[363] Gynecologic Malignancies Are Commonly Encountered on Fine Needle Aspiration of Supraclavicular Lymph Nodes

Daniel J Fix, Paul N Staats. University of Maryland Medical Center, Baltimore, MD; University of Maryland School of Medicine, Baltimore, MD

Background: Patient recurrence and survival outcomes have been shown to correlate with stage, most importantly regional lymph node and distant metastasis status, in patients with gynecologic malignancies. Associated with gastric malignancies, the supraclavicular node(s) (SN) are involved in the metastasis of a diverse spectrum of neoplasms, and represent an opportunity to provide nodal staging information on fine-needle aspiration (FNA). Data regarding relative rates of metastasis to this site is limited. We aimed to examine the rate of involvement of the SN on cytology, and to describe useful cytologic features found in observed gynecologic metastases.
Design: A search of the computerized laboratory database was performed for cytologic specimens containing the phrase “supraclavicular” (surgical excisions containing this phrase were included) and ”neck” over a two-year period (09/2010 – 09/2012). Results corresponding to aspiration of a lymph node were reviewed, and neoplastic findings recorded and grouped based on site of origin.
Results: We identified 112 malignancies. Proportions are listed in the table below. Gynecologic malignancies were among the most common metastases to the SN (8.9%), trailing only head/neck, pulmonary, and thyroid carcinomas. The gynecologic malignancies identified include squamous cell carcinoma of the cervix (4), uterine endometrioid carcinoma (2), uterine clear cell carcinoma of the uterus (1), uterine carcinoma with clear cell features (1), high grade serous carcinoma of the fallopian tube (1), and juvenile granulosa cell tumor of the ovary (1). These cases were reviewed to determine morphologic features helpful in recognition of the correct diagnosis.

Site of Origin# of Cases (%)
Head/Neck47 (41.9%)
Hematologic16 (14.3%)
Pulmonary15 (13.4%)
Thyroid11 (9.8%)
Gynecolgic10 (8.9%)
Breast4 (3.6%)
Prostate3 (2.7%)
Skin2 (1.8%)
Esophagus1 (<1%)
Stomach1 (<1%)
Colon1 (<1%)
Testicle1 (<1%)

Conclusions: Gynecologic metastases represent a significant proportion of neoplasms found in SN (8.9%). In the cytologic (or histologic) evaluation of a metastatic carcinoma of unknown origin to the SN, it is important to consider the possibility of a gynecologic origin. These findings indicate advanced disease; therefore inclusion in the differential diagnosis (e.g. in young patients at risk for advanced SCC of the cervix) is paramount. Cytomorphologic and immunohistochemical features of these lesions and correlation with thorough clinical history are critical to reaching a correct diagnosis.
Category: Cytopathology

Monday, March 4, 2013 1:00 PM

Poster Session II # 94, Monday Afternoon


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