Glandular Inclusions in Pelvic and Abdominal Para-aortic Lymph Nodes: A Study of Autopsy and Surgical Material in Males and Females

Abstract

The pelvic and abdominal para-aortic lymph nodes from 50 male and 50 female unselected autopsies and from surgical material obtained from 17 males were examined for benign glandular inclusions. In addition, surgically removed lymph nodes with previously diagnosed glandular inclusions from 11 females were reviewed. Serial sections of these lymph nodes revealed glandular inclusions in seven (14%) of the 50 female autopsies. None of these seven patients had malignant tumors. There were no glandular inclusions in any of the lymph nodes obtained from males. Most of the glandular inclusions were in the capsule and cortical portions of the lymph nodes and revealed striking histologic similarities to ovarian germinal inclusion cysts and to oviduct epithelium. Neither endometrial stroma nor areas of hemorrhage were seen in the vicinity of these inclusions. We concluded that these inclusions occurred exclusively in females, and that genital malignancy played no role in their pathogenesis. Although genuine endometriosis can occur in pelvic and abdominal para-aortic lymph nodes, the inclusions described here are more likely akin to ovarian germinal epithelium inclusion cysts and may be due to metaplastic proliferation of peritoneal mesothelium which is a derivative of coelomic epithelium from which the Müllerian system originates.