Lymph node infarction: role of underlying malignancy, tumour proliferation fraction and vascular compromise - a study of 35 cases and a comprehensive review of the literature

Aims:  To determine the roles of the presence of malignancy, tumour proliferation fraction, vascular compromise and therapeutic and diagnostic manipulations in lymph node infarction (LNI). Methods and results:  Thirty‐five cases of LNI were identified over a 20‐year period. Of the 35 patients, 31 (8...

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Bibliographic Details
Published in:Histopathology 2013-01, Vol.62 (2), p.315-325
Main Authors: Jiang, Xiaoyin 'Sara', West, Dava S, Lagoo, Anand S
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Biological and medical sciences
Biomarkers, Tumor - metabolism
Biopsy, Fine-Needle
Databases, Factual
Factor VIII - metabolism
Female
Fractions
Hematologic and hematopoietic diseases
Humans
infarction
Infarction - etiology
Infarction - pathology
Investigative techniques, diagnostic techniques (general aspects)
ischaemia
Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis
lymph nodes
Lymph Nodes - blood supply
Lymph Nodes - injuries
Lymph Nodes - metabolism
Lymph Nodes - pathology
Lymphatic Diseases - etiology
Lymphatic Diseases - pathology
lymphoma
Lymphoma - complications
Lymphoma - metabolism
Lymphoma - pathology
Male
Medical sciences
Middle Aged
Neck
Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques
proliferation fraction
recanalized thrombi
Thrombosis - complications
Thrombosis - pathology
Young Adult
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Summary:Aims:  To determine the roles of the presence of malignancy, tumour proliferation fraction, vascular compromise and therapeutic and diagnostic manipulations in lymph node infarction (LNI). Methods and results:  Thirty‐five cases of LNI were identified over a 20‐year period. Of the 35 patients, 31 (89%) had an underlying malignancy: 27 of the 31 (87%) were haematologic malignancies, the rest being metastatic carcinoma (two), melanoma, and seminoma. Of the four patients without evidence of malignancy, two were diagnosed with viral infection, one had LNI adjacent to a thrombosed pancreas graft, and one was lost to follow‐up. Ki67 immunostaining in viable tumour demonstrated a range (5–60%) of proliferation fractions. A history of fine needle aspiration alone was present in seven of the 35 patients (20%), a history of chemotherapy alone in 11 (31%), and a history of both in two (5.7%). Factor VIII immunostaining highlighted thrombosed and recanalized vessels next to the infarction. Conclusions:  Infarction of lymph nodes is associated with previous, concurrent or subsequent diagnosis of malignancy in the vast majority of cases. Chemotherapy or previous fine needle aspiration can precipitate infarction in some cases, but infarction may occur without such intervention, possibly because of an underlying subacute or chronic vascular compromise produced by vascular thrombosis.
ISSN:0309-0167
1365-2559
DOI:10.1111/j.1365-2559.2012.04361.x