Study of Metastasis in Lymphnode Biopsies with Special Reference to Immunohistochemistry (IHC) in Metastatic Breast Carcinoma EC13-EC16
Dr. Sainath K Andola,
Professor and Head of the Department, Department of Pathology, M. R. Medical College, Gulbarga, Karnataka -585105, India.
Context: Lymph nodes are the most common site of metastatic malignancy, and sometimes constitute the first clinical manifestation of the disease. Metastases are tumour implants discontinuous with the primary tumour. The characterization of a neoplasm as primary or metastatic has always troubled surgical pathologists.
Aim: To study distribution of lymph node metastasis in North Karnataka region based on age, sex, location and morphological features, and to explore the utility of special stains and immunohistochemistry (IHC) in its diagnosis.
Materials and Methods: The present study includes 228 cases of lymph node metastasis studied over a 10-year period (July 2004- June 2014). The H&E slides were reviewed, special stains and IHC done wherever necessary.
Results: Out of 228 cases, maximum were seen between 2012-2014 (79 cases, 34.65%). Age ranged from 16-85y (Mean- 47.02) with female predominance (Male:Female 1:2.55.). In 186 cases (81.58%) more than one lymph node received, while in majority of cases (35.09%) size of the lymph node was between 1-2cms. Most common site of metastasis was axillary lymph nodes (33.77%) followed by cervical (22.50%) and pelvic (9.64%). Primary was mainly from breast carcinoma (33.77%) followed by squamous cell carcinoma (31.57%) and adenocarcinoma (10.52%). IHC in 60 cases with breast carcinoma metastasis showed ER positivity in 45.00%, PR positivity in 41.67% and HER2/neu positivity in 38.33%.
Conclusion: Identification of the size, number, microscopic type and possible primary site of metastasis is important prognostically especially in breast carcinoma. This study elaborates the pattern of distribution of lymph node metastasis in North Karnataka region with IHC as an aid to diagnosis.