CODE: 5 - Calcification of pelvic lymph nodes: morphologic curiosity, or a potential symptom of nanobacterial infection?
Article published in Urologia Polska 2006/59/Suplement 1.
Marek Sosnowski 1, Krzysztof W. Zieliński 2, Dorota Snopkowska 2, Dariusz Młoczkowski 2
- 1 I Klinika Urologii Katedry Urologii UM w Łodzi, Uniwersytecki Szpital Kliniczny Nr 2 im. WAM
2 Zakład Patomorfologii i Cytopatologii Klinicznej UM w Łodz
- Introduction. The presence of calcifications in pelvic lymph nodes is a morphologic sign well known to the pathologists, but infrequently analyzed in the literature. According to the scarce information concerning this phenomenon, lymph node calcification is characteristic of lymph nodes located in the ,,aorto-iliac" region and is a secondary process, involving calcification of homogeneous, acidophilic protein material deposited in their stroma. The process has no clinical significance. The aspect that prompted us to address this problem was a hypothesis that the phenomenon may be an indicator of nanobacterial infection, which is more and more widely accepted as a factor inducing pathologic calcifications, especially within the pelvis and the urinary tract.
- Objectives. The aim of the study was to evaluate the presence of nanobacteria in calcitied lymph nodes of the pelvis using immunohistochemical analysis.
- Materials and methods. The study was carried out in a group of 21 men aged 49-79 lat (mean age 63.4) in whom, during radical prostatectomy performed due to prostatic carcinoma, the total of 61 lymph node groups, containing no metastases (right and left retropubic nodes, right and left iliac nodes). The lymph nodes were subjected to routine histopathological investigation and to von Koss staining for calcium salts. The extent of calcifications was assessed independently by three pathologists, according to the following rank score scale: 0 - no calcifications, 2 - small calcifications (of 50-100 um diameter range) scattered throughout the whole lymph node section area, 3 - numerous calcifications, both small and large, located in the whole lymph node. All the assessments of the three pathologists were added and the mean rank of calcification severity was calculated from the total. The obtained data were subjected to statistical analysis.
- Results. Among the examined 61 lymph node groups, calcifications were found in 51 (83.6%), without significant differences between the assessments of the individual pathologists. In all the patients, there was at least one lymph node group more or less affected by calcifications. The mean rank of calcification severity in all the examined lymph nodes was 1.79 with a standard deviation of 0.80. No significant differences in calcification severity in particular lymph node groups were noted. The mean calcification severity for all lymph nodes collected from one patient significantly correlated with his age (Spearman's coefficient R=0.48, p=0.029). The calcification severity score found in lymph nodes of three patients with urolithiasis was, on the average, slightly higher (2.06) than in the remaining 18 patients with no history of urolithiasis (1.74), but the difference did not reach statistical significance (p=0.56).
- Conclusions. The hypothesis concerning the potential role of nanobacteria in calcification of pelvic lymph nodes seems to be supported by the following evidence provided by our observations and literature data: it is a common phenomenon, affecting especially lymph nodes draining the urinary tract organs and slightly more pronounced in lymph nodes of subjects suffering from urolithiasis, there is a significant correlation between the subjects' age and extent of calcifications. The fact that in contrast to the previously studied pathologic lesions, lymph node calcification affects tissue with no pathologic changes and therefore it is not dystrophic calcification, is interesting.