The first case of gland inclusion in an intrapulmonary lymph node: a mimic of metastasis

Chenglong Wang,Lijuan Wang,Min Zeng,Yijia Cao,Youde Cao,Xiaojing Cao,Lingfeng Zou

doi:10.1186/s12957-019-1726-1

Abstract

BackgroundLymph node inclusions are foci of ectopic tissue in lymph nodes, which were reported in different areas of the body. However, inclusions in the mediastinal lymph node are rare. Here, we report the first case of glandular inclusion within the parenchyma of the intrapulmonary lymph node in a patient with primary lung adenocarcinoma.Case presentationA computed tomography (CT) scan showed a solid pulmonary nodule in the right upper lobe in a 44-year-old man. After a fine needle aspiration biopsy diagnosis of adenocarcinoma, lobectomy and lymph dissection were performed. Histological sections of the lung demonstrated a papillary predominant adenocarcinoma and one intrapulmonary lymph node, which displayed glandular inclusion occupying the node parenchyma. The gland inclusion was very similar to metastasis, but was formed by two layers of epithelial cells, and the abluminal cells were positive for P63, P40, and CK5/6. The patient has remained alive without recurrence and metastasis at the last follow-up before publication.ConclusionsIt is very important to correctly diagnose a lymph node inclusion for proper clinical management.

Highlights

Lymph node inclusions are foci of ectopic tissue in lymph nodes
Discusion and conclusions In this case study, a gland inclusion in the intrapulmonary lymph node was formed by two layers of epithelial cells, and the abluminal cells were positive for P63, P40, and CK5/6
As the inclusion was not observed in the subsequent section, we could not add the myoepithelial marker to identify whether the abluminal cells were myoepithelial cells or basal cells

Summary

Introduction

Lymph node inclusions are foci of ectopic tissue in lymph nodes. Certainly, tumour can develop from the ectopic tissue of lymph nodes [1]. There are only three reports about mediastinal lymph node inclusions, including one mesothelial cell inclusion [2] and two benign salivary gland tissue inclusions [3, 4]. We report the first case of a glandular inclusion within the parenchyma of the intrapulmonary lymph node in a patient with primary lung adenocarcinoma. Case presentation Our patient was a 44-year-old man whose chest CT scan showed a solid pulmonary nodule in the right upper lobe a month ago (Fig. 1).

Results

Conclusion