Immuno-reactivity of excised lymph nodes in neck dissections of squamous cell carcinomas of oral cavity

Abstract

Background:Regional lymph nodes play an important role in acting as anatomic barriers to systemic dissemination of tumor cells. This reflects in the host immunologic response. Oral squamous cell carcinoma, is known to be associated with early deficiencies of cell-mediated immunity, the pathology of which is reflected in the histology of the regional lymph nodes.Aim:The goal of this study was to study the different immunity reactions in the lymph nodes and to correlate it with the histopathology of tumor proper.Materials and Methods:Out of 40 head and neck dissections, 30 were male and 10 females within the age range of 21–72 years. According to Tumor Node Metastasis classification, there were 12 cases of stage II and stage III, respectively while 16 were of stage IV. A total of 372 nodes were histologically evaluated. The harvested lymph nodes were categorized into metastatic and non-metastatic nodes exhibiting four patterns as: Lymphocyte predominance pattern, germinal center predominance pattern, lymphocyte depleted pattern and unstimulated pattern.Results:The predominant pattern of lymph node reactivity was of lymphocyte predominance (199 nodes) followed by germinal center predominance (117 nodes); lymphocyte depleted (17 nodes) and unstimulated node pattern (39 nodes). Twenty-seven nodes were positive for metastasis. A statistically significant relationship (P = 0.0019 and P = 0.0290, chi square, respectively) was observed between the number of nodes harvested and stage and level of lymph nodes. A brief follow-up period of 3 years was carried out.Conclusion:Further studies relating the immuno-morphologic assessment of the lymph nodes in conjunction with other factors may be helpful in assessing the metastases risk of the individual.

Architectural changes in the regional lymph nodes of oral squamous cell carcinoma

“…LP pattern is thought to reflect changes related to CMI and to be associated with a better prognosis. [1411] Increased volume caused by hyperplasia of follicles, prominent germinal centers and enlarged medullary cords are associated with humoral immunity. [1] This GCP pattern was noted in 105 LNs in this study.…”

“…found 21 nodes with SH and 42 nodes with prominent vascularity apart from four basic patterns in 372 LNs. [11] Markedly distended LN sinuses with or without blood and LN architecture being completely replaced by the proliferation of congested vasculature typifies VTS. Such changes were noted in 116 LNs in this study.…”

“…The uncommon unstimulated pattern is frequently observed in levels IV–V, implying that as the levels of nodes are away from primary site, the nodal pattern remains unchanged, suggesting reduced antigenic stimulus. [11] LN is of normal or diminished size, and the lymphocyte population is depleted. Loosely packed lymphocytes are separated by deposits of amorphous substance and areas of fibrocollagen describe LD.…”

“…found LP as a frequent finding wherein it was suggested that this pattern may be actively engaged in a CMI response. [1115] Further, it was also suggested that SH and lymphoid hyperplasia are manifestations of CMI and thus may indicate a favorable prognosis. [1115] In nonmetastatic cases, predominant patterns noted were LP (94%) and VTS/SH (100%), reinforcing the supposition that CMI may avert LN invasion.…”

Metastatic Lymph Node Ratio: A Promising Parameter and Its Relation with Patient Related Factors in Cases of Primary Organ Malignancy

“…[9] Dedavid et al found 82% of colorectal cancers in stage T3/T4 and 61% belonging to well/moderately differentiated group. [10] Suchitra et al found 40% oral malignancies in T4 stage [11].…”