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PubMed1989

Lymph node hemangioma.

Lymph node hemangiomas are rare lesions. There have been two previous articles on the subject in the literature. We describe another case in which a lymph node was surgically removed from the inguinal region of a 4 1/2-year-old boy, with a five-month history of a right-sided groin mass. The literature was reviewed, regarding some vasoformative benign lymph node lesions, and a general working classification of these lesions is listed, as we attempted to recognize possible patterns in reactive-proliferative processes and separate them from true neoplasms with hamartomatous features.

Child, Preschool↗

PubMed1980

Are alveolar macrophages translocated to the lymph nodes?

Hilar lymph nodes from 5 rabbits exposed for 3 months (5 days/week, 6 h/day) to metallic nickel dust (1.2 mg/m3) and from 2 controls were studied with electron microscopy. Some lymph node macrophages were filled with laminated bodies and had a vesiculated cytoplasm, a well developed endoplasmic reticulum and a few of them contained nickel particles as well. This means that they appeared identical to macrophages found in alveoli in nickel exposed rabbits. We propose that there is a transport of alveolar macrophages to the lymph nodes in nickel exposed rabbits.

Animals↗

PubMed2005

Does the number of lymph nodes examined in patients with lymph node-negative breast carcinoma have prognostic significance?

BACKGROUND: There are conflicting data on the prognostic significance of the number of lymph nodes examined in patients with lymph node-negative breast carcinoma. Therefore, the authors analyzed the impact of the number of tumor-free axillary lymph nodes on disease-free survival (DFS) in two distinct patient populations. METHODS: Eight hundred thirty-three consecutive patients with breast carcinoma who underwent mastectomy between 1927 and 1987 and 1094 consecutive patients with breast carcinoma who underwent with breast-conservation therapy between 1984 and 2001 were diagnosed pathologically with negative axillary lymph node status. Patients were stratified into 4 groups according to the number of lymph nodes examined: Group 1 had 1-3 lymph nodes examined, Group 2 had 4-9 lymph nodes examined, Group 3 had 10-20 lymph nodes examined, and Group 4 had >20 lymph nodes examined. RESULTS: In the mastectomy cohort, with a median follow-up of 153 months, the 10-year DFS rate was 70%, 65%, 79%, and 81% for Groups 1-4, respectively. On multivariate analysis, pathologic tumor size (P<0.001) and the number of lymph nodes examined (P=0.010) were significant predictors for long-term DFS. In the breast-conservation cohort, with a median follow-up of 53 months, the 5-year DFS rate was 90%, 91%, 92%, and 95% for Groups 1-4, respectively. On multivariate analysis, the only predictors of DFS were method of detection (clinically vs. mammographically) (P=0.003) and tumor size (P=0.035). CONCLUSIONS: The recovery of <10 lymph nodes in lymph node-negative patients who underwent mastectomy resulted in a 10-15% decreased long-term DFS rate compared with patients who had a more extensive axillary assessment. However, the number of lymph nodes examined did not have an impact on the DFS rate in a contemporary cohort of patients who underwent breast-conservation therapy, which included radiation.

Adult↗

PubMed1992

Pelvic lymph node metastases in cervical cancer: comparison of lymphography, inspection, radiography, and histologic examination of lymph nodes.

Lymphangiography is commonly performed in the pretreatment evaluation of patients with cervical carcinoma, but its value is controversial. The purpose of this report is to determine the reliability of lymphography in the indication of metastatic pelvic lymph nodes by comparing data from preoperative lymphangiography, inspection of lymph nodes during laparotomy, radiography of surgically removed lymph nodes, and postoperative histologic report. Twenty-one patients (mean age 51.1 years, SD 14.5) with cervical cancer FIGO stages I b to II b were enrolled in this study. They all underwent Wertheim's radical hysterectomy with pelvic lymphadenectomy. With reference to histologic report this series included 8 squamous carcinomas (38%), 10 adenocarcinomas (48%) and 3 sarcomas (14%). Seven patients (33%) had a positive preoperative lymphangiography, in 9 patients (43%) lymph nodes were considered positive at the inspection during laparotomy, postoperative radiography of the lymph nodes was considered probably positive in 7 patients (33%) and positive in 2 patients (10%), histologic report was positive for lymphonodal metastases in 4 patients (19%). A total of 335 lymph nodes were studied, and with reference to the evaluated methods (lymphangiography, inspection, radiography, histology), 1 positive method was found in 40 lymph nodes (12%), 2 positive methods in 6 lymph nodes (2%), 3 or 4 positive methods in none of the lymph, nodes, and 4 negative methods in 289 lymph nodes (86%). Histologic report was positive in 4 lymph nodes (1%). Lymphangiography in the pretreatment evaluation in cases of cervical carcinoma is not reliable in indicating possible metastatic lymph nodes. It remains a useful exam fixation to be routinely performed.

Adult↗

PubMed2003

Sentinel lymph node biopsy has no benefit for patients with primary cutaneous melanoma metastatic to a lymph node: an assertion based on comprehensive, critical analysis: part I.

The thesis is set forth in this treatise that there is no place in the routine practice of medicine for the procedure for melanoma known conventionally and universally as sentinel node biopsy. Our assertion is based on assessment of the extensive body of literature devoted to the subject of treatment of melanoma before any metastasis has manifested itself clinically and of that dedicated to therapy for overt metastatic melanoma by a variety of modalities, chief among those addressed here being elective lymph node dissection and sentinel lymph node biopsy. In this era of sentinel lymph node biopsy, elective lymph node dissection has been modified to include only patients with metastasis of melanoma to lymph nodes, a procedure now termed "selective complete lymph node dissection." Among adjuvant medical therapies, the most popular today is interferon alpha-2B. Critical, incisive scrutiny of the literature leads to the conclusion, incontrovertibly, that elective lymph node dissection has no benefit for a patient and that all modifications of it also are devoid of value. The reason, logically, for the lack of utility of elective lymph node dissection becomes apparent by virtue of the route taken by cells of melanoma as they metastasize; those cells proceed in the same fashion as does lymph, bacteria, foreign material (including vital dyes and radioactive tracers), and other kinds of cells, to wit, by passing rapidly through nodes, including the sentinel one, and even bypassing entirely the nodes. In reality, cells of metastatic melanoma are not held up in nodes for any significant period of time, contrary to what is asserted repeatedly, but without any basis in fact, by many students of the subject. Moreover, not a single adjuvant medical therapy available currently is effective against metastatic melanoma and, therefore, none of them should be invoked to justify performance of sentinel node biopsy. Even if the sentinel node is found to house cells of melanoma, which, as a rule, conveys a grim message regarding the future, the finding in an individual patient is meaningless; a particular patient may live in harmony with metastases of melanoma for more than 30 years and even die of an unrelated malady. In short, no surgeon, pathologist, or oncologist is a seer, diviner, or prophet when it comes to predicting accurately the outcome for a patient with metastasis of melanoma; the end could come in weeks, months, or decades. If, however, a sentinel node is found to contain nary a cell of metastatic melanoma, it, too, means nothing for an individual patient because the existence of metastases widely is not excluded by that finding. In short, sentinel node biopsy cannot be considered the standard of care in the daily practice of medicine; it is woefully substandard because it is without benefit. There is no justification, whatsoever, for the procedure, scientifically or practically, and for that reason it should be abandoned, without delay, now.

Female↗

PubMed1989

Clinicopathology of non-neoplastic and neoplastic lymph node swelling.

Lymph node swelling, which can be problematic when attempting differential diagnosis between non-neoplastic or neoplastic types, can be grouped into three categories. The first is lymph node swelling due to heterotopia, hamartoma or hyperplasia, the second is due to non-neoplastic lymphoid cell and/or histiocyte proliferation with the appearance of neoplastic proliferation and the third is due to true neoplastic proliferation, but apparently simulating a non-neoplastic condition. The present paper describes some of the clinicopathological features of representative diseases or cases in each category, e.g. Castleman's disease, necrotizing lymphadenitis, "IBL"-like T-cell lymphoma, and lymphoma showing an unusual course initially simulating a non-neoplastic process and then gradually disclosing its neoplastic nature in the late stage. These cases emphasize the importance of close collaboration between the clinician and pathologist together with immunohistochemical studies of lymph node pathology.

Adolescent↗

PubMed1998

Radical resection with autonomic nerve preservation and lymph node dissection techniques in lower rectal cancer surgery and its results: the impact of lateral lymph node dissection.

Lateral lymph node metastases occur in 9% of rectal cancer patients. For cancers localized in the lower rectum below peritoneal reflection, the frequency increases to 13% of all cases and to 25.5% in those of Dukes' stage C. The most important technique in colorectal surgery for decreasing local failure in the pelvis is lateral lymph node dissection. Today, however, it is also regarded as crucial that with perfect lymph node dissection of the lateral area outside of the pelvic plexus, the postoperative functions of urination and sexual ability are preserved. Since 1988 we have performed autonomic nerve-preserving curative resection (ANP) with lateral dissection in most patients with advanced lower rectal cancer. The mean 5-year survival rate of patients with lateral lymph node metastasis from the lower rectum was 37.5%, improving from 32.1% to 43.4% during this period. In cases of ANP with lateral dissection the local recurrence rate was 4.8% overall and 7.4% in the Dukes' C group. Postoperative urinary function has been good or fair in all ANP patients. Sexual function remained problematic, especially regarding male ejaculation. We describe our method for preserving the autonomic nervous system in the pelvis and for achieving complete dissection in the lateral area.

Autonomic Nervous System↗

PubMed1977

Selective accumulation of cells with 'B' properties in stimulated lymph nodes.

Draining lymph nodes from mice which had been stimulated with bacterial adjuvants or the skin sensitizing agent, oxazolone, showed a marked increase in cell content, presumably due to lymphocyte immigration. A surprisingly large proportion of these cells exhibit properties of B lymphocytes: the presence of surface Ig, lack of Thy-1-like antigen and responsiveness to lopopolysaccharide (LPS). The relationship between the presence of surface markerand responses to class-specific mitogens, of cells from the stimulated nodes, was established by testing fractionated lymphocyte populations. Enriched T cells did not react to LPS, whereas removal of cells with Thy-1 antigen by specific antisera eliminated the reactions to T mitogens but had little or no effect on the LPS response. The data thus suggest that B cells, which make up a small portion of the circulating lymphocyte pool, are selectively accumulated in lymph nodes stimulated by different immunogens, including T-specific stimulants. This interpretation contradicts the generally accepted assumption, that stimulat lymph nodes trap mostly T lymphocytes.

Animals↗

PubMed1985

[Lymph node involvement in carcinoma of the esophagus--re-evaluation for the grouping of lymph nodes].

Based on the analysis of the lymph nodes dissected during resection of 234 esophageal carcinomas and the long-term results of the patient, lymph nodes of the esophagus were grouped into 3 categories, n1, n2 and n3. The lymph nodes of n1 group were frequently involved in metastases and the long-term results of the patients with these lymph nodes metastases were excellent. The n2 lymph nodes were frequently involved in metastases but the survival rates of the patients were low. The n3 lymph nodes were rarely involved and the prognoses of the patients were poor. In comparison with the classification of lymph nodes for surgical dissection as described by the Japanese Society for Esophageal Disease, some problems in this category are discussed. However, this category was revealed to have close relation to the long-term results of the patients with carcinoma of the esophagus and was considered to be of clinical use.

Adult↗

PubMed2005

Sentinel lymph node tumor load: an independent predictor of additional lymph node involvement and survival in melanoma.

BACKGROUND: Even though 60% to 80% of melanoma patients with a positive sentinel lymph node (SLN) have no positive additional lymph nodes (ALNs), all these patients are subjected to an ALN dissection (ALND) with its associated morbidity. The aim of this study was to predict the absence of ALN metastases in patients with a positive SLN by using features of the primary melanoma and SLN tumor load. METHODS: Of 71 SLN-positive patients, 52 had metastasis limited to the SLN (group 1), and 19 had > or =1 positive ALN after ALND (group 2). The tumor load of the SLN was assessed by measuring the total surface area by computerized morphometry. Breslow thickness, ulceration and lymphatic invasion of the primary tumor, and total SLN metastatic area were tested as covariates predicting the absence of positive ALNs. RESULTS: The mean SLN metastatic area was 1.18 mm(2) (group 1) and 3.39 mm(2) (group 2) (P = .003) and was the only significant and independent factor after multivariate analysis (P = .02). None of the patients with both a Breslow thickness <2.5 mm and an SLN metastatic area <.3 mm(2) had a positive ALN. CONCLUSIONS: SLN metastatic area can be used to predict the absence of positive ALNs in melanoma patients. In this study, patients with a Breslow thickness <2.5 mm and an SLN tumor load <.3 mm(2 )seemed to have no positive ALN and had excellent survival. We hypothesize that this subgroup might not benefit from ALND. Prospective larger trials, using this model and randomizing between ALND and no ALND, should confirm this hypothesis.

Adolescent↗

PubMed1999

Cost analysis of sentinel lymph node biopsy as an alternative to elective lymph node dissection in patients with malignant melanoma.

In the current era of managed care and cost containment, physicians and administrators are placed in the predicament of increasing quality of care while decreasing costs. The purpose of this article is to offer a cost analysis, while also demonstrating what patients, providers, payers, employers, and industry may stand to gain from establishing sentinel lymph node biopsy as a standard care in certain groups of patients.

Biopsy↗

PubMed2001

Prospective validation of the association of local tumor stage and grade as a predictive factor for occult lymph node micrometastasis in patients with penile carcinoma and clinically negative inguinal lymph nodes.

PURPOSE: We prospectively validated the association of local tumor stage and grade as a predictive factor for occult lymph node micrometastasis in patients with penile carcinoma and clinically negative lymph nodes. MATERIALS AND METHODS: In a retrospective study of 66 patients we demonstrated the predictive value of the association of local tumor stage and grade for occult micrometastasis, identifying 3 risk groups. A therapy strategy was designed according to these risk groups. A total of 37 consecutive patients were included in a prospective study in which the same criteria for risk group allocation and the same therapeutic recommendations were used as in the retrospective study. RESULTS: In the prospective study we noted positive lymph nodes in 11% of stage T1, 63% of stages T2-3, 15% of grade 1, 67% of grade 2 and 75% of grade 3 cases. The incidence of positive nodes was 0% in the low, 83.3% in the high and 33.3% in the intermediate risk group. These rates were similar to those in the retrospective study with no significant difference. CONCLUSIONS: The predictive value of the association of local tumor stage and grade for occult lymph node micrometastasis was validated in a prospective study. This factor allows the differentiation of 3 risk groups of patients with high reliability in the low and high risk groups. However, other prognostic factors are needed in the intermediate risk group to improve the prediction of lymph node involvement.

Adult↗

PubMed2006

Re-fixation in a lymph node revealing solution is a powerful method for identifying lymph nodes in colorectal resection specimens.

AIM: To verify an impact of a lymph node revealing solution (LRS) on the number of lymph nodes (LN) revealed in colorectal resection specimens. MATERIAL AND METHOD: Fifty-nine cases of rectosigmoid carcinomas divided into two subgroups-stage pT2&3 (20 cases) and ypT2&3 (with pre-operative radiotherapy-39 cases)-were formalin fixed for 42-72 h, serially sectioned and re-fixed in LRS containing ethanol, diethyl ether, glacial acetic acid, and formalin for 24 h. The number of LNs was matched to a control group consisting of 34 cases of colorectal carcinoma, 14 pT2&3 and 20 ypT2&3 rectosigmoid carcinomas examined routinely. Results were statistically tested by Student's t-test. RESULTS: In the study group the total number of revealed LNs was 869, range 1-48, average 14.7 per specimen, median 15. In the control group the number of LNs was 200, range 0-13, average 5.9 per specimen, median 6. The difference between the study and the control group was statistically significant (P = 0.05). CONCLUSION: Using LRS leads to a significant increase in the number of revealed LNs in colorectal resection specimens and makes it possible to find more than 12 LNs in a majority of stage pT2 and pT3 adenocarcinomas.

Acetic Acid↗

PubMed2006

Safety and efficacy of modified radical lymph nodes dissection in patients with papillary thyroid cancer and clinically evident lymph nodes metastasis.

INTRODUCTION: Papillary cancer of the thyroid gland is well known as a lymphotropic type of cancer. In more than 50 percent of all cases it metastasizes first and mainly in regional lymph nodes. The extent of surgical intervention remains a subject of controversy and discussions. AIM: The aim of our retrospective study was to evaluate efficacy and safety of modified radical lymph node dissection (MRND) in patients with papillary thyroid cancer (PTC). PATIENTS AND METHODS: We performed a retrospective analysis of survival and quality of life of 19 patients who underwent surgery at the Department of General Surgery. All patients had papillary thyroid cancer and regional lymph nodes metastases. The results were compared to literature data on surgical interventions differing in extent and specifics. RESULTS: Our analysis and its parallel with literature data revealed better survival rates and quality of life in patients who had undergone total thyroidectomy (TT) with modified radical lymph nodes dissection in comparison with those ones who had undergone total thyroidectomy with berry picking (BP). CONCLUSIONS: Modified radical lymph nodes dissection is an effective and comparatively safe procedure for the treatment of patients with papillary thyroid cancer and regional lymph nodes metastases. If adequately performed it ensures better quality of life, longer survival and improves further control on distant metastases.

Adult↗

PubMedDate not supplied

[The clinical significance of lymph node micrometastases and of concept of sentinel lymph node].

Micrometastases, (metastases smaller than 2 mm), had benn subject of several studies. In literature is documented a prognostic worsening due to their presence. Research of micrometastases in sentinel lymph node is of great interest and can allow a clinical application with profitable cost efficacy ratio. The Authors discuss about clinical, prognostical and therapeutical implicationes in case of micrometastases into sentinel lympho nodes.

Adenocarcinoma↗

PubMed1992

[Syncytial variant of the nodular sclerosing type of Hodgkin's disease in cervical lymph nodes with simultaneous sarcoidosis-like granulomatosis in the intrathoracic lymph nodes and liver].

A woman aged 31 years had been afflicted with mediastinal lymph node enlargement and hepatopathy for two years. Epithelioid-cell granulomatosis was diagnosed at another institute on the basis of biopsies taken from the liver and thoracic lymph nodes, resulting in the differential diagnosis of sarcoidosis or tuberculosis. Another biopsy was taken from enlarged cervical lymph nodes, after tuberculostatic therapy had remained unsuccessful and had not prevented deterioration of the patient's condition. We diagnosed from that biopsy the syncytial variant of nodular sclerosis of Hodgkin's disease. Immunohistochemically, the tumour cells exhibited positive reactions to antigens CD 15 and CD 30, whereas no evidence was provided to the presence of cytokeratins, lysozyme and S-100 protein. In grading, we associated our case with subtype 2 of nodular sclerosis and clinical stage II. Combined radiotherapy and chemotherapy resulted in complete remission of the tumour disease. Presence of granulomatosis similar to sarcoidosis was confirmed by follow-up examination of the liver and lymph node biopsies which originally had been histopathologically examined at another institute. The question is discussed whether or not this granulomatous reaction reflected an increased immunological defence reaction of the organism to Hodgkin's disease and thus offered an explanation for the unexpected favourable course of the patient's disease.

Adult↗

PubMed1977

Lymph node activating factor from mixed cultures of allogeneic lymphoid cells: effect on the lymph nodes of euthymic and athymic mice.

The action of "lymph node activating factor" (present in supernatants from 4hr cultures of allogeneic lymphocytes) on the lymph nodes of athymic nu/nu mice, nu/+ hybrids and euthymic BALB/c mice was studied. An increase in lymph node weight, cellularity and changes in lymph node morphology, i.e. an increase of the dense lymphatic tissue of the cortex and paracortex and appearance of follicles with light centers, were found in all mice. Lymphocyte activation evaluated by the presence of lymphocytes with RNA synthesizing nucleoli occurred only in nu/nu mice and nu/+ hybrids. Marked changes in lymph node morphology found in nu/nu homozygotes suggest relation of the lymph node activating factor to mediators acting directly on B cells.

Animals↗

PubMed2003

The risk of regional lymph node metastases in patients with melanoma less than 1.0 mm thick: recommendations for sentinel lymph node biopsy.

BACKGROUND: Lymphatic mapping and sentinel lymph node biopsy can upstage patients with intermediate thickness (1.0 to 4.0 mm) melanoma. Currently, there are no strict guidelines for sentinel lymph node biopsy in patients with melanoma <1.0 mm thick. STUDY DESIGN: A retrospective review of our patient database (598 patients treated at two institutions in Baltimore, MD, between January 1970 and June 2002) was performed to identify patients with primary cutaneous melanoma <1.0 mm thick who developed recurrent disease. This cohort of patients with > or =5 years of followup from the date of diagnosis was compared with patients with primary melanoma of similar thickness and similar followup intervals without recurrent disease. RESULTS: A total of 114 patients with primary cutaneous melanoma <1.0 mm thick were identified, 17 of whom developed disease recurrence. In 13 patients, the site of first recurrence was the regional lymph nodes and in 4 patients disease recurred with distant metastases. The median time to lymph node recurrence was 55 months (range 2 to 112) months. Patients with regional lymph node recurrences had a significant (p = 0.02) difference in median primary tumor thickness of 0.80 mm versus 0.45 mm in patients without recurrent disease; there was no association of Clark level of invasion to recurrence (p = 0.42). In all, 35% of patients (7 of 20) presenting with melanoma 0.80 to 0.99 mm thick developed lymph node recurrence a median of 41 months (range 8 to 112 months) after surgical treatment. CONCLUSIONS: Sentinel lymph node biopsy can be justified for patients with melanoma > or =0.8 mm thick provided that the technique would detect metastatic disease years before it becomes clinically evident.

Adolescent↗