Limb lymph node response to bone fracture

In previous clinical studies, dilation of afferent lymphatics and enlargement of inguinal lymph nodes (LN) were observed in lymphoscintigrams from patients with persistent posttraumatic edema of lower extremities after fractures and trauma of soft tissues. In this study, changes in rat popliteal and iliac lymph nodes draining lymph from the site of tibial fracture and adjacent soft tissue injury were investigated. The observed parameters were lymph node weight, cell number, phenotype frequency, cell cytokine expression, and reactivity to mitogens. The key observations included: a) increase in the weight and total cell number of the lymph nodes; b) increased autotransformation rate and responsiveness of lymph node cells to mitogen; c) decreased frequency of ED1 macrophages and activated OX8 cytotoxic cells in flow cytometry analysis; d) high expression of OX6 class II-positive, OX7 (stem cells), OX62 (migrating dendritic cells), ED1 (macrophages), and OX12 (B cells) on immunohistochemical sections of LNs with some few HIS48 (granulocytes); e) high expression of NOS3 and TGF beta by lymph node lymphocytes and endothelial cells. In summary, local lymph nodes reacted to internal wounds, such as bone fracture and injury to adjacent tissues, through mobilization of cells from the blood circulation, along with activation of cellular subsets. The molecular mechanism that provides the signal for this reaction remains unknown. The absence of major changes in the frequency of lymph node cell subpopulations indicates that lymph nodes are constitutively prepared for influx of antigens from damaged tissues and react only with increase in cell number and cell activation. The nature of the reaction, including lack of immunization against autoantigens, remains unclear. Further elucidation will require studies on the mechanism of cross-tolerance to self-antigens during wound healing.     

Initial steps in lymph node metastasis formation in an experimental system: possible involvement of recognition by macrophage C-type lectins

 We used histological observations and experiments with fluorescent cell tracers to investigate the roles of tissue macrophages in recognition through a galactose/N-acetylgalactosamine-specific C-type lectin (mMGL) in lymph node metastasis formation by mouse ovarian tumor OV2944-HM-1 (HM-1) cells. Lymph node metastasis from subcutaneous sites was shown to be initiated by the entry of tumor cells into the subcapsular sinus of lymph nodes where mMGL-positive cells were mainly located. To investigate whether mMGL-positive cells contributed to host resistance against lymph node metastasis, we repeatedly treated mice bearing transplanted tumors with an mMGL-blocking monoclonal antibody that was known to inhibit mMGL binding to its ligands. The number of HM-1 cells recovered from lymph nodes 2 weeks after subcutaneous injections was significantly greater when the mice were treated with the blocking anti-mMGL antibody. These results suggested that mMGL-positive macrophages contributed to the host's defense against lymph node metastasis. Received: 30 July 1999 / Accepted: 1 November 1999     

Protein signatures for survival and recurrence in metastatic melanoma

Patients with melanoma metastatic to regional lymph nodes exhibit a range in tumor progression, survival, and treatment. Current approaches to stratify patients with this stage of disease predominantly involve clinical and histological methods. Molecular classification thus far has focused almost exclusively on genetic mutations. In this study, proteomic data from 69 melanoma lymph node metastases and 17 disease free lymph nodes acquired by histology-directed MALDI imaging mass spectrometry were used to classify tumor from control lymph node and to molecularly sub-classify patients with stage III disease. From these data, 12 survival associated protein signals and 3 recurrence associated signals in the acquired mass spectra were combined to generate a multiplex molecular signature to group patients into either poor or favorable groups for recurrence and survival. Proteins represented in the signature include cytochrome c, s100 A6, histone H4, and cleaved forms of thymosin β-4, thymosin β-10, and ubiquitin. In total over 40 protein signals from the tissue were identified.     

PRC2/EED-EZH2 Complex Is Up-Regulated in Breast Cancer Lymph Node Metastasis Compared to Primary Tumor and Correlates with Tumor Proliferation In Situ

Background

Lymph node metastasis is a key event in the progression of breast cancer. Therefore it is important to understand the underlying mechanisms which facilitate regional lymph node metastatic progression.

Methodology/Principal Findings

We performed gene expression profiling of purified tumor cells from human breast tumor and lymph node metastasis. By microarray network analysis, we found an increased expression of polycomb repression complex 2 (PRC2) core subunits EED and EZH2 in lymph node metastatic tumor cells over primary tumor cells which were validated through real-time PCR. Additionally, immunohistochemical (IHC) staining and quantitative image analysis of whole tissue sections showed a significant increase of EZH2 expressing tumor cells in lymph nodes over paired primary breast tumors, which strongly correlated with tumor cell proliferation in situ. We further explored the mechanisms of PRC2 gene up-regulation in metastatic tumor cells and found up-regulation of E2F genes, MYC targets and down-regulation of tumor suppressor gene E-cadherin targets in lymph node metastasis through GSEA analyses. Using IHC, the expression of potential EZH2 target, E-cadherin was examined in paired primary/lymph node samples and was found to be significantly decreased in lymph node metastases over paired primary tumors.

Conclusions/Significance

This study identified an over expression of the epigenetic silencing complex PRC2/EED-EZH2 in breast cancer lymph node metastasis as compared to primary tumor and its positive association with tumor cell proliferation in situ. Concurrently, PRC2 target protein E-cadherin was significant decreased in lymph node metastases, suggesting PRC2 promotes epithelial mesenchymal transition (EMT) in lymph node metastatic process through repression of E-cadherin. These results indicate that epigenetic regulation mediated by PRC2 proteins may provide additional advantage for the outgrowth of metastatic tumor cells in lymph nodes. This opens up epigenetic drug development possibilities for the treatment and prevention of lymph node metastasis in breast cancer.     

Fibroblast-type reticular stromal cells regulate the lymph node vasculature

The lymph node vasculature is essential to immune function, but mechanisms regulating lymph node vascular maintenance and growth are not well understood. Vascular endothelial growth factor (VEGF) is an important mediator of lymph node endothelial cell proliferation in stimulated lymph nodes. It is expressed basally in lymph nodes and up-regulated upon lymph node stimulation, but the identity of VEGF-expressing cells in lymph nodes is not known. We show that, at homeostasis, fibroblast-type reticular stromal cells (FRC) in the T zone and medullary cords are the principal VEGF-expressing cells in lymph nodes and that VEGF plays a role in maintaining endothelial cell proliferation, although peripheral node addressin (PNAd)(+) endothelial cells are less sensitive than PNAd(-) endothelial cells to VEGF blockade. Lymphotoxin beta receptor (LTbetaR) blockade reduces homeostatic VEGF levels and endothelial cell proliferation, and LTbetaR stimulation of murine fibroblast-type cells up-regulates VEGF expression, suggesting that LTbetaR signals on FRC regulate lymph node VEGF levels and, thereby, lymph node endothelial cell proliferation. At the initiation of immune responses, FRC remain the principal VEGF mRNA-expressing cells in lymph nodes, suggesting that FRC may play an important role in regulating vascular growth in stimulated nodes. In stimulated nodes, VEGF regulates the proliferation and expansion of both PNAd(+) and PNAd(-) endothelial cells. Taken together, these data suggest a role for FRC as paracrine regulators of lymph node endothelial cells and suggest that modulation of FRC VEGF expression may be a means to regulate lymph node vascularity and, potentially, immune function.     

Functional morphology of the lymphatic system of the rat uterus during pregnancy

In the regional lymph nodes of the uterus the comparative volume of the paracortical zone significantly increases, especially within the period of the 13th-17th days of pregnancy. In the popliteal lymph node similar effect is not discovered. From the 7th up to the 11th day edema, vasodilatation, infiltration with special leucocytes are revealed. Endothelium of the postcapillary venules is hypertrophied, contains many migrating lymphocytes, which accumulate around the vessels mentioned. The volume of the microcirculatory bed is moderately increased. By the 17th day plasmoblasts, plasmocytes, Motta's cells, monocytes and especially macrophages appear in the paracortical zone. In B-zones and in medullary sinuses blasts, plasma cells, monocytes, macrophages, mitotically deviding cells increase in number. The part of the reticular cells decreases. The tensometric method demonstrates an increasing pressure of lymph in the iliac lymph node at pregnancy. Collateralies appear in the ovarian vein system, in the broad ligament of the uterus, in the lumbar area. The uterine vascular system is supposed to participate in adaptation to pregnancy. In genesis of the regional lymph node changes, discirculatory shifts, predominating during placental organogenesis, combine with phenomena of cell migration and proliferation (clearly revealed by the time when formation of the placenta is completed).     

CCNG2在胃癌中的表达及其临床意义

为检测CCNG2在胃癌中的表达改变,并探讨其变化与胃癌临床参数和预后之间的关系,构建了225例胃癌组织芯片。用免疫组化检测了CCNG2的表达,分析其表达与临床病理参数及胃癌患者预后的关系。免疫组化结果显示,CCNG2在癌旁粘膜中均有表达,而胃癌中的表达率为51.1%(115/225)。CCNG2的表达与肿瘤浸润深度、淋巴结转移、疾病分期以及组织学分化呈负相关。生存分析表明,CCNG2可以是判断胃癌患者预后的独立指标。由此得出结论,CCNG2在胃癌的发生发展过程中起着重要作用,可作为判断胃癌患者预后的指标。     

Pyrogen release in vitro by lymphoid tissues from patients with Hodgkin's disease

The mechanism of fever in patients with Hodgkin''s disease was investigated by examining endogenous pyrogen production by blood, spleen, and lymph node cells incubated in vitro. Blood leucocytes from febrile or afebrile patients with Hodgkin''s disease did not produce pyrogen spontaneously. Spleen cells, however, frequently released pyrogen during initial incubations, unlike spleen cells from patients with non-malignant diseases. Pyrogen production occurred from spleens without observed pathologic infiltrates of Hodgkin''s disease. Lymph nodes involved with Hodgkin''s disease produced pyrogen more frequently than did nodes involved with other diseases. Pyrogen production by tissue cells was prolonged, required protein synthesis, and in some cases was due to mononuclear cells; it did not correlate with fever in the patient. These studies demonstrate spontaneous production of endogenous pyrogen in vitro by lymphoid tissue cells from patients with Hodgkin''s disease.     

Age and features of the construction and cellular composition of superior tracheobronchial lymph nodes in adult humans]

Age peculiarities in composition of the upper tracheobronchial lymph nodes have been studied in 60 corpses at the age of 16-70 years. Cause of death has not been connected with diseases of blood, lymphatic system or thoracic origins. Routine histological and morphometric methods have been applied. Certain age-dependent rearrangement in the connective tissue stroma, trabecular vegetations and differences in correlations of structural components have been noted. A rather essential volumetric increase of the medullary substance takes place at the level of hilus of the lymph node. Cellular composition of the lymph nodes is greatly polymorphous but is more or less constant for each age group. The number of macrophages containing carbon pigment is increasing with age.     

Primary neuroendocrine carcinoma of inguinal lymph node

Ninety-seven percent of neuroendocrine carcinomas are located in the gastrointestinal tract or in the bronchopulmonary tree. Inguinal lymph nodes as the primary tumor site for neuroendocrine carcinoma represent a very unusual location, and have only been described in 2 patient series in the literature. A 64-year-old, previously healthy, Caucasian female presented with a 2-month history of an enlarged inguinal lymph node on the right side. The removed lymph node showed histological and immunohistochemical characteristics of neuroendocrine differentiation (positive for synaptophysin, cytokeratin 20, neuron-specific enolase and chromogranin A). Although extensive investigations including repeated CT and NMR scans, classical endoscopy, wireless capsule endoscopy of the small intestine, octreotide- and MIBG scintigraphy were performed, no other primary tumor was found. Furthermore, there was no evidence of Merkel cell carcinoma on dermatological examinations. A possible explanation for the presence of neuroendocrine carcinomas within the lymph nodes is malignant transformation of preexisting intranodal epithelial nests, which have previously been described in lymph nodes located close to the salivary glands, thyroid gland, breast tissue and pancreas. Since the surgical removal of the affected lymph node, the patient has now been disease-free for 42 months. We therefore consider our case to represent a primary undifferentiated neuroendocrine carcinoma in an inguinal lymph node.     

Ontogeny of human fetal lymph nodes.

Developing lymph nodes from 30 human embryos and fetuses with crown-rump lengths (CRL) of 18 mm (5.6 wk) to 245 mm (26 wk) were examined by light microscopy. The nodes were embedded in araldite, and the sections examined were approximately 1 mu in thickness. The development of nodes was divided into three stages: 1. the lymphatic plexus and connective tissue invagination (30 mm to 67 mm CRL); 2. the early fetal lymph node (43 mm to ,5 mm CRL); and 3. the late fetal lymph node (CRL greater than 75 mm). The lymphatic plexus was formed by connective tissue invaginations and bridges which divided a lymph sac into a meshwork of channels and spaces. Connective tissue invaginations were endothelially-lined and were surrounded by lymphatic space. Reticular cells, macrophages, and blood vessels were found in these invaginations. Early fetal lymph nodes were formed from invaginations when the cellular density and lymphocyte content increased. The lymphatic space surrounding the early node was the developing subcapsular sinus. With further development the early node became packed with lymphocytes, increasing the cellular density and size of the node. The connective tissue surrounding the subcapsular sinus condensed to form the capsule. Afferent lymphatic vessels pierced the capsule. Capillaries, veins, postcapillary venules, and occasional arteries were found in early and late nodes.     

乳腺浸润性导管癌组织中AIB1 与Ki67的表达及临床意义

目的:探讨乳腺浸润性导管癌(IDC)中乳腺癌扩增性抗原1(AIB1)和增殖细胞核抗原(Ki67)蛋白的表达及临床意义。方法:选择2012年6月到2014年6月在我院经病理检查确诊为IDC患者的组织石蜡标本160例,采用链霉素-生物素(SP)免疫组化法检测标本中AIB1和Ki67蛋白的表达,多因素Logistic回归分析二者与IDC临床病理学特征的相关性。结果:AIB1、Ki67的阳性表达率分别为75.63%和80.63%。AIB1、Ki67的表达与淋巴结转移、组织学分级及TNM分期存在相关性(P0.05),且随组织学分级和TNM分期的增高,阳性表达率逐渐增高(P0.05),Ki67的表达水平随肿瘤变大,阳性率逐渐增加(P0.05)。淋巴结阳性组AIB1、Ki67的阳性表达率显著高于淋巴结阴性组(P0.05)。多因素Logistic回归分析显示,AIB1、Ki67的阳性表达是淋巴结转移、病理组织学分级及TNM分期的危险因素(P0.05)。结论:在IDC组织中AIB1和Ki67的阳性表达均增高,二者与IDC临床病理学特征有密切关系。     

Histopathological study on six cases of calf leukosis.

A pathological study was carried out on six calves 4 to 10 months of age affected with lymphoid tumors. Most of the lymph nodes enlarged in consequence of leukotic changes in all the calves. These changes occurred also in other various organs. When the leukotic lesions were investigated to clarify the distribution and histological manifestation, three pathological patterns were discriminated among them. One of the patterns was seen in four cases, in which leukotic lesions were present constantly in bone marrow, thymus, liver and kidney. In the lymph nodes, tonsils, and intestinal lymphatic apparatus, neoplastic cellular proliferation took place in paracortical or interfollicular areas and medullary cords obliterating the lymph follicles. Leukotic involvement was observed in the interstitial and the vascular connective tissue in the thymus, as well as in liver and kidney. A second pattern of lesion was revealed in one of the other two cases. Besides lymph nodes in which neoplastic proliferation was seen in the paracortical area, only the thymus manifested intralobular neoplastic involvement in this case. In the remaining case, the leukotic lesion was characterized by the presence of neoplastic cellular masses resembling large lymph follicles in appearance in the lymphatic tissues. It was manifested distinctly in the spleen. Severe thymic atrophy and granulocytic hyperplasia in bone marrow were present in this case.     

VEGF-C在结肠癌生长及淋巴转移中的作用

目的：通过观察我院收治的结肠癌患者临床诊断资料,探讨分析血管内皮生长因子-C（VEGF-C）在该疾病患者中的生长以及淋巴转移的作用情况。方法：对我院收治的72例结肠癌患者与同期12例癌旁非癌组织患者,采用免疫组化法检测VEGF-C表达情况。结果：结肠癌与癌旁非癌组织患者的VEGF—C的阳性表达率分别为65-3％与8-3％,对比差异显著（P〈O．05）;VEGF．C在结肠癌中的表达与淋巴转移、浸润深度以及TNM分期情况有关（P〈0．05）。结论：结肠癌患者血管内皮生长因子-C（VEGF-C）的阳性表达率高,具体表达的水平高低与患者的淋巴转移、结肠癌浸润深度以及TNM分期有关,值得临床上进一步探讨与研究。     

Identification of Shared Populations of Human Immunodeficiency Virus Type 1 Infecting Microglia and Tissue Macrophages outside the Central Nervous System

Infection of microglia and other cells of the macrophage/monocyte lineage in the central nervous system (CNS) by human immunodeficiency virus type I (HIV-1) underlies the development of giant cell encephalitis (GCE). It is currently unknown whether GCE depends on the emergence of virus populations specifically adapted to replicate in cells of the monocyte/macrophage lineage and whether this also leads to the specific targeting of macrophages in other nonlymphoid tissues. Autopsy samples from lymph node, brain (frontal region), lung, and full-thickness colon sections were obtained from nine study subjects with GCE and from nine without. The two groups showed no significant differences in CD4 counts, disease progression, or treatment history before death. Genetic relatedness between variants recovered from lymph node and nonlymphoid tissues was assessed by sequence comparison of V3 and p17(gag) regions using a newly developed method that scores the sample composition at successive nodes in a neighbor-joining tree. The association index enabled objective, numerical comparisons on the degree of tissue compartmentalization to be made. High proviral loads and p24 antigen expression in the brain were confined to the nine individuals with GCE. GCE was also associated with significantly higher proviral loads in colon samples (median of the GCE(+) group: 1,010 copies/10(6) cells; median of GCE(-) group, 10/10(6) cells; P = 0.006). In contrast, there were no significant differences in proviral load between the GCE(+) and GCE(-) groups in lymph node or lung samples, where HIV infection was manifested predominantly by infiltrates of lymphoid cells. V3 sequences from brain samples of individuals with GCE showed the greatest compartmentalization from those of lymph node, although samples from other tissues, particularly the colon, frequently contained variants phylogenetically related to those found in brain. The existence of shared, distinct populations of HIV specifically distributed in cells of the monocyte/macrophage lineage was further indicated by immunocytochemical detection of CD68(+), multinucleated giant cells expressing p24 antigen in samples of lung and colon in two individuals with GCE. This study provides the basis for future investigation of possible phenotypic similarities that underline the shared distributions of HIV variants infecting microglia and tissue macrophages outside the CNS.     

The fine needle aspiration appearances of Kikuchi's lymphadenitis

Objective:  To describe the fine needle aspiration cytological appearances of Kikuchi's lymphadenitis.
Methods:  Cytological review with histological correlation of all cases of Kikuchi's disease (KD) in which there had been an antecedent fine needle aspirate of the involved lymph node prior to lymph node excision between 2001 and 2006.
Results:  Twelve cases of KD were identified in which cytological and histological material was available. In eight cases the original prospective diagnosis of necrotizing non-granulomatous lymphadenitis consistent with KD had been suggested on the lymph node aspirate. Review of these cytological samples identified abundant extra- and intracellular apoptotic debris – the latter embedded in the cytoplasm of crescentic and phagocytic macrophages, set in a background reactive lymphoid population. Three of 12 cases were initially reported as in keeping with nonspecific reactive lymphadenopathy. Review identified intracellular apoptotic debris but no conspicuous extracellular nuclear debris. One case had originally been reported as possible non-Hodgkin's lymphoma. Histological review of the excised lymph nodes in all 12 cases showed the classical appearances of KD.
Conclusion:  The accurate diagnosis of KD on fine needle aspiration is possible given correct clinical data, an adequately sampled and well-prepared specimen in which the characteristic intra- and extracellular apoptotic nuclear debris with admixed crescentic macrophages are identified on a reactive lymphoid background.     

T-cell mediated suppression in the MRL mouse

MRL/lpr mice possess an autosomal recessive gene, lpr, which is associated with lymphoproliferation and acceleration of autoimmune disease. Lymphoproliferation has been ascribed to a single gene defect predominantly affecting the T-lymphocyte component of the immune system. MRL/++ mice do not possess the lpr autosomal recessive mutation and do not develop early lymphadenopathy. T-lymphocyte functional activity was studied in these mice using the polyclonal T-cell mitogens PHA and Con A. Our results indicated a significant suppression of the spleen and lymph node response of MRL/lpr mice to these polyclonal mitogens as compared to the MRL/++ response noted as early as 6 weeks of age. In addition, there was a progressive decline in the MRL/lpr spleen and lymph node cell mitogenic responses with increasing age. Spleen and lymph node cells from 20-week MRL/lpr mice were also relatively unresponsive in the mixed lymphocyte culture reaction as compared to cells from MRL/ ++ or BALB/c mice. The in vitro proliferative response of the MRL mice was further examined with respect to possible accessory cell modulation by both macrophages and T cells. It was found that in 20-week MRL/lpr lymph nodes a significant degree of suppression of lymphocyte proliferation could be mediated by the MRL/lpr T cell. Increased lymphocyte proliferation to a mitogenic signal could only be demonstrated in those MRL/lpr mice 3 weeks of age.     

Le ganglion sentinelle dans les cancers de la cavité orale : impact clinique et apport de l’imagerie hybride

ObjectivesWe report a prospective evaluation of the sentinel lymph node identification and biopsy in oral cavity cancer in order to assess the additional value of the single photon emission computed tomography-computed tomography (SPECT-CT).Patients and methodsThirteen patients with T1 or T2 clinical N0 oral cavity cancer were prospectively included. They first underwent a lymphoscintigraphy with planar imaging. A SPECT-CT was performed secondly. Finally, excised sentinel lymph nodes were screened according to a specific histological processing.ResultsThe scintigraphic detection rate was 100%, both with planar and SPECT/CT imaging. Dynamic and early images were predictive of the lymph node drainage territory for 11 patients (85%). An impact of SPECT/CT in 83% of cases was achieved with additional quantitative information in 58% cases and qualitative information in 58% cases. A greater sensibility was also pointed out for level 1 sentinel lymph nodes, close to the injection site. Once, an occult metastasis was revealed by the histological analysis of the sentinel lymph nodes.ConclusionRadioisotopic sentinel lymph node technique for oral cavity cancers allowed determining neck node status for all patients. Ninety-two percent of them were spared from a radical neck dissection or radiotherapy. Preoperative detection of sentinel lymph node is optimised in most cases by hybrid imaging procedure. Anatomical data provided by hybrid imaging are useful for surgery.     

Lymphocytic Thyroiditis is Associated with Increased Number of Benign Cervical Nodes and Fewer Central Neck Compartment Metastatic Lymph Nodes in Patients with Differentiated Thyroid Cancer

Objective: Whether or not autoimmune thyroid disease influences the progression of differentiated thyroid cancer (DTC) remains controversial. Findings of previous studies are influenced by lead time bias and/or procedure bias selection. These biases can be reduced by studying a single-institution patient population that underwent a similar extent of surgical resection.Methods: From a cohort of 660 patients with DTC who underwent thyroidectomy, we retrospectively studied 357 patients who underwent total thyroidectomy and central compartment node dissection (CCND) for DTC between 2003 and 2013.Results: Forty-one percent (140/345) of study patients had lymphocytic thyroiditis (LT), and 30% (91/301) had serum positive for thyroglobulin antibody (TgAb). LT was reported in 78% of the TgAb-positive cases. Sixty percent (213/357) of cases had metastatic thyroid carcinoma in 1 or more neck lymph nodes (55% [198/357] central compartment, and 22% [77/356] lateral compartment). Patients with LT had fewer metastatic cervical lymph nodes than those with no LT (2.7 ± 4.7 vs 3.5 ± 4.8, respectively, P = .0285). Patients with positive TgAb and thyroiditis had a larger number of benign cervical lymph nodes removed than those with negative TgAb or no LT. No significant difference was observed in age, tumor size, multifocality, extrathyroidal extension, vascular invasion, or frequency of cervical lymph node metastasis between TgAb-negative and -positive cases or between cases with and without LT.Conclusion: Lymphocytic thyroiditis is associated with fewer central neck compartment metastatic lymph nodes and a larger number of excised reactive benign cervical lymph nodes. Whether this association indicates a protective role of thyroid autoimmunity in lymph node spreading remains unclear.Abbreviations:CCND = central compartment node dissectionDTC = differentiated thyroid cancerHT = Hashimoto thyroiditisLT = lymphocytic thyroiditisTgAb = thyroglobulin antibodyTPO = thyroid peroxidase     

Evaluation of Tumor Cell Proliferation by Ki-67 Expression and Mitotic Count in Lymph Node Metastases from Breast Cancer

Few studies have addressed the risk of recurrence by assessing proliferation markers in lymph node metastasis from breast cancer. Here, we aimed to examine Ki-67 expression and mitotic count in lymph nodes in comparison with primary tumors. A cohort of node positive breast cancer (n = 168) was studied as a part of the prospective Norwegian Breast Cancer Screening Program (1996–2009). The percentage of Ki-67 positivity was counted per 500 tumor cells in hot-spot areas (x630). Mitotic count was conducted in the most cellular and mitotic active areas in 10 high power fields (x400). Our results showed that Ki-67 and mitotic count were significantly correlated between primary tumor and lymph nodes (Spearman`s correlation 0. 56 and 0.46, respectively) and were associated with most of the histologic features of the primary tumor. Univariate survival analysis (log-rank test) showed that high Ki-67 and mitotic count in the primary tumor and lymph node metastasis significantly predicted risk of recurrence. In multivariate analysis, mitotic count in the lymph node metastasis was an independent predictor of tumor recurrence. In conclusion, proliferation markers in lymph node metastases significantly predicted disease free survival in node positive breast cancer.