Immune hyperplasia patterns in lymph nodes draining breast cancer: A correlation with histomorphological parameters

Background: Lymph nodes serve as site of immunologic expansion of lymphocyte populations. Enlargement of nodes may be caused by spread and growth of cancer cells or it can be due to reactive hyperplasia of lymph nodes. Aim : To study the pattern of reaction in involved and uninvolved lymph nodes draining breast carcinoma and correlate different patterns of hyperplasia with other morphological parameters in modified radical mastectomy (MRM) specimens. Material and Methods: Histopathological examination of 734 lymph nodes isolated from MRM specimens over a period of 2 years was performed on routine microsections. Results: Mixed pattern of hyperplasia was the most widespread followed by the diffuse pattern, the follicular hyperplasia, sinus histiocytosis, and paracortical hyperplasia in decreasing order. Follicular hyperplasia was seen in 23.44% of the ductal carcinomas and 36.36% of the malignant phylloides tumor. Sinus histiocytosis was seen in 23.53% of the metaplastic carcinomas, 22.22% of the medullary carcinomas with a decline to 12.10% amongst the ductal carcinomas. However, mixed pattern of hyperplasia was seen in 28.57% of the papillary carcinomas, 26.31% of the lobular and 27.41% of the ductal carcinomas. The incidence of sinus histiocytosis increased from 10.96 to 23.68% with the grade of tumor. There was a decline in the incidence of sinus histiocytosis, paracortical hyperplasia with the increase in the size of the tumor. Conclusions: The assessment of the reactive behavior of lymph nodes serves as an indicator to the histologic immunostaging of malignant tumors. This data indicate that the lymph node reaction to cancer and their incidence and prognostic significance may vary depending upon the stage and type of tumor.