Morphological hallmarks facilitating distinction of omental milky spots and lymph nodes: An exploratory study on their discriminative capacity

Cindy G. J. Cleypool, Claire Mackaaij, Bernadette Schurink, Ronald L. A. W. Bleys

Research output: Contribution to JournalArticleAcademicpeer-review


Background. Omental milky spots (OMSs) are the primary lymphoid structures of the greater omentum. However, the presence of lymph nodes (LNs) has occasionally been mentioned as well. Understanding which lymphoid structures are present is of significance, especially in gastric tumor metastasis; tumor deposits in omental LNs suggest local lymphatic spread, whereas tumor deposits in OMSs suggest peritoneal spread and hence extensive disease. Since LNs and OMSs share morphological characteristics and OMSs might be wrongly identified as LNs, reliable hallmarks facilitating easy discrimination are needed. Materials and method. A series of microscopic morphological hallmarks unique to LNs were selected as potential candidates and were assessed for their discriminative capacity: 1) capsule, 2) trabeculae, 3) subcapsular sinus, 4) afferent lymphatic vessels, 5) distinct B-and T cell regions, and 6) a layered organization with, from the outside in a capsule, cortex, paracortex, and medulla. These hallmarks were visualized by multiple staining techniques. Results. Hallmarks 1, 2 5 and 6 were shown to be the most efficient as these were consistent and discriminative. They were best visualized by Picrosirius red, smooth muscle actin and a B-cell / T-cell double staining. Conclusion. The presence of a capsule, trabeculae, distinct B-and T-cell regions and a layered organization represent consistent and reliable morphological features which allow to easily distinguish LNs from OMSs, especially when applied in combination.
Original languageEnglish
Pages (from-to)1275-1284
Number of pages10
JournalHistology and histopathology
Issue number11
Publication statusPublished - 2020


  • Greater omentum
  • Lymph nodes
  • Lymphoid tissue
  • Milky spots
  • Omentectomy

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