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Regauer, S.
Histopathological work-up and interpretation of sentinel lymph nodes removed for vulvar squamous cell carcinoma
HISTOPATHOLOGY. 2009; 55(2): 174-181. Doi: 10.1111/j.1365-2559.2009.03350.x
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Leading authors Med Uni Graz: Regauer Sigrid
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Abstract:: Aims: To evaluate the work-up of sentinel lymph nodes (SLNs) removed for vulvar pT1-pT2 squamous cell carcinoma (SCC). Inguinal lymphadenectomy yields metastases in only 30% of cases. Patients with missed inguinal disease, however, have a risk of dying from systemic disease. SLN dissections reduce morbidity, but work-up should reliably identify metastatic disease. Methods and results: All SLNs removed from 38 patients with pT1-pT2 SCC and clinically negative inguinal lymph nodes were submitted for frozen section analysis. When negative, SLN were formalin-fixed, sectioned entirely at 330-mu m intervals to produce three slides per millimetre [two haematoxylin and eosin (H&E) stained slides; one slide for immunohistochemistry]. If screening of H&E-stained sections was negative, all remaining slides were subjected to immunohistochemistry with an antibody to cytokeratin. Twenty-five of 38 patients (66%) were pN0, 7/38 (18%) had metastases on frozen sections/H&E stains. Immunohistochemistry detected micrometastases in two patients and single tumour cells and anucleate cell structures in four patients. In 12/13 patients the SLN metastases, including all single-cell deposits, were from lichen sclerosus (LS)-associated SCC. Twelve of 13 patients with metastases had a pT2 SCC. Conclusions: Micrometastases and single tumour cell deposits in SLNs are typical of LS-associated vulvar SCC. Single tumour cell deposits in SNLs should be regarded as 'positive'. Identification requires serial sectioning and immunohistochemical analysis of all removed SLNs.
Find related publications in this database (Keywords): lichen sclerosus; micrometastases; vulvar carcinoma