Lymphoepitheliomas of the cervical lymph nodes.

Abstract

IN Malaya there is a high incidence of a peculiar type of malignant tumours of cervical lymph nodes termed " lymphoepithelioma '. These tumours may appear in the cervical lymph nodes without any clinical evidence of a primary growth elsewhere and have, therefore, in previous cancer statistics, sometimes been classified either as metastases of indeterminate origin or as primary tumours of lymphoid tissue. Because of their histological resemblance to certain tumours found in the nasopharynx, and because of their actual association with these in many cases, it is now considered that there is sufficient evidence to justify their inclusion in the class of nasopharyngeal cancers. MATERIAL AND METHODThis study is based on the material collected in the Pathology Division of the Institute for Medical Research, Kuala Laumpur, over the 8 year period from 1953 to 1960 inclusive. The material comprised 134 malignant nasopharyngeal cancers and 430 tumours of cervical lymph nodes of the lymphoepithelioma type. These two groups were compared histologically and their clinical histories carefully reviewed in order to find how many could reasonably be correlated. OBSERVATIONS AND RESULTS HistologyAmong the 134 nasopharyngeal tumours, 118 showed the typical appearance of the " lymphoepithelioma " as described by Regaud (1921) and Schmincke (1921). They consisted of strands of cells with large pale-staining vesicular nuclei and poorly delimited cytoplasm embedded in a stroma rich in lymphocytes. The outlines of the individual cells were indistinct and in many places the appearance was that of a syncytium. In the Regaud type, the tumour cells invaded the nasopharyngeal tissue in small groups or columns which were interspersed, here and there, by numerous lymphocytes (Fig. 1). In the Schmincke type, the tumour cells were more dissociated from one another and seemed to mingle with the lymphoid tissue giving the impression of a mixed cell sarcoma rather than a carcinoma (Fig. 2). However, examination of other areas usually revealed tumour cells arranged in definite epithelial columns. Occasionally, the tumour cells were seen to have coalesced into broad solid alveolar masses sharply demarcated from the lymphoid stroma by varying degrees of fibrosis (Fig. 3). These tumours were described as " transitional-cell carcinomas " by Quick and Cutler (1927)

Cytomorphological Pattern of Lymph Node Lesions- A Five Year Study in Regional Institute of Medical Sciences, Imphal

“…The pattern of metastatic deposits of squamous cell carcinoma, followed by adenocarcinomas and others are in accordance with other studies, 11,12,13,14 Metastatic squamous cell carcinoma was found in majority of the cases (61 out of 182 cases, 33.51%). Hirachand et al also noted that the commonest type of metastatic carcinoma to lymph node was of squamous cell variety.…”

Role of FNAC in the diagnosis of cervical lymphadenopathy

“…Carcinomas of the nasopharynx and oropharynx are notorious for presenting with metastases in the cervical lymph nodes while the primary neoplasm remains unnoticeable. 15 In our hospital clinical workup after FNAC diagnosis of metastatic deposits showed that majority of the cases had a primary origin in the oral cavity. FNAC is a useful prognostic tool in stage III cancers wherein metastasis to regional lymph nodes is usually found.…”

Role of FNAC in diagnosis of cervical lymphadenopathy

“…In recent years, FNAC of lymph nodes supplemented by ancillary studies has been increasingly accepted as an approach for primary diagnosis of reactive lymphoid lesions and lymphomas. [20,21].In our study only 7 primary lymphomas (3 Hodgkin's and 4 non-hodgkin's)were diagnosed on cervical node FNAC. The accuracy of cytological diagnosis is still limited in some forms of Non hodgkin's lymphoma, notably lymphomas with small cells, mainly marginal zone lymphoma, peripheral T cell lymphoma & T cell/ Histiocyte rich B cell lymphoma, nodular lymphocytes predominant hodgkin's lymphoma [17]; That's why, subtyping of hodgkin's&non hodgkin's lymphomas was not done in current study.…”