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mesothelial cells pathology outlines : Mesothelial - Pathology Outlines

mesothelial cells pathology outlines :  Mesothelial - Pathology Outlines

Lymph nodes & spleen, nonlymphoma

Ectopic tissue / inclusions


Authors: Jayalakshmi Balakrishna, M.D., Abdelsalam Sharabi, M.D.

Topic Completed: 1 June 2014

Minor changes: 18 December 2020

Copyright: 2003-2021, PathologyOutlines.com, Inc.

PubMed Search: Mesothelial cell inclusions [title]

Jayalakshmi Balakrishna, M.D.

Page views in 2020: 1,550

Page views in 2021 to date: 1,295

Table of Contents

Definition / general | Terminology | Epidemiology | Sites | Etiology | Clinical features | Diagnosis | Radiology images | Prognostic factors | Case reports | Treatment | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Negative stains | Differential diagnosis | Additional references

Cite this page: Balakrishna J. Mesothelial. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/lymphnodesmesothelialcellinclusions.html. Accessed May 22nd, 2021.

Definition / general

Inclusions of benign mesothelial cells in lymph nodes

Often missed on routine H&E sections (Am J Surg Pathol 1999;23:1264)

Hyperplastic mesothelial cells in nodal tissue may derive from reactive serosal mesothelium that is dislodged into draining lymphatics (Arch Pathol Lab Med 2000;124:609)

Often associated with serosal fluid collection (pericardial, pleural, abdominal) at time of nodal biopsy (Hum Pathol 1998;29:339), including episodes of intraperitoneal hemorrhage and ascites (Pathology 2001;33:239), perhaps because effusion allows for mesothelial cell migration into lymphatics (Diagn Cytopathol 2003;29:163)


  • Benign mesothelial inclusions
  • Benign metastasizing mesothelial cells
  • Epidemiology
  • Very rare occurrence
  • Sites
  • Mediastinal and abdominal lymph nodes
  • Rare - cervical lymph nodes
  • Etiology

Transportation of these cells through the lymphatics to the lymph node during injury or manipulation at the primary site of the origin

They undergo a degeneration, and thus it becomes difficult to find them

  • Clinical features
  • Incidental finding
  • Enlarged lymph nodes
  • Site specific symptoms
  • Diagnosis
  • Biopsy plus immunohistochemistry
  • Radiology images

Contributed by Kristin Dittmar, M.D.

Enlarged lymph node due to mesothelial inclusion

Prognostic factors

Benign process with no significant clinical implications

Case reports

12 year old boy with diffuse hyperplastic mesothelial cells in multiple lymph nodes (Int J Clin Exp Pathol 2013;6:926)

16 year old boy with mesothelial cell inclusions mimicking adenocarcinoma (Indian J Med Paediatr Oncol 2010;31:62)

18 year old woman with benign metastasizing mesothelial cells (J Clin Oncol 2011;29:e546)

52 year old woman with mesothelial pelvic lymph node inclusions mimicking metastatic thyroid carcinoma (Gynecol Oncol 1998;68:210)

Mesothelial cell inclusions in mediastinal lymph nodes mimicking metastatic carcinoma (Am J Clin Pathol 1990;93:741)

Mesothelial cell inclusions within mediastinal lymph nodes (Histopathology 1994;25:483)

Mesothelial pelvic lymph node inclusion in a patient with ovarian microinvasive borderline mucinous tumor (Int J Gynecol Cancer 2007;17:917)

Benign hyperplastic mesothelial cells in lymph node (Int J Surg Pathol 2007;15:297)


Depends upon the clinical presentation / underlying cause

In incidental findings, none necessary

Gross description

Enlarged lymph nodes with yellowish tan to gray white, smooth to mottled surface

Microscopic (histologic) description

Small clusters and singly scattered, round to polygonal cells, seen in the subcapsular and interfollicular sinuses of the nodes

These cells show a round, vesicular nucleus with small nucleolus

The nuclear - cytoplasmic ratio is low

No mitotic activity is detected

There is no extranodal or parenchymal infiltration of the cells

Tiny spaces are

Positive stains

Cytokeratin AE1 / AE3, cytokeratin 7 (CK7)

Calretinin (nuclear and cytoplasmic), WT1, CK5 / 6, CAIX (membranous)

EMA (weak and cytoplasmic)

Negative stains

Cytokeratin 20 (CK20)

Carcino-embryonic antigen (CEA)


Thyroid transcription factor 1 (TTF1)


Differential diagnosis

Lymphangioma: multicystic, has smooth muscle and lymphocytes in cyst wall and lumen, keratin+

Metastatic adenocarcinoma

Metastatic mesothelioma

Mucinous cystadenoma: ovarian-like stroma, mucin+, CEA+, negative for hyaluronic acid

Müllerian inclusions: ER+; negative for calretinin, CK5 / 6; PAX8 can be positive in both

Simple hemorrhagic cyst: keratin-

Sinus histiocytosis

Additional references

Ioachim's Lymph Node Pathology, 4th Edition, 2008, Dunphy: Frozen Section Library: Lymph Node, 2012, Jaffe: Hematopathology, 1st Edition, 2010

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