Mesothelial Cell Inclusions in Abdominal and Thoracic Lymph Nodes in Association With Recurrent Chylothorax in a Young Man: A Diagnostic Pitfall.
Moiom H Phom, Md Ali Osama, Muniza Bai et al.
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Case in brief
A 19-year-old man presented with bilateral chylothorax, mediastinal lymphadenopathy, and extensive venous thrombosis, prompting concern for malignancy. Fine-needle aspiration of an inframammary lymph node showed numerous mesothelial cells, raising the possibility of metastatic mesothelioma. Histopathologic assessment, immunohistochemistry, and fluorescence in situ hybridization supported a benign reactive mesothelial proliferation within the lymph node.
What made this case unusual
Mesothelial cell inclusions were identified in abdominal and thoracic lymph nodes in association with recurrent chylothorax, and their cytologic appearance could mimic metastatic malignant mesothelioma.
Diagnostic / clinical pearl
Mesothelial cells in a lymph-node aspirate do not by themselves establish metastatic mesothelioma; correlate with histology and use ancillary studies to distinguish benign inclusions from malignancy.