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Case Reports
. 2019 Nov 4;17(1):181.
doi: 10.1186/s12957-019-1726-1.

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

Chenglong Wang  1 , Yijia Cao  1 , Min Zeng  1 , Lijuan Wang  1 , Xiaojing Cao  1 , Lingfeng Zou  1 , Youde Cao  2   3
Affiliations
Case Reports

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

Chenglong Wang et al. World J Surg Oncol. .

Abstract

Background: Lymph 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 presentation: A 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.

Conclusions: It is very important to correctly diagnose a lymph node inclusion for proper clinical management.

Keywords: Epithelial inclusion; Lung adenocarcinoma; Lymph node; Metastasis; Tumour staging.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
CT image showing a solid pulmonary nodule in the right upper lobe
Fig. 2
Fig. 2
a The solid nodule of the right upper lobe showing a papillary predominant adenocarcinoma and the previous needle tract at the centre of the picture. b The tumour cells contained abundant eosinophilic cytoplasm and vacuolar nuclei with irregular contours and distinct nucleoli at high magnification
Fig. 3
Fig. 3
a A small number of glands (black circle) within the parenchyma of the intrapulmonary lymph node. b CK. c The glands contained two layers of epithelial cells, the luminal cells contained abundant eosinophilic cytoplasm and vacuolar nuclei with relatively regular contours and distinct nucleoli, and the abluminal cells showed small round hyperchromatic nuclei with indistinct cytoplasm. d CK5/6
See this image and copyright information in PMC

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