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Diffuse hyperplastic mesothelial cells in multiple lymph nodes: case report with review of the literature
1Department of Pathology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
Insights
This study details a rare case of diffuse hyperplastic mesothelial cells found in multiple lymph nodes, particularly the cervical lymph nodes. This benign finding is crucial for pathologists to avoid misdiagnosing malignancy.
Area of Science:
- Pathology
- Immunohistochemistry
- Cell Biology
Background:
- Mesothelial cells are typically found lining body cavities.
- Hyperplasia of mesothelial cells in lymph nodes is an uncommon phenomenon.
- Accurate diagnosis is essential to differentiate benign conditions from malignancy.
Observation:
- A case of diffuse hyperplastic mesothelial cells observed in multiple lymph nodes, primarily cervical.
- Microscopic examination revealed expanded lymphatic sinuses with proliferating epithelioid-like cells.
- Immunohistochemical analysis showed positivity for mesothelial markers (Calretinin, CK5/6, D2-40) and negativity for melanoma and lymphoma markers.
Findings:
- The proliferating cells exhibited features of mesothelial cells with a benign clinical course over 22 months.
- Immunohistochemistry confirmed the mesothelial origin and ruled out other neoplastic processes.
- This represents the first reported instance of diffuse mesothelial cell hyperplasia involving systemic lymph nodes.
Implications:
- Highlights the importance of recognizing benign mesothelial hyperplasia in lymph nodes.
- Prevents potential misdiagnosis of metastatic carcinoma or lymphoma.
- Contributes to the understanding of mesothelial cell behavior in lymph node pathology.
Abstract:
We report a case of diffuse hyperplastic mesothelial cells in multiple lymph nodes. Microscopically, the lymph nodes had a normal follicular pattern. The lymphatic sinus was extremely expanded, within the sinuses the epithelial-like cells proliferated actively in the form of sheets and clusters. Epithelioid-like cells had eosinophilic cytoplasm, prominent nucleoli and vesicular nuclei. Mitotic figures were rarely observed. These cells were immunopositive for Calretinin, CK5/6, D2-40, MC and Ckpan and immunonegative for S-100, HMB45, MelanA, TTF-1, CDX-2, Villin, ALK, CD30, CD20, CD3, CD1a and CD68. In addition, during a 22 months follow-up period failed to identify any malignant neoplasms, thus confirming the benign nature of these cells. It is the first reported case of diffuse hyperplastic of mesothelial cells mainly in the cervical lymph nodes associated with systemic multiple lymph node involvement. Awareness of this event is important for the pathologist in preventing the misdiagnosis of malignancy.
