Does the Necrotic Portion of Metastatic Lymphadenopathy from Squamous Cell Carcinoma Still Have Tumoral Oncologic Information? - microRNA Differential Diagnosis of Benign Necrotic Lymphadenopathy

Sep 24, 2026

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Neck necrotic lymph nodes can reflect either metastatic squamous cell carcinoma or benign inflammatory disorders such as Kikuchi disease and tuberculosis, while routine imaging-guided sampling may yield ambiguous results. This study developed a differential diagnostic approach using microRNAs and associated genes by comparing inflammatory necrosis and cancer necrosis derived from FFPE tissue, with tissue microarray separation to enhance partitioning. Differential expression highlighted cancer-related miRNA patterns and pathways, supporting improved cervical metastatic necrotic lymphadenopathy stratification and avoidance of unnecessary excisional biopsies.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages12

Reading Time30 min

AccessFree to download

Introduction

Diagnostic challenge of cervical lymphadenopathy

Role and limitations of imaging and biopsy methods

Study rationale and approach

microRNA targets and gene identification

Tissue separation and RNA analysis

Findings and implications

biomedicines Article Does the Necrotic Portion of Metastatic Lymphadenopathy from Squamous Cell Carcinoma Still Have Tumoral Oncologic Information? Differential Diagnosis of Benign Necrotic Lymphadenopathy Using microRNA Eun Shin 1, Seung Hoon Han 2, Il-Seok Park 2, Jee Hye Wee 3, Joong Seob Lee 3 and Heejin Kim 3, * Citation: Shin, E.; Han, S.H.; Park, I.-S.; Wee, J.H.; Lee, J.S.; Kim, H. Does the Necrotic Portion of Metastatic Lymphadenopathy from Squamous Cell Carcinoma Still Have Tumoral Oncologic Information? Differential Diagnosis of Benign Necrotic Lymphadenopathy Using microRNA. Biomedicines 2023, 11, 2407. [https://](https://)[ ](https://)[doi.org/10.3390/biomedicines11092407](doi.org/10.3390/biomedicines11092407) Academic Editor: Manuela Cabiati Received: 28 July 2023 Revised: 14 August 2023 Accepted: 22 August 2023 Published: 28 August 2023 Copyright: © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ([https://](https://)[ ](https://)[creativecommons.org/licenses/by/](creativecommons.org/licenses/by/)[ ](creativecommons.org/licenses/by/)[4.0/](4.0/)) . 1 Department of Pathology, Dongtan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea; [sea4197@hallym.or.kr](sea4197@hallym.or.kr) 2 Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea; [mip115@hallym.or.kr](mip115@hallym.or.kr) (S.H.H.); [ispark@hallym.or.kr](ispark@hallym.or.kr) (I.-S.P.) 3 Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Sacred Heart Hospital, Anyang 14068, Republic of Korea; [weejh07@hallym.or.kr](weejh07@hallym.or.kr) (J.H.W.); [apniosio@hallym.or.kr](apniosio@hallym.or.kr) (J.S.L.) * [Correspondence: mir5020@hallym.or.kr](Correspondence: mir5020@hallym.or.kr); Tel.: +82-31-380-3849 Abstract: Neck necrotic lymph nodes commonly correspond to metastasis or benign inﬂammatory conditions such as Kikuchi disease and tuberculosis. Ultrasound-guided biopsy can be used for differential diagnosis, but results may be unclear. Therefore, this study aimed to identify target microRNAs (miRNAs) and genes for the differential diagnosis of inﬂammatory and malignant necrotic lymph nodes. We selected six inﬂammatory lymphadenitis formalin-ﬁxed parafﬁn-embedded (FFPE) samples that showed internal necrosis and ﬁve cancer necrotic FFPE samples. Tissue microarray (TMA) was performed to separate the necrotic and cancerous portions. Total RNA was extracted from six pairs of separated inﬂammatory necrosis, ﬁve pairs of cancer necrosis, and cancer portions. Differentially expressed miRNAs were analyzed by comparing inﬂammatory necrosis, cancer, and cancer necrosis. Seventeen miRNAs were upregulated in cancer necrosis compared to inﬂammatory necrosis, and two miRNAs (hsa-miR-155-5p and hsa-miR-146b-5p) showed lower expression in cancer necrotic cells. Nineteen miRNAs that were differentially expressed between inﬂammatory and cancer necrosis were analyzed for target gene expression; these transcripts demonstrated a clear relationship with cancer. The differentially expressed miRNAs in inﬂammatory and tumor necrosis were associated with cancer-related pathways. These preliminary results might help in the differential diagnosis of cervical metastatic necrotic lymphadenopathy and avoiding unnecessary excisional biopsies. Keywords: intranodal necrosis; metastasis; tuberculosis; microRNA; core needle biopsy 1. Introduction The diagnosis of cervical lymphadenopathy (LAP) is challenging for physicians. Imaging studies, such as computed tomography (CT) or ultrasonography (US), are required to make an exact diagnosis. In particular, when necrosis is observed within the enlarged lymph nodes in imaging studies, pathologic conditions such as inﬂammatory disease or tumor inﬁltration must be considered in the d

FAQs

What clinical problem does the study address?

Diagnosing necrotic cervical lymph nodes is difficult because necrosis can occur in both malignancy (e.g., squamous cell carcinoma metastasis) and benign inflammatory diseases such as Kikuchi disease and tuberculosis.

How do the researchers attempt differential diagnosis?

They identify target microRNAs and genes by comparing inflammatory necrotic and cancer necrotic portions, using tissue microarray separation and differential miRNA analysis.

Why might microRNA signatures reduce unnecessary biopsies?

The study reports cancer-associated miRNA expression differences and related pathways that may help distinguish malignant necrosis from benign causes, potentially lowering the need for unnecessary excisional biopsies when biopsy results are unclear.

Sep 24, 2026

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