23. Benign epithelial inclusions in a renal hilar lymph node – a case presentation and brief review

Abstract

Background Benign epithelial inclusions can be a pitfall while assessing for metastatic carcinoma in lymph nodes. There are very few case reports of benign epithelial inclusions in renal hilar lymph nodes with the vast majority of these inclusions in lymph nodes removed during nephrectomy for Wilm’s tumour. Case presentation We present a case of benign epithelial inclusions in the renal hilar lymph node of a 30-year-old female who underwent a left nephrectomy for chronic pyelonephritis and reno-cutaneous fistula. There was no evidence of malignancy on extensive sampling. The inclusions stained for immunohistochemical markers of renal tubular origin. Discussion Benign epithelial inclusions can mimic metastatic carcinoma. We will describe the morphology and immunohisto-chemical staining pattern of benign epithelial inclusions in renal hilar lymph nodes. We will also briefly discuss benign epithelial inclusions in axillary and pelvic lymph nodes which are commonly examined in specimens removed for breast and gynaecological malignancies. Conclusion Benign epithelial inclusions in renal hilar lymph nodes are rare. These can be a pitfall in the assessment of lymph nodes for metastatic carcinoma. Our case demonstrates the features of benign renal epithelial lymph node inclusions in the context of a nephrectomy for chronic pyelonephritis. It is important to recognise these as benign as they can be mistaken for metastatic carcinoma and lead to unnecessary investigations for a primary tumour or over treatment of patients.