关键词: 结核, 淋巴结, 癌, 乳头状, 癌, 鳞状细胞, 病理学, 临床, 共病现象

Abstract:

Objective: To investigate the clinical and pathological features of cervical lymph node tuberculosis complicated with metastatic carcinoma. Methods: A retrospective study was conducted to collect the clinical data of 2782 patients with lymphadenectasis who were hospitalized in Wuhan Pulmonary Hospital from January 2015 to March 2023. Based on the pathological diagnosis of surgery and puncture biopsy (Hematoxylin-Eosin staining and/or immunohistochemistry were performed in all cases), 2387 cases (85.80%) of lymph node tuberculosis, 151 cases (5.43%) of malignant tumors and 231 cases (8.30%) of lymphadenitis were excluded. Therefore, the left 13 cases (0.47%) of cervical lymph node tuberculosis complicated with metastatic carcinoma were taken as the research object, and their clinical and pathological characteristics were analyzed. Results: The disease duration of 13 patients ranged from 1 month to 2 years. Among them, 10 patients considered for lymph node tuberculosis due to neck mass puncture biopsy and 2 patients suspected of pulmonary tuberculosis with lymph node enlargement were confirmed after cervical lymph node dissection. Finally, 8 patients were diagnosed as lymph node tuberculosis complicated with metastatic papillary thyroid carcinoma and 4 patients with metastatic nasopharyngeal or laryngeal squamous cell carcinoma by postoperative pathogenic microbiology and pathological examination. One case was diagnosed as laryngeal squamous cell carcinoma and underwent cervical lymph node dissection, and finally lymph node tuberculosis was confirmed by pathology. The pathological manifestations of tuberculosis showed that epithelioid histiocytes and Langhans giant cells formed nodules of varying sizes with or without caseous necrosis. The pathological manifestations of papillary thyroid carcinoma were papillary and follicular structures, the nuclei of cancer cells were ground-glass like, with nuclear overlap, nuclear grooves, intranuclear pseudoinclusion bodies and psammoma bodies, and thyroid transcription factor-1 (TTF-1) and thyroglobulin (Tg) were strongly expressed by immunohistochemistry. The pathology of nasopharyngeal or laryngeal squamous cell carcinoma showed that heterogeneous epidermal cells or basal-like cells formed solid, cord-like nests and irregular infiltrating growth.Tumor suppressor gene P63 and cytokeratin (CK) were strongly expressed by immunohistochemistry. Among 237 abnormal lymph node lesions, 25 (10.55%) showed both pathological manifestations in the lymph nodes simultaneously, and the original pathological morphological characteristics were maintained. Conclusion: Both cervical lymph node tuberculosis and metastatic carcinoma can be presented as cervical lymph node enlargement. The coexistence of the two is rare, and most of them are distributed in different lymph nodes, which is easy to be missed. Pathological examination of multiple lymph nodes can confirm the diagnosis and avoid misdiagnosis.

Key words: Tuberculosis, lymph node, Carcinoma, papillary, Carcinoma, squamous cell, Pathology, clinical, Comorbidity