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PubMed1995

Lymph node metastasis from carcinoma in situ of the penis: a case report.

Lymph node metastasis from carcinoma in situ of the penis is rare. We report a case of carcinoma in situ of the penis that was initially managed with circumcision and topical 5-fluorouracil. Subsequently inguinal and para-aortic lymph node metastasis developed, which was treated successfully with systemic chemotherapy and right inguinal lymph node dissection. The patient is free of disease 7 years after initial diagnosis and 3 years after the diagnosis of nodal metastasis.

Carcinoma in Situ↗

PubMed2004

Prediction of mediastinal lymph node metastasis in medullary thyroid carcinoma.

BACKGROUND: Mediastinal lymph node metastases can be life threatening owing to their proximity to vital organs. Reliable identification of mediastinal metastasis is of utmost importance for timely mediastinal lymph node dissection, although suitable clinicopathological variables for their detection in patients with thyroid cancer have yet to be identified. METHODS: This was an analysis of 83 consecutive patients with radiological suspicion of mediastinal metastasis who underwent trans-sternal mediastinal lymph node dissection for node-positive medullary thyroid carcinoma between November 1994 and March 2003. RESULTS: Univariate analysis revealed that extrathyroidal extension (P < 0.001), distant metastasis (P = 0.001), the preoperative serum calcitonin level (P = 0.001), operation type (P = 0.004), contralateral cervicolateral metastasis (P = 0.016) and bilateral nodal metastasis (P = 0.031) were significantly associated with mediastinal involvement. Only extrathyroidal extension remained significant in a multivariate logistic regression analysis of mediastinal lymph node metastasis. Prediction of mediastinal metastasis by extrathyroidal extension was best at reoperation, with a specificity of 97 per cent and a positive predictive value of 88 per cent. CONCLUSION: Mediastinal lymph node dissection should be considered in patients undergoing reoperation for node-positive medullary thyroid carcinoma who have extrathyroidal extension and cervical lymph node metastases.

Adult↗

PubMed2004

Correlations between lymph node metastasis and depth of submucosal invasion in submucosal invasive colorectal carcinoma: a Japanese collaborative study.

BACKGROUND: Depth of submucosal invasion (SM depth) in submucosal invasive colorectal carcinoma (SICC) is considered an important predictive factor for lymph node metastasis. However, no nationwide reports have clarified the relationship between SM depth and rate of lymph node metastasis. Our aim was to investigate the correlations between lymph node metastasis and SM depth in SICC. METHODS: SM depth was measured for 865 SICCs that were surgically resected at six institutions throughout Japan. For pedunculated SICC, the level 2 line according to Haggitt's classification was used as baseline and the SM depth was measured from this baseline to the deepest portion in the submucosa. When the deepest portion of invasion was limited to above the baseline, the case was defined as a head invasion. For nonpedunculated SICC, when the muscularis mucosae could be identified, the muscularis mucosae was used as baseline and the vertical distance from this line to the deepest portion of invasion represented SM depth. When the muscularis mucosae could not be identified due to carcinomatous invasion, the superficial aspect of the SICC was used as baseline, and the vertical distance from this line to the deepest portion was determined. RESULTS: For pedunculated SICC, rate of lymph node metastasis was 0% in head invasion cases and stalk invasion cases with SM depth <3000 micro m if lymphatic invasion was negative. For nonpedunculated SICC, rate of lymph node metastasis was also 0% if SM depth was <1000 micro m. CONCLUSIONS: These results clarified rates of lymph node metastasis in SICC according to SM depth, and may contribute to defining therapeutic strategies for SICC.

Adult↗

PubMed1984

Mucoepidermoid carcinoma of the bronchus in a 4-year-old child. A high-grade variant with lymph node metastasis.

A high-grade mucoepidermoid carcinoma with lymph node metastasis occurred in the bronchus of a 4-year-old child. The tumor was pedunculated, obstructive, and invasive. Squamous and glandular elements were seen on light and electron microscopic examination. This is a very rare tumor in the pediatric age group. This is the first instance of this lesion associated with metastasis.

Bronchial Neoplasms↗

PubMed2004

Gene-expression profile changes correlated with tumor progression and lymph node metastasis in esophageal cancer.

PURPOSE: The purpose of this research was to identify molecular clues to tumor progression and lymph node metastasis in esophageal cancer and to test their value as predictive markers. EXPERIMENTAL DESIGN: We explored the gene expression profiles in cDNA array data of a 36-tissue training set of esophageal squamous cell carcinoma (ESCC) by using generalized linear model-based regression analysis and a feature subset selection algorithm. By applying the identified optimal feature sets (predictive gene sets), we trained and developed ensemble classifiers consisting of multiple probabilistic neural networks combined with AdaBoosting to predict tumor stages and lymph node metastasis. We validated the classifier abilities with 18 independent cases of ESCC. RESULTS: We identified 71 genes of 1289 cancer-related genes of which the expression correlated with tumor stages. Of the 71 genes, 47 significantly differed between the Tumor-Node-Metastasis pT1/2 and pT3/4 stages. Cell cycle regulators and transcriptional factors possibly promoting the growth of tumor cells were highly expressed in the early stages of ESCC, whereas adhesion molecules and extracellular matrix-related molecules possibly promoting invasiveness increased in the later stages. For lymph node metastasis, we identified 44 genes with predictive values, which included cell adhesion molecules and cell membrane receptors showing higher expression in node-positive cases and cell cycle regulators and intracellular signaling molecules showing higher expression in node-negative cases. The ensemble classifiers trained with the selected features predicted tumor stage and lymph node metastasis in the 18 validation cases with respective accuracies of 94.4% and 88.9%. This demonstrated the reproducibility and predictive value of the identified features. CONCLUSION: We suggest that these characteristic genes will provide useful information for understanding the malignant nature of ESCC as well as information useful for personalizing the treatments.

Algorithms↗

PubMed2003

Prediction of lymph node metastasis by p53, p21(Waf1), and PCNA expression in esophageal cancer patients.

Esophageal cancer is still one of the most widespread diseases, and surgery for esophageal carcinoma is very stressful for patients. Even though lymph node metastasis occurs more frequently in cases of early esophageal cancer than it does in cases of gastric cancer, surgeons prefer to avoid lymph node dissection if possible, thereby subjecting patients to less invasion. Thus, the aim of the present study was to examine the possibility of predicting lymph node metastasis on the basis of tumor location, quantification theory II analysis of tumor expression of genetic markers in primary esophageal cancer. Surgical specimens from 63 patients of esophageal cancer with submucosal invasion were examined for the relationship between tumor location and lymph node metastasis. In 19 of these 63 patients, p53, p21(Waf1, and proliferating cell nuclear antigen (PCNA) were examined immunohistologically, and to quantify the risk of lymph node metastasis, computer analysis was performed on the basis of quantification theory II, in which pathological lymph node metastasis (pN) was the objective variable and "high" or "low" expression of each of the three markers was the predictive variable. Tumors located in the lower third of the esophagus had no lymph node metastasis to the upper mediastinal region, and were thus indicated for trans-hiatal esophagectomy. A coefficient greater than 0.91 predicted node negative disease accurately without false-negative results; false-positive results were obtained for 54.5% of patients with a coefficient less than 0.064. Thus, we found that quantification theory II may be useful when considering indications for surgery without lymph node dissection in some cases of T1 esophageal carcinoma.

Carcinoma↗

PubMed2004

Lymph node metastasis at the splenic hilum in proximal gastric cancer.

We performed splenectomy on patients with macroscopic advanced gastric cancer located at the proximal part of the stomach to achieve complete D2 lymphadenectomy. The aim of this study was to clarify the survival benefit of splenectomy in the treatment of gastric cancer. The clinical records of 225 patients who underwent total gastrectomy with splenectomy for gastric cancers involving the proximal part of the stomach were analyzed retrospectively. Nodal involvement at the splenic hilum (no. 10) was detected in 47 cases (20.9%). All of these cases were macroscopically diagnosed as positive for serosal invasion or regional lymph node metastasis at the time of surgery. In considering the lymphatic pathway from the primary tumor to no. 10 lymph nodes, metastasis at lymph nodes along the lesser curvature (no. 3), the short gastric vessels, or the gastroepiploic vessels (no. 4) may be good indicators of no. 10 lymph node metastasis. The overall survival of 47 patients with positive no. 10 lymph nodes was extremely poor. However, when curative surgery was performed, the survival of no. 10 positive patients was not different from that of no. 10 negative patients. Thus, for patients with advanced gastric cancer located in the proximal part of the stomach, D2 lymphadenectomy with splenectomy is recommended when patients show macroscopic evidence of serosal invaded tumor with regional lymph node metastasis.

Gastrectomy↗

PubMed2002

Extended pelvic lymphadenectomy in patients undergoing radical prostatectomy: high incidence of lymph node metastasis.

PURPOSE: Lymphadenectomy for prostate cancer is limited to obturator and external iliac lymph nodes, although the internal lymph nodes represent the primary landing zone of lymphatic drainage. We performed anatomically adequate extended pelvic lymphadenectomy to assess the incidence of lymph node metastasis in cases of clinically localized prostate cancer. MATERIALS AND METHODS: A total of 103 consecutive patients underwent extended pelvic lymphadenectomy at radical retropubic prostatectomy comprising 9 selective fields, namely the external iliac, internal iliac, obturator and common iliac lymph nodes bilaterally, and the presacral lymph nodes. Histopathological findings were compared with serum prostate specific antigen (PSA), histopathological stage, preoperative biopsy and postoperative prostatectomy Gleason score. Extended pelvic lymphadenectomy was compared with radical retropubic prostatectomy and standard lymphadenectomy in 100 consecutive patients in terms of complications, the number of lymph nodes dissected and operative time. RESULTS: There were no significant differences in age, preoperative PSA or mean biopsy Gleason score in patients who underwent extended pelvic and standard lymphadenectomy. Metastases were diagnosed in 27 of the 103 patients (26.2%) who underwent the extended procedure. A mean of 28 lymph nodes (range 21 to 42) were dissected. Metastases were identified in the internal iliac and presacral regions despite negative obturator lymph nodes. Of the 27 patients 1 to 3 lymph nodes involved with metastasis were detected in 15, 9 and 1, respectively. In 26 of the 27 patients (95.8%) with lymph node metastasis PSA was greater than 10.5 ng./ml. and preoperative biopsy Gleason sum was 7 or greater. A low risk of 2% for lymph node disease was noted in patients with serum PSA less than 10.5 ng./ml. and biopsy Gleason sum less than 7. There were no significant differences in regard to intraoperative and postoperative complications, lymphocele formation or blood loss in the 2 groups. CONCLUSIONS: Extended pelvic lymphadenectomy is associated with a high rate of lymph node metastasis outside of the fields of standard lymphadenectomy in cases of clinically localized prostate cancer. Lymphadenectomy including the internal iliac lymph nodes should be performed in all patients with prostate cancer who are at high risk for lymph node involvement, as indicated by PSA greater than 10.5 ng./ml. and biopsy Gleason sum 7 or greater. In the low risk group pelvic lymphadenectomy can be omitted.

Aged↗

PubMed2006

[Diagnostic value of 18F-fDG Pet/CT in the detection of the cervical lymph nodes metastasis].

OBJECTIVE: To explore the diagnostic value of 18F-FDG PET/CT in the detection of the cervical lymph nodes metastasis. METHOD: According to the pathological result, the data of neck PET, CT, PET/CT of 20 patients with head and neck tumors were analyzed retrospectively. RESULT: The sensitivity, specificity and accuracy of PET, CT and PET/CT in detection cervical lymph nodes metastasis were (92.3%, 85.7%, 90.0%), (77.0%, 57.1%, 70.0%), (92.3%, 100.0%, 95.0%) respectively, the accuracy of PET/CT was better than that of CT alone (P < 0.05) and a little better than that of PET alone. Among 13 cases after irradiation,the correct diagnose was found in seven cases by CT and in 12 cases by PET/CT. Four cases were found with cervical lymph node metastasis in the seven clinical N0 (cN0) patients after functional neck dissection (FND). The preoperative diagnose of PET/CT was completely consistent with the postoperative pathological result. CONCLUSION: 18F-FDG PET/CT is better than CT alone and PET alone for the detection of cervical lymph nodes metastasis, especially for the recurrent tumors. It may be served as the indication of neck dissection in the head and neck cancers.

Adult↗

PubMed1987

Malignant cystosarcoma phyllodes with lymph node metastasis--a case report.

A case of malignant cystosarcoma phyllodes with metastasis in the interpectoral lymph node (Rotter's) is presented in this paper. To the author's best knowledge, this is the first case in Japan on this disease, with lymph node metastasis. Although the surgical management of the disease has not yet been standardized, radical or modified radical mastectomy is thought to be the appropriate procedure.

Biopsy↗

PubMed1989

Lymph node metastasis and retroperitoneal lymphadenectomy in ovarian cancer.

While clinicians are devoting themselves to the study of the behaviour of ovarian cancer as well as to the search for more effective therapeutic modalities, little attention has been paid to an important route of metastasis in this group of diseases: retroperitoneal spread through the lymphatic pathway. The purpose of this report is to present a 5-year experience of a prospective study on lymph node metastasis in patients with ovarian cancer through retroperitoneal lymphadenectomy at the Peking Union Medical College Hospital. From June 1982 through May 1987, retroperitoneal lymph node dissection was performed in 105 cases of ovarian cancer. Seventy-seven (73.3%) were histologically diagnosed as cancer of epithelial origin, and 28 (26.7%) as germ-cell tumours. The overall incidence of retroperitoneal positive nodes was 54.3% (57/105). The incidence of positive pelvic nodes was 46.7% (49/105), and that of positive para-aortic nodes was 37.5% (30/80). In 69 patients who underwent systemic lymphadenectomy, 39 were found to have glandular involvement; in these 39 patients both aortic and pelvic nodes were positive in 19 cases (48.7%), aortic nodes were positive and pelvic nodes negative in 7 cases (18.0%), and pelvic nodes were positive and aortic nodes negative in 13 cases (33.3%). Preoperative lymphography was performed in 30 cases. The positive and negative correspondence rates with the pathological findings were both 83.3%. In 38 cases in which the primary cancer originated in the left ovary, 17 (44.7%) were found to have positive pelvic nodes, whereas in 25 cases with primary cancer arising in the right ovary only 2 (8%) had metastasis of the ipsilateral pelvic nodes. The lymph nodes obtained from 22 patients with positive nodes and sufficient preoperative chemotherapy were carefully examined under the microscope for the effects of the drugs. Some cellular degeneration of the lymph node metastasis was observed in only one of the 15 cases of epithelial cancer, and no response at all was noted in three cases of immature teratoma. Cellular degeneration accompanied by extensive necrosis was demonstrated in the metastatic tumours of the lymph nodes in all four cases of endodermal sinus tumour. Seventy-two patients were followed-up for at least 2 1/2 years. The rate of complete remission was 46.7% (14/30) in patients with negative nodes, but only 33.3% (14/42) in those with positive nodes. However, the difference was not statistically significant.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1990

Regional lymph node metastasis in renal cell carcinoma: incidence, distribution and its relation to other pathological findings.

Extended ipsilateral lymphadenectomy performed on 102 patients with renal cell carcinoma revealed 21 patients (21%) having regional lymph node metastasis. Of the 21 patients, 6 (6%) had single-node metastasis and 15 (15%) multiple-node metastasis. PT, pV, pM, cell type and grade were all correlated with regional node metastasis. The metastatic lymph node foci were distributed along the pathways of normal lymphatic drainage. The recurrence of the disease was correlated with lymph node metastasis, indicating that metastasis is one of the prognostic factors. The very close correlation of node metastasis with vein invasion suggests that removal at least of the ipsilateral lymph node might be necessary when removal of a thrombus in the renal vein or vena cava is indicated.

Carcinoma, Renal Cell↗

PubMed2000

Gastric cancer with extragastric lymph node metastasis: multivariate prognostic study.

BACKGROUND: Although many authors have investigated the prognostic factors of gastric cancer, there are few comprehensive studies on the prognosis of patients with extensive lymph node metastasis. The aim of this study was to clarify the prognostic factors of gastric cancer with extragastric lymph node metastasis, using multivariate analysis.METHODS: The study population consisted of 121 patients who had undergone radical gastrectomy and extended lymph node dissection (D2, D3) for gastric cancer with extragastric lymph node metastasis. We examined 18 clinicopathologic factors, including the type of gastrectomy, tumor size, depth of wall invasion, status of lymph node metastasis, and stage of disease. Survival rates were analyzed by the Kaplan-Meier and Mantel-Cox methods, and multivariate analysis was done using the Cox proportional hazards model.RESULTS: The overall 5-year survival rate was 32%, and the 5-year survival rate after curative gastrectomy was 37%. Overall survival rate was associated with the type of gastrectomy, stage of disease, operative curability, tumor size, depth of wall invasion, and anatomical distribution of positive nodes, whereas the survival rate after curative gastrectomy was correlated with the type of gastrectomy, stage of disease, tumor size, gross type, and depth of wall invasion. Independent prognostic factors were operative curability and depth of wall invasion, and survival after curative gastrectomy was influenced only by the depth of wall invasion (mucosa and submucosa [T1], muscularis and subserosa [T2] vs serosa [T3]).CONCLUSION: In patients with gastric cancer with extragastric lymph node metastasis, independent prognostic factors after gastrectomy were operative curability and depth of wall invasion. Long-term survival can be achieved when the patients have no serosal invasion (T1, T2) and are treated by curative gastrectomy.

Journal Article↗

PubMed1997

Lymph node metastasis and relation to tumor growth potential and local immune response in advanced gastric cancer.

To evaluate the relation between the degree of lymph node metastasis and the growth potential of tumour cells and the local immune function in gastric cancer, we analyzed data on 444 patients with advanced serosally invasive gastric cancer who underwent curative gastrectomy. Tumour growth potential was evaluated based on the value proliferating cell nuclear antigen (PCNA) in the primary tumour, and dendritic cell infiltration into the tumour was determined as an indicator of local immune function. The values of PCNA labeling in the primary tumour increased and the infiltration of dendritic cells into the tumour decreased in relation to the extent of lymph node metastasis. High growth potential and low immune function were seen in cases with n3 lymph node metastasis. There was a reverse relation between the PCNA labeling index and dendritic cell infiltration. A variety of forms of recurrence was noted in patients with lymph node metastasis while the prognosis was less favorable, in relation to the degree of lymph node metastasis. Thus, the potential for nodal spread appears to be associated with the growth potential of tumour cells and with the local immune status of the tumour.

Cell Count↗

PubMed2006

Nitric oxide in papillary thyroid carcinoma: induction of vascular endothelial growth factor D and correlation with lymph node metastasis.

PURPOSE: Vascular endothelial growth factor-D (VEGF-D) plays an important role in lymph node metastasis via lymphangiogenesis in papillary thyroid carcinoma (PTC). Although PTC metastasizes to regional lymph nodes at a high frequency, the regulation of VEGF-D expression is largely unknown. EXPERIMENTAL DESIGN: Nitrite/nitrate levels and VEGF-D production were assessed in K1 papillary thyroid carcinoma cells after induction and/or inhibition of nitric oxide (NO) synthesis. Formation of nitrotyrosine, a biomarker for peroxynitrate formation from NO in vivo, was analyzed in primary human PTC. RESULTS: The production of nitrite/nitrate and VEGF-D in K1 cells was increased by treatment with the NO donor, (Z)-1-[N-(2-aminoethyl)-N-(2-ammonioethyl)amino]diazen-1-ium-1,2-diolate (DETA NONOate). The NO synthase inhibitor N(G)-nitro-l-arginine methyl ester inhibited the increase in nitrate/nitrite and eliminated the increase in VEGF-D. High-grade nitrotyrosine staining was observed in 51.8% (29 of 56) of PTCs. Nitrotyrosine levels were significantly correlated with VEGF-D immunoreactivity and lymph node metastasis. CONCLUSIONS: Our data showed a role for NO in stimulating VEGF-D expression in vitro. The formation of its biomarker, nitrotyrosine, was also correlated with VEGF-D expression in human PTC. NO may induce lymph node metastasis via VEGF-D stimulation in PTC.

Adolescent↗

PubMed2006

CXCR4 expression is associated with lymph-node metastasis of oral squamous cell carcinoma.

The support mechanisms that are involved in lymph-node metastasis of oral squamous cell carcinoma (OSCC) remain largely unknown. Recent studies have demonstrated that tumor cells express chemokine receptors and use chemokines to metastasize to the target organ in many malignancies in humans. In this study, we examined the expression and function of chemokines and their receptors in OSCC. The expression of chemokine receptors was assessed in eight OSCC cell lines. CXCR3 mRNA and protein were expressed in all the OSCC cell lines examined, while CXCR4 mRNA and protein were expressed only in HSC2, HSC3, and Ca9-22 cells. Treatment with the ligand for CXCR4, stromal cell-derived factor-1 (SDF-1), enhanced the motility and invasiveness of OSCC cells expressing CXCR4. However, the CXCR3 ligand, Mig, did not affect the migration or invasiveness of CXCR3-positive cells. We also evaluated the clinical significance of CXCR4 expression immunohistochemically. CXCR4 expression was detected in 27 (30%) of the 90 OSCC tissues tested, and was localized in the membrane and cytoplasm of cancer cells. There was a highly significant correlation between CXCR4 expression and lymph-node metastasis (P=0.0035). Collectively, these findings suggest that CXCR4 might be involved in the lymph-node metastasis of OSCC.

Carcinoma, Squamous Cell↗

PubMed2006

Gene expression pattern in oral cancer cervical lymph node metastasis.

Treatment protocols for malignant tumors in the oral cavity differ greatly based on the presence of cervical lymph node metastasis. We applied gene expression profiling to the pathological lymph node status and used a training-test approach to evaluate the reliability of cDNA microarray-based classifications of 15 matched resected primary oral squamous cell carcinomas (OSCCs) and corresponding normal oral tissues. The clustering of all the microarray data was separated into two groups based on metastatic node positivity and node negativity. Furthermore, a 20-gene signature was identified that differentiated the testing set (n=8) with high classification accuracy (88%). Our findings support the hypothesis that the lymph node metastasis status can be predicted using the gene expression patterns of the primary OSCC, and may be a powerful tool in identifying patients at high risk of lymph node metastasis.

Aged↗

PubMed2007

Significance of lymphatic invasion on regional lymph node metastasis in early gastric cancer using LYVE-1 immunohistochemical analysis.

It has been reported that lymphatic invasion is a predictor for lymph node metastasis in early gastric cancer (EGC); however, it has been impossible to differentiate between lymphatic invasion and blood vessel invasion using current staining techniques. We studied the significance of lymphatic invasion on regional lymph node metastasis in EGC by using human lymphatic vessel endothelial hyaluronan receptor-1 (LYVE-1) antibody, specific to lymphatic vessels, and von Willebrand factor (vWF) antibody, specific to the blood vessels, to clearly distinguish these vascular tissues.EGC tissues were obtained from 66 node-positive and 66 node-negative subjects and were matched by age and sex. These tissues were immunostained with antibodies against LYVE-1 and vWF. Multivariate logistic regression analysis demonstrated that lymphatic invasion was a significant independent predictor for regional lymph node metastasis (odds ratio, 4.667; P = .0094), whereas blood vessel invasion was not. Thus, lymphatic invasion identified by LYVE-1 antibody could predict the existence of regional lymph node metastasis in EGC.

Biomarkers, Tumor↗