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Lymphatic/vascular invasion & nodal disease



Lymphatic/vascular invasion




A cuff of lymphatic invasion around a small vein in a vascular bundle
A cuff of lymphatic invasion around a venous channel - low power
A cuff of lymphatic invasion around a venous channel - high power

Further examples of lymphatic/vascular invasion
Two foci of lymphatic invasion by carcinoma - the focus on the right is close to a venous channel Vascular bundle with lymphatic invasion by carcinoma
Venous invasion by carcinoma - note adjacent small artery Invasion of dermal lymphatics and dermal connective tissue by recurrent carcinoma of breast


The images below are from the same case.
On the left the arrow points to a possible focus of lymphatic invasion; on the right lymphatic invasion is unequivocal.
The diagnosis is made considerably more secure by confirming the presence of a lymphatic "in company" with a vein and small artery
Low and medium power views of intermediate grade DCIS with adjacent invasion (circled). Low and hgh power views of lymphatic invasion - note adjacent artery & vein

An example of NOT lymphatic/vascular invasion. This is a rtraction artefact and is very common.
This focus was regarded as NOT being diagnostic of lymphatic invasion but more likely to be simply retraction artefact of surrounding tissues



Nodal metastases




Subclassification of nodal metastases (TNM6)
Replacement metastases ≥ 2mm
Micrometastases 0.2mm-2mm
Isolated tumour cells < 0.2mm




Two examples of replacement metastases in axillary nodes. Note extracapsular spread into adjacent fat (right)
Lymph node with replaceemnt metastasis - low power Extranodal extension of carcinoma into perinodal fat


Subcapsular micrometastasis - this image shows a deposit measuring just over 0.2mm on the pan CK section.

Subtle micrometastasis - this image shows a deposit measuring just under 0.6 mm.
Micrometastasis

Subtle micrometastasis - detail of photomicrograph above.
Micrometastasis

Subcapsular micrometastasis - the deposit in this photomicrograph measured 1.9mm

Two subtle subcapsular deposits (arrows) of metastatic carcinoma in an axillary node sample -
the sentinel node was negative in this case.
The deposit in the upper left quadrant measures <0.2mm and on its own would be recorded as "isolated tumour cells" (N0)
The deposit in the lower right hand quadrant measures 0.27mm and therefore qualifies as a micrometastasis (N1)


The enlarged photomicrograph below shows more detail of the metastatic foci when you move the mouse over those areas



A subtle focus of metastatic carcinoma in a subcapsular sinus (A). Note the adjacent sinus histiocytosis (B)
Sinus histiocytosis and metastatic carcinoma in a lymph node
Sinus histiocytosis and metastatic carcinoma in a lymph node
Sinus histiocytosis and metastatic carcinoma in a lymph node

Subtle intra-capsular micrometastasis from an invasive lobular carcinoma.
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Invasive lobular carcinoma Invasive lobular carcinoma Invasive lobular carcinoma



Replacement metastasis in an axillary node with an adjacent sarcoid-like granulomatous reaction to tumour.
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Granulomatous reacttion to metastatic carcinoma in a lymph node Granulomatous reacttion to metastatic carcinoma in a lymph node Granulomatous reacttion to metastatic carcinoma in a lymph node


An example of lipogranulomatous axillary lymphadenopathy due to leakage of contents of a triglyceride-filled breast implant. This type of implant has now been withdrawn from the market.
Free lipid in lymph node sinuses
Foamy macrophage and giant cell reaction to lipid material in lymph node


See also Naevus cell rests or aggregates in lymph nodes.


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