Paracortical alteration in lymphadenopathic and tumor-draining lymph nodes: histologic study

Histologic studies of 142 enlarged lymph nodes from 124 patients, diagnosed histologically as nonspecific chronic lymphadenitis or reactive hyperplasia, revealed a characteristic nodular alteration in the paracortical area of nodes from the axillary, cervical, and inguinal regions, and rarely in abdominal, mediastinal, and retroperitoneal groups. In 1389 lymph nodes from 100 radical mastectomy specimens similar changes were noted more frequently in the lower than in higher levels of the tumor-draining axillary nodes. The nodule was composed of small lymphocytes associated with postcapillary venules and histiocytes-macrophages. The latter varied in distribution from a scattered pattern resembling a starry-sky appearance in the initial phase of paracortical alteration to the replacement of small lymphocytes in advanced stages. Plasma cells and lymphatic sinuses were characteristically absent from this nodular alteration. An impressive example of such changes was seen in four cases of dermatopathic lymphadenitis. Studies of the paracortical area may provide new insight into the pathogenesis of some lymphadenopathies.