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Image of the Month (2011-4)



Isolated tumour cells and micrometastases



50 year old female - sentinel node biopsy - confirmed carcinoma

The image is dominated by a pericapsular lymphatic containing tumour but immediately beneath and to the right is a small (100 micron) deposit in the subcapsular sinus. "Mouse-over" for a higher powered view.

Isolated tumour cells


Same view of Level 1. Mouse over for a deeper level where the subcapsular deposit (B) now measures 300 microns.

Micrometastasis

This simple set of images illustrates an important practical point that what is present in one section may not be fully representative.

  • In this case the first level showed a tiny tumour deposit in a subcapsular sinus that would have been classified as isolated tumour cells and therefore regarded as node-negative


  • The deeper level shows that in reality the deposit is at least 300 microns and therefore qualifies as a micrometastasis - node-positive


  • This has important therapeutic and prognostic implications



See also Classification of nodal metastases

I am grateful to many colleagues who kindly advised me on this interesting case



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