Morphometric analysis of "pancitokeratin-positive" neoplastic lesions of the lymph nodes of the neck
DOI:
https://doi.org/10.14739/2310-1237.2017.3.118730Keywords:
neoplasms, lymph nodes, ImageJAbstract
Cancer metastasis to the lymph nodes of the neck from an unknown primary source is a histological diagnosis of metastatic carcinoma without another clinical manifestation of the malignant process. In addition to the oropharynx and nasopharynx, metastasis to the lymph nodes of the neck can come from anywhere in the head and neck, as well as another organ. Such cancers are more often diagnosed between the fifth and seventh decades with a peak incidence in the sixth and remain an actual diagnostic problem.
The aim of the work was to investigate the complex of morphological, morphometric and immunohistochemical characteristics of elements of pancitokeratin-positive tumor tissue of metastatic origin in the lymph nodes of the neck for the improvement of diagnostic algorithms.
Materials and methods. A retrospective analysis of 41 cases of neoplastic lesions of the lymph nodes of the neck was made without other clinical manifestations of primary localization during the period August 2016 - July 2017. The mean age of the patients was 47.68 ± 16.41 years (median 46).
Results. Squamous cell carcinomas of the head and neck have an accessible visualization and rare phenotypes that produce metastatic cells before the increase in the primary focus (only 2 of 41), therefore should not fall under the ciphers of cancers of unknown primary localization. But the number of observations of metastatic lesions of the lymph nodes in the neck of category 3 "confirmed cancer of unknown primary localization" of our region is much higher than the world statistics, as a result of incomplete examination of patients at the "pre-biopsy stage".
Conclusions. In the diagnosis of Cytokeratin, PAN AE1 / AE3 (+) metastatic lesions of the lymph nodes, it is advisable to use objective parameters of the nuclei of tumor cells (area, perimeter, roundness coefficient) along with the primary panel of IGH markers (Cytokeratin, PAN AE1 / AE3, Vimentin, CD45, S100), comparing them with the size of conventional lymphocytes. This reduces the subjectivity of the evaluation and significantly helps to determine the diagnostic algorithm of the second stage of the IHC study.
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