Lymph Node Infarctions a Likely Sign of Malignancy

October 21, 2011 (Las Vegas, Nevada) — The vast majority of lymph node infarction cases are associated with past or future malignancy, according to a study presented here at the American Society for Clinical Pathology 2011 Annual Meeting.

Lymph node infarction has been associated with malignancy, but previous studies have shown a wide range of incidence.

"The literature [on infarcted lymph nodes] goes back to the 1980s, but people haven't looked to see if they're associated with malignancy or with chemotherapy, fine-needle aspirations, or other interventions," Xiaoyin Jiang, MD, a pathology resident at Duke University Medical Center, Chapel Hill, North Carolina, who presented the study, told Medscape Medical News.

The researchers examined pathology records over a 20-year period to identify cases of lymph node infarction or coagulative necrosis. In each case, they reviewed diagnosis, patient history, and histology or cytology, when available.

In 34 cases of lymph node infarction, 30 patients (88%) were ultimately diagnosed with a malignancy. In 22 cases (73%), the diagnosis came before the infarction; 18 of those 22 (82%) were hematologic cancers, and diffuse large B-cell lymphoma (DLBCL) was the most common type. The other 4 malignancies were pancreatic adenocarcinoma, squamous cell carcinoma, melanoma, and seminoma.

In 5 (17%) of the 30 patients ultimately diagnosed with a malignancy, the diagnosis was made from a sample of the infarcted lymph node. All 5 cases were hematologic malignancies, either DLBCL or follicular lymphoma. Three of the 30 (10%) cases were later diagnosed with hematologic malignancies (DLBCL, follicular lymphoma, anaplastic large cell lymphoma). Of the 4 patients with no eventual evidence of malignancy, 2 were diagnosed with a viral infection, 1 with a thrombosed pancreas graft near the infarcted lymph node, and 1 case was not followed-up.

Nineteen of the 34 cases had previously undergone chemotherapy or recent fine-needle aspiration.

"If your patient presents with a lymph node infarction and has no obvious malignancy, that's a patient you really need to watch closely," Dr. Jiang said.

The study is valuable, according to Steven Kroft, MD, professor of pathology and director of hematopathology at the Medical College of Wisconsin, Madison. "It tells me as a pathologist, if I see an infarcted lymph node, that the patient needs to be evaluated for a concurrent malignancy. It becomes a red flag. It changes the nature of my consultation with the patient's clinician," Dr. Kroft told Medscape Medical News.

Dr. Jiang and Dr. Kroft have disclosed no relevant financial relationships.

American Society for Clinical Pathology (ASCP) 2011 Annual Meeting: Abstract 142. Presented October 20, 2011.