W. Brown, et al. (1996)
• Ribonucleotide reductase immunoreactivity in adenocarcinoma cells and malignant or reactive mesothelial cells in serous effusions — H. Okamura, T. Kamei, et al. (2003)

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