Hilar lymph nodes

Regional node(s) cannot be assessed No regional lymph node metastasis Metastasis in the cystic ducts, pericholedochal lymph nodes, and/or hilar lymph nodes (i.e., in the hepatoduodenal ligament) Metastasis in the peripancreatic (head only), periduodenal, periportal, celiac, superior mesenteric, and/or posterior pancreaticoduodenal lymph nodes... 

Although several animal studies have found histological alterations in the lymphoreticular system, in particular granulomas in the hilar lymph nodes, these effects are secondary to the pulmonary effects (Steinhagen et al. 1978 Thomson et al. 1986) and resulted from the removal of aluminum from the lungs by alveolar macrophages. 

Roggli VL, Benning TL. 1990. Asbestos bodies in pulmonary Hilar lymph nodes. Modem Pathol 3 513-517. 

The tuberculous primary complex in the liver with caseation of the associated hepatic hilar lymph nodes may become the source of spread causing early systemic generalization. Given the clinical picture of a coarse-nodular or a miliary tuberculosis, this may result in the death of the newborn child. 

Caroli-Bosc, F.-X., Conio, M., Maes, B., Chevallier, P., Hastier, P., Del-mont, J.-P. Abdominal tuberculosis involving hepatic hilar lymph nodes. X. Clin. Gastroenterol. 1997 25 541-543... 

No No regional lymph node involvement N, Metastasis in ipsilateral peribronchial and/or ipsilateral hilar lymph node(s), including direct extension N2 Metastasis in ipsilateral mediastinal and/or subcarinal lymph node(s)... 

Yanez-Diaz et al. (1992) presented two male patients with SSc and pulmonary silicosis after occupational exposure to silica, and one of them to trichloroethylene as a degreasing agent. The clinical and analytical findings could not be distinguished from those present in idiopathic SSc except the chest X-ray with interstitial images featuring calcified hilar lymph nodes suggestive of pulmonary silicosis. 

The hilar lymph nodes, which are encountered within the lung at the bifurcations of the large bronchi, are complete nodes with a subcapsular sinus and follicles. From the hilar nodes, the lymph drains via extensively anastomosing channels through tracheobronchial lymph nodes clustered alongside the main stem bronchi, beneath the Carina, and along the course of the trachea. In the me-... 

Fig. 202. Simple pneumoconiosis dust focus with central vessel cut obliquely. Soft coal miner from the Rhondda valley aged 36 years who had worked underground for 16 years. Cause of death acute myelitis. Post-mortem (Prof Gough, Cardiff) additionally showed pneumoconiosis and enlarged tuberculous hilar lymph nodes. Fixed in formalin. Paraffin section impregnated with silver. Eyepiece Leitz Periplan 4X objective Leitz 12/0.30, 16 mm apochromat. (from Schiller 1954)...

Fig. 349. Autopsy specimen (Duisburg A. 64/61) of a magno-cellular pulmonary carcinoma of the right lower lobe with metastases to the hilar lymph nodes. Micronodular silicotu-berculosis with marked emphysema. Patient (born in 1902) worked from luly 1, 1922 to November 1, 1959 as a trimmer...

The chest can be involved in sarcoidosis in many ways, and because of the multitude of potentially different findings, sarcoidosis can be regarded as one of the great mimickers in thoracic radiology. The most common intrathoracic manifestation of sarcoidosis is the presence of mediastinal lymphadenopathy with usually bilateral and rather symmetric involvement of hilar lymph nodes. They can calcify in chronic disease... 

Other rare vascular complications of sarcoidosis (limited to a few case reports) include pulmonary arterial stenoses from granulomatous involvement of the vessels, extrinsic compression of pulmonary arteries by enlarged hilar lymph nodes or fibrosing mediastinitis (6), pulmonary veno-occlusive disease (resulting from obstruction of interlobular septa veins by granulomata or perivascular... 

Fig. 5.3a,b. A 67-year-old old retired tunnel worker, a Posterior-anterior (PA) chest radiograph obtained in 2000 showing small nodules predominantly on the upper lobe. The nodule size and profusion are p/p and i respectively, b PA chest radiograph obtained in 2004 show progression in the profusion of the nodules from 1/1 to 2/2. There is also more prominent egg-shell calcification of enlarged hilar lymph nodes (arrows)... 

Lymph node involvement in silicosis reflects the pathogenesis of the disease, and hilar lymphadenop-athy on the chest radiograph is therefore common. Eggshell calcification of lymph nodes has become synonymous with silicosis, since they were first described over half a century ago and are mainly referable to the hilar lymph nodes (Fig. 5.3), although abdominal lymph nodes have also been described as bearing eggshell calcification (Jacobson et al. 1967 Jacobs et al. 1956 Gross et al. 1980). Its presence in coal and metal miners has been attributed to the concomitant exposure to silica (Jacobson et al. 1967). 

Cheng SJ, MA Y, Pan YX (1993) A study on the diagnosis of pulmonary tuberculosis and silicotuberculosis by PCR. Zhonghua Jie He He Hu Xi Za Zhi 16 221-224 Chiyotani K, Saito K, Okubo T et al (1990) Lung cancer risk among pneumoconiosis patients in Japan, with special reference to silicotics. lARC Sci PubI 97 95-104 Corry D, Kulkarni P, Lipscomb MF (1984) The migration of bronchoalveolar macrophages into hilar lymph nodes. Am J Pathol 115 321-328... 

Enlarged mediastinal and hilar lymph nodes are often seen in coal miners, especially when large areas of PMF are also present (Seal et al. 1986) (Fig. 6.14). Enlarged lymph nodes can be found in all mediastinal sites, but the internal mammary and superior diaphragmatic nodes are less frequently involved. Necrosis can occur, but a typical feature of these lymph nodes is eggshell calcification, although punctuate or massive calcification may also occur (Remy-Jardin et al. 1992 Webb et al. 2001) (Fig. 6.14). 

Fig.6.14a,b. Coal worker s pneumoconiosis computed tomography scan showing enlarged mediastinal and hilar lymph nodes, a Axial view with slice thickness of 5 mm. b Coronal reconstruction with slice thickness of 3 mm. A typical feature of the enlarged lymph nodes is eggshell calcification (arrows)... 

N1 Metastases in ipsilateral bronchopulmonary or hilar lymph nodes... 

Pulmonary metastases from mesothelioma can either manifest as nodules or masses. Less commonly, miliary nodules can be seen on CT. The most important differential diagnosis of such lesions is pleural metastases from other origins (Fig. 9.8). Rarely, CT may also show extrathoracic spread of mesothelioma, for example, direct invasion of the liver or extension to the retroperitoneum and the retrocrural spaces (Kawashima and Libshitz 1990). At autopsy, metastasis to the mediastinal and hilar lymph nodes is present in 40-45% of patients with mesothelioma (Huncharek and Smith 1988) (Fig. 9.9). 

Lymphatic metastases in HCC are not common. They are seen in no more than 10-15% even in autopsy cases, especially in the hepatic hilar lymph nodes (Bartolozzi and Lencioni 1999). Extrahepatic hematogenous metastases are usually associated with advanced-stage tumors. The lung is the most common site of metastases, followed by the bone and the adrenal gland. CT is valuable for the diagnosis of adenopathies and distant metastatic disease, except for bone metastases. Assessment of tumor spread in selected patients (i.e. candidates for liver transplantation, inclusion in therapeutic trials) may therefore require thin section spiral CT of the chest and bone scintigraphy. 

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