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PubMed1998

Primary cutaneous adenoid cystic carcinoma with lymph node metastasis.

We report on a case of primary cutaneous adenoid cystic carcinoma with local recurrence and lymph node metastasis. The patient was a 52-year-old Japanese woman. The initial cutaneous lesion was a skin-colored, centrally elevated, thumb-sized nodule with hair loss on the scalp in the right side of the parietal region. Three and half years after the initial combined treatment consisting of surgery and irradiation, a recurrent nodule on the left side of the parietal region of the scalp and a lymph node metastasis with perinodal tissue involvement in the left retroauricular area were discovered. In the literature on primary cutaneous adenoid cystic carcinoma, the average age in the 37 cases reported, including the present case, is 58.1 years, and 23 of the patients are women. Thirty-two percent of the carcinomas (12 cases) occur on the scalp and 16% (6 cases) on the breast. The average size of the tumors in the 24 documented cases is 3.2 cm. The local recurrence rate is 51% (19 cases). Distant metastasis to the lungs and pleura are recorded in three cases. Lymph node metastasis is recorded only in two cases including the present case. Multiple modalities including surgery, irradiation, and chemotherapy should be used for this locally aggressive and potentially metastasizing carcinoma.

Adolescent↗

PubMed2003

Expression of vascular endothelial growth factor-C predicts regional lymph node metastasis in early oral squamous cell carcinoma.

The purpose of this study was to investigate the association of the expression of vascular endothelial growth factor-C (VEGF-C) with regional lymph node metastasis in oral squamous cell carcinoma (OSCC). The expression of VEGF-C in biopsy specimens obtained from 62 patients with OSCC was examined by immunohistochemistry. In the early stages of T1 and T2 (38 cases), VEGF-C expression strongly correlated with lymph node metastasis (P < 0.001), and the percentage of VEGF-C-positive staining was 88.2% for patients with lymph node metastasis (15 of 17 cases) and 28.6% for those without lymph node metastasis (6 of 21 cases). However, in the advanced stages of T3 and T4, no significant correlation between VEGF-C expression and lymph node metastasis was observed. These results indicate that VEGF-C expression in biopsy specimens can be used as a reliable predictor of regional lymph node metastasis, particularly in early OSCC, and may become an important factor in the selection of appropriate treatment.

Aged↗

PubMed2005

Para-aortic lymph node metastasis in carcinoma of the head of the pancreas.

BACKGROUND: Metastasis to para-aortic lymph nodes often occurs in pancreatic head cancer, but factors that predict it are not well known. METHODS: Using histopathologic data of 178 patients who underwent extended lymph node dissection for pancreatic head cancer, we analyzed the distribution of metastases to lymph node groups classified in detail and attempted to identify the lymph node groups that have a strong relation with metastasis to para-aortic lymph nodes. RESULTS: A high incidence of lymph node metastasis was found in para-aortic lymph nodes (No. 16, 19%) as well as in regional lymph nodes, such as those on the posterior aspect of the pancreas head (No. 13, 47%), on the anterior surface of the pancreas head (No. 17, 29%), along the superior mesenteric artery (No. 14, 28%), and along the hepatoduodenal ligament (No. 12, 19%). Statistical analysis showed that metastases to para-aortic lymph nodes had a strong correlation with metastases to Nos. 12, 13, 14, and 17 lymph nodes. Para-aortic lymph node metastases were seldom observed among the patients who had no metastases to Nos.13, 14, and 17 lymph nodes. CONCLUSIONS: Examination of Nos. 13, 14, and 17 lymph nodes may be useful to predict the involvement of para-aortic lymph nodes.

Adult↗

PubMed2006

[Correlation between the expression of HER-2/neu, nm23 protein and local invasion and lymph node metastasis of human LSCC].

OBJECTIVE: To explore the relationship between the expressions of HER-2/neu, nm23 protein and local invasion and lymp node metastasis of LSCC. METHOD: The expression of HER-2/neu, nm23 protein was detected by immunohistochemical technique in 56 patients with human LSCC. RESULT: The positive expression rate of HER-2/neu protein in LSCC was not correlated with histological grade (P > 0.05). There was a significant relationship between the expression of HER-2/neu and the clinical stages, lymph node metastasis (P < 0.05, P < 0.01). The positive expression rate of nm23 protein was significantly higher in the group without lymph node metastasis than those with lymph node metastasis (P < 0.01). The negative correlation was found between the nm23 expression and lymph node metastasis of LSCC. Furthermore, the negative correlation was found between the positive expression of HER-2/neu protein and the positive expression of nm23 protein in the group with lymph node metastasis. CONCLUSION: The abnormal expression of HER-2/neu, nm23 protein play an important role in development and lymph node metastasis of LSCC.

Adult↗

PubMed1995

[Histopathological and immunohistochemical evaluation of lymph node metastasis in superficial esophageal cancer--with reference to the expression of E-cadherin and alpha-catenin].

We compared node-negative patients (13 cases) with node-positive patients (17 cases) with submucosal cancer of the esophagus, to assess the relationship between clinicopathological factors and lymph node metastasis. We also investigated the expression of E-cadherin, an intercellular adhesion molecule (27 cases), and alpha-catenin, an undercoat protein of adherence junction (16 cases) by immunohistochemical staining to evaluate the association between intercellular adhesiveness and lymph node metastasis in superficial esophageal cancer. There was no significant difference between the node-negative and node-positive groups in other clinicopathological factors and tumor size, while the frequency of lymphatic invasion in the node-positive group was statistically higher than that in the node-negative group (p < 0.05). The frequency of lymph node metastasis in 14 cases with preserved expression of E-cadherin was significantly lower than that in 13 cases with reduced or negative expression (7.1% vs. 46.2%: p < 0.05). Moreover, all three patients with negative expression of alpha-catenin had lymph node metastasis, while only one of 13 patients with preserved or reduced expression of alpha-catenin had lymph node metastasis (100% vs. 7.7%: p < 0.01). In conclusion, we have found that the evaluation of both E-cadherin and alpha-catenin expression might be of great value in predicting lymph node metastasis in superficial esophageal cancer.

Adult↗

PubMed2006

Predicting regional lymph node metastasis in Chinese patients with penile squamous cell carcinoma: the role of histopathological classification, tumor stage and depth of invasion.

PURPOSE: We determined whether histological factors of primary penile squamous cell carcinoma could predict the risk of regional lymph node metastasis. MATERIALS AND METHODS: The clinical records of 72 consecutive Chinese patients with squamous cell carcinoma of the penis were analyzed retrospectively. Of the patients 58 underwent bilateral inguinal lymph node dissection, of whom 9 also underwent unilateral or bilateral pelvic lymph node dissection. Primary lesions were evaluated according to recently revised standards. The variables recorded were histopathological classification, histological grade, pathological tumor stage, invasion depth, vascular invasion, and the number and position of metastatic lymph nodes. RESULTS: No patients with verrucous carcinoma had regional lymph node metastasis. However, 100% of patients with basaloid, 33.3% with warty and 30% with typical squamous cell carcinoma had lymph node metastasis (p = 0.002). The rate of lymph node metastasis was 18.8% in patients with pT1, as compared with 53.1% in patients with pT2 or pT3 (p = 0.004). The mean depth of invasion was 9.3 (range 2 to 22) vs 3.2 mm (range 1 to 6) in patients with and without lymph node metastasis, respectively (p < 0.001). CONCLUSIONS: Histopathological classification, pathological tumor stage and depth of invasion of the primary lesion are significant predictors of regional lymph node metastasis in Chinese patients with penile squamous cell carcinoma. Combining these predictors can be used to select patients who are the best candidates for regional lymphadenectomy.

Adult↗

PubMed1997

Early gastric cancer and lymph node metastasis.

A total of 1,845 cases of gastric cancer have been resected in our hospital during the past 18 years. Of these, 764 cases (41.5%) were early gastric cancer. The rate of lymph node metastasis was 2% in early mucosal cancer and 19.4% in early submucosal cancer (p < 0.001). In the cases of early mucosal cancer, the rate of lymph node metastasis was 0.9% for the elevated type and 2.4% for the depressed type. In the cases of early submucosal cancer, the rate of lymph node metastasis was 25.3% for the elevated type and 17.3% for the depressed type. In the mucosal cancers the rate of lymph node metastasis was high in the 0-IIc and IIc + III macroscopic type, and in the poorly differentiated microscopic type. In the submucosal cancers the rate of lymph node metastasis was 40% in mucinous adenocarcinoma and 33% in papillary adenocarcinoma. There was no lymph node metastasis in any case of early gastric cancer smaller than 1 cm surface diameter.

Adult↗

PubMedDate not supplied

Intra-operative diagnosis of N2 lymph node metastasis of gastric cancer.

BACKGROUND/AIMS: Limited lymph node dissection for gastric cancer, which is prevalent in Western countries, leaves cancer cells in the second tier of nodes in patients who have metastasis in those nodes. It is, however, difficult to correctly diagnose nodal status during surgery. The present study was, therefore, designed to examine how to detect N2 metastasis intra-operatively. METHODOLOGY: Five hundred and eight patients undergoing extended lymph node dissections for gastric cancer were retrospectively analyzed. Accuracy of the intraoperative diagnosis of node involvement based on macroscopic findings was investigated, according to the N stage and histological type of the tumor. Furthermore, the distributions of N2 metastasis were clarified, according to tumor site. RESULTS: Intra-operative macroscopic findings were frequently assessed as being less severe than histological findings in cases with N2 metastasis (61.9%, 39/63). Intra-operative recognition of N2 metastasis was significantly lower in the cases with undifferentiated adenocarcinoma (28.2%, 11/39) than in those with differentiated adenocarcinoma (56.5%, 13/23). The distributions of N2 metastasis revealed nodes along the left gastric and common hepatic arteries to be the key junctions for lymphatic flow from the middle and lower thirds of the stomach, respectively. CONCLUSIONS: Intra-operative diagnosis of N2 metastasis is difficult to make based on macroscopic findings, especially in undifferentiated tumors. To detect N2 metastasis intra-operatively, the nodes along the left gastric or common hepatic artery should be submitted to frozen section examination for primary tumors located in the middle or lower third of the stomach, respectively.

Adenocarcinoma↗

PubMed1989

[Meibomian gland adenocarcinoma with regional lymph node metastasis].

Meibomian gland carcinoma of the eyelid is a common neoplasm which clinically simulates a benign condition of chalazion. Although growing slowly, metastasis to regional lymph nodes is frequent, at a rate of 17-28% in this country. Eleven (11) cases of Meibomian gland carcinoma with regional lymph node metastasis are reported, and the therapeutic modalities have been tailored to suit the individual cases, including full-thickness local excision, orbital exenteration, radical cervical dissection, and superficial parotidectomy.

Adult↗

PubMed2004

[Retroperitoneal lymph node metastasis in epithelial cancer of the ovary: a report of 58 cases].

OBJECTIVE: To analyze the retroperitoneal lymph node metastasis in epithelial cancer of the ovary and offer scientific indications for lymph node radical dissection. METHODS: Fifty-eight patients with ovarian cancer treated from January 1990 to December 2000 were retrospectively reviewed. Single-factor and multifactor analysis with Logistic regression model were performed by SPSS 10.0 statistic software. RESULTS: The metastasis rates of overall lymph nodes, pelvic nodes and para-aortic nodes were 48.3%, 37.9% and 25.9% respectively, among which no significant difference was noted (P > 0.05). Single-factor analysis showed that tumor location, ascitic condition, clinical stage and the size of residual tumor were associated with retroperitoneal lymph node metastasis. Multifactor analysis revealed that clinical stage and size of residual tumor were independent risk factors for metastasis of retroperitoneal lymph nodes. CONCLUSION: For early ovarian cancer patients, it is extremely important to perform radical dissection of the retroperitoneal lymph nodes. For advanced or residual lesions, radical dissection of pelvic nodes and para-aortic nodes could be considered in the second exploration.

Adult↗

PubMed2002

[A case report of primary hepatic carcinoid with lymph node metastasis--treatment of hepatic arterial infusion to post-reoperative liver and radiation to metastasis of para-aortic lymph nodes].

We report a case of primary liver carcinoid. A 50-year-old woman had undergone left nephrectomy six years earlier for renal cell carcinoma. She developed abdominal pain. CT scans showed a low-density area in the lateral segment of the liver and lymph node swelling to the left of the abdominal aorta. Angiography showed a hypovascular tumor. After lateral segmentectomy and examination of the gastrointestinal tract, we diagnosed primary liver carcinoid. Unfortunately, the tumor recurred at multiple sites in the residual liver about 9 months after the first operation. She underwent further liver resection and microwave coagulation therapy. At that time, lymph node biopsy confirmed metastatic carcinoid. We began hepatic arterial chemotherapy for the residual liver and radiation therapy for the para-aortic lymph nodes (total 45 Gy). During chemotherapy, no recurrence was seen. At 11 months after reoperation, however, multiple liver metastases occurred with severe liver dysfunction and jaundice. She died about 24 months after the first liver resection.

Carcinoid Tumor↗

PubMed1991

Retroperitoneal schwannoma mimicking lymph node metastasis of seminoma.

We report a case of retroperitoneal schwannoma mimicking lymph node metastasis. A 32-year-old man presented with an intrascrotal mass, and underwent radical orchiectomy. Histological examination revealed a typical seminoma of the testis. Systemic work-up for staging demonstrated a retroperitoneal mass, which was located in the supra-hilar inter-aortocaval region. Under the diagnosis of retroperitoneal metastasis of the seminoma, he underwent three courses of cisplatin, vinblastine, and bleomycin (PVB) therapy. Persistence of the tumor after the chemotherapy led to retroperitoneal lymphadenectomy, histological examination then revealing a benign schwannoma. The location of the tumor and its unresponsiveness to chemotherapy might be useful indicators for differentiating lymph node metastasis of seminoma from primary tumors of other origin.

Adult↗

PubMed2004

Endosonographic detection of mediastinal lymph node metastasis in superficial carcinoma of the esophagus: assessment by type classification and histogram.

BACKGROUND: Endoscopic ultrasonography (EUS) has been shown to be useful for detecting lymph node metastasis in esophageal cancer. The evaluation of nodal metastasis requires both objective and subjective analyses. In the present study, mediastinal lymph nodes in superficial esophageal carcinoma (SEC) were examined by both EUS appearance and histography, using NIH image software. METHODS: One hundred and seventy-one lymph nodes of 56 patients with SEC were detected by EUS. These lymph nodes were diagnosed by type classification, based on boundary and internal echo, and by the construction of internal echo histograms using NIH image software. The results were compared with the histological findings. RESULTS: . The sensitivity, specificity, and accuracy in assessing mediastinal lymph node metastasis by type classification were 83.3%, 88.2%, and 87.7%, respectively. The mean and SD of the histogram correlated well with histological findings and type classification ( P < 0.0001). All lymph nodes with a mean value of less than 185 of the histogram were negative nodes. When positive nodes by type classification were reevaluated according to the threshold value of 185 using the histogram, the sensitivity, specificity, and accuracy improved to 83.3%, 100%, and 98.2%, respectively. CONCLUSIONS: Type classification assisted by histography improved the diagnostic accuracy of mediastinal lymph node metastasis in SEC.

Carcinoma, Squamous Cell↗

PubMedDate not supplied

Expression of E-cadherin, beta-catenin, CD44s and CD44v6 in gastric adenocarcinoma: relationship with lymph node metastasis.

BACKGROUND: The aim of this study was to examine the expression of E-cadherin, beta-catenin, CD44s and CD44v6 in gastric adenocarcinoma and to investigate whether these proteins are objective in markers in predicting the lymph node metastasis. MATERIALS AND METHODS: In 99 cases of gastric adenocarcinoma, the expressions of E-cadherin, beta-catenin, CD44s and CD44v6 were studied by immunohistochemistry. RESULTS: The expressions of E-cadherin and beta-catenin were significantly associated with histological type, but not with tumor progression and lymph node metastasis. In contrast, the expressions of CD44s and CD44v6 showed significant relationships with lymphovascular invasion, TNM stage, p53 expression, high Ki-67 LIs and lymph node metastasis. Under univariate analysis, the diffuse-type of Lauren classification, CD44s expression, CD44v6 expression and p53 expression were predictive of lymph node metastasis. By multivariate analysis, diffuse-type and p53 expression were independent factors of lymph node metastasis; among the CAMs investigated, only CD44v6 expression was a significant risk factor related to lymph node metastasis in the advanced carcinoma group. CONCLUSION: Expressions of CD44s and CD44v6 play an important role in tumor progression; especially, CD44v6 expression may be a useful predictor of lymph node metastasis, while the expressions of E-cadherin and beta-catenin complex are more probably related to tumor morphology than to tumor progression.

Adenocarcinoma↗

PubMed2006

[Evaluation of the ultrasonographic features of axillary lymph node metastasis in breast cancer].

OBJECTIVE: To analyze the ultrasonographic features of axillary lymph node metastasis in breast cancer patients, and to evaluate the accuracy of these features by Receiver Operating Characteristic (ROC) curve. METHODS: Ultrasonography was carried out in 113 patients (mean age 56.5 yr, range 29 - 77 yr). The ultrasonographic features of the primary tumor and the axillary lymph node were observed. Univariate analysis was performed by Chi-squared test and Fisher exact test, and multivariate analysis to determine independent significant individual variables by multiple logistic regression analysis. ROC curve analysis was done to determine the sensitivity and specificity of individual and combined ultrasonographic features in distinguishing metastatic lymph node from the normal one. RESULTS: The primary tumor size, abundance of blood supply in the primary tumor, longitudinal-transverse diameter ratio, cortex-hilum thickness ratio (on the longitudinal section), abnormal cortex thickness, distribution of intra-nodal vascularity of axillary lymph nodes were found to be statistically significant factors by univariate analysis. The primary tumor size, longitudinal-transverse ratio and cortex-hilum thickness ratio of lymph node were proved to be significant independent predictors of axillary lymph node metastasis by logistic regression analysis. Through ROC analysis, the combination of these independent ultrasonographic feature predictors was found to contribute significantly in differentiating metastatic lymph node from the normal with a sensitivity of 88.6% and specificity of 84.5%. CONCLUSION: Axillary ultrasonography is helpful in staging the axillary lymph node in breast cancer patient. The primary tumor size, longitudinal-transverse diameter ratio and cortex-hilum thickness ratio of lymph node are the main features to determine whether metastatic involvement is present or not.

Adult↗

PubMed2005

Volumetric MR imaging of oral, maxillary sinus, oropharyngeal, and hypopharyngeal cancers: correlation between tumor volume and lymph node metastasis.

BACKGROUND AND PURPOSE: The size of the primary lesion and the lymph node metastasis are critical indicators for the patient prognosis. Here we attempted to assess the correlation between these 2 prognostic parameters in patients with oropharyngeal, hypopharyngeal, oral, or maxillary sinus cancer. METHODS: We retrospectively studied 66 patients with oropharyngeal or hypopharyngeal (n = 24), oral (n = 35), or maxillary sinus (n = 7) cancer. Of these patients, 25 (10 with oral or maxillary sinus and 15 with pharyngeal cancers) had lymph node metastases. We measured the volumes of the primary lesions as sums of gadolinium-enhanced areas on fat-suppressed, spectral presaturation with inversion recovery (SPIR) T1-weighted images. Histologically confirmed metastatic nodes were mapped to the neck levels. RESULTS: The tumor volumes were well correlated with the clinical T-category for the primary lesions in oral, maxillary sinus, and oropharyngeal and hypopharyngeal cancers. The volumes of the oropharyngeal and hypopharyngeal cancers were significantly greater (P < .05) in patients with metastatic nodes than in patients without metastasis, whereas there was no significant correlation between the tumor volume and nodal metastasis in patients with oral or maxillary sinus cancer (Mann-Whitney U test). Furthermore, the correlation between tumor volume and the distribution of metastatic nodes in the neck was observed to be weak in patients with oral or maxillary sinus cancer. CONCLUSION: The MR image-based tumor volume measurement proved to be clinically feasible. We observed a good correlation between tumor volume and lymph node metastasis in patients with oropharyngeal or hypopharyngeal cancer but not in those with oral or maxillary sinus cancer.

Aged↗

PubMed2005

[Contralateral cervical lymph node metastasis in piriform sinus carcinoma].

OBJECTIVE: To evaluate relative factors affecting contralateral cervical lymph node metastasis in piriform sinus carcinoma. METHODS: Ninety-six cases of piriform sinus carcinoma with no preoperative treatments were selected. The contralateral cervical lymph node metastasis and relative factors were analyzed during operation or postoperative follow-up. The contralateral cervical metastasis was defined as followed: 1 contralateral cervical metastasis was confirmed pathologically after bilateral neck dissection (pN2c) or 2 contralateral cervical metastasis was found firstly during postoperative follow-up and the recurrence of primary lesion was excluded. RESULTS: The incidence of contralateral cervical metastasis was 32% (31/96). According to the T stage, the incidence of contralateral cervical metastasis was T1: 0% ,T2: 18%, T3: 37%, T4: 32% and to the N stage N0: 12%, N1: 13%, N2a: 17%, N2b: 39%, N2c: 100%, and N3: 75%. For primary lesions beyond midline the incidence of contralateral cervical metastasis was 52% but for those remaining on ipsilateral side it was 18%. CONCLUSIONS: Contralateral cervical lymph node showed higher metastatic incidence with higher T and N stage. When the primary lesions invaded beyond midline, the contralateral cervical metastasis increased greatly and neck dissection should be selected positively.

Adult↗

PubMed2001

Decreased expression of E-cadherin and Yamamoto-Kohama's mode of invasion highly correlates with lymph node metastasis in esophageal squamous cell carcinoma.

OBJECTIVES: A reduction in cell-cell adhesion in cancer cells is an essential step in the progression from localized malignancy to metastatic disease. E-Cadherin is an important component of cell-cell adhesion molecules and may be a crucial determinant of tumor invasion and metastasis. E-Cadherin expression is reported to be correlated with lymph node metastasis in esophageal squamous cell carcinoma (SCC). The objective of this experiment is to examine the factors that are associated with invasion and metastasis of esophageal SCC. METHODS: Forty-six cases of esophageal SCC were examined by immunohistochemical staining for E-cadherin. The relationship between E-cadherin-staining patterns, conventional clinicopathological parameters and Yamamoto-Kohama's (Y-K's) mode of invasion were examined. RESULTS: The expression of E-cadherin on the cell membrane was reduced or lost in some of the esophageal SCC. Lymph node metastasis was highly correlated with the expression pattern of E-cadherin (p = 0.0002) and also highly correlated with Y-K's mode of invasion (p = 0.0078). However, lymph node metastasis was not correlated with any conventional clinicopathological parameters for invasion. CONCLUSIONS: These results indicate that E-cadherin plays a crucial role in invasion and metastasis in esophageal SCC, and that Y-K's mode of invasion highly reflects the invasiveness and metastatic potentials of esophageal SCC cells. Therefore, examination of the expression of E-cadherin and Y-K's mode of invasion would be helpful in predicting lymph node metastasis in esophageal SCC.

Aged↗