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PubMed1992

[Recurrence of cervical lymph node involvement in surgically treated thyroid cancer. Uselessness of routine cervical lymph node excision (medullary carcinoma excluded)].

From 1966 throughout September 1990, 753 patients underwent surgery for thyroid carcinoma, in the same institution, covering all pathological types. Complete follow-up was achieved in 96% of them, being at least 7 years in 50% of cases. 599 (80%) are currently alive. Neck dissection was not routinely done, except for medullary thyroid carcinoma, but rather selectively, if nodes were palpable either pre or intraoperatively, and also (since oct. 1983 i.e. the last 400 cases) if, after routine sampling of mid jugular nodes, frozen sections assessed nodal invasion. On the grounds of this policy, 205 patients underwent unilateral or bilateral neck dissection; 17% of them died during follow-up whereas 5.9% (12 cases) exhibited a cervical nodal recurrence, 6 of them occurring less than two years post-operatively, including 3 medullary thyroid carcinomas. 548 had no neck dissection; 9% died during follow-up whereas 0.9% (5 cases) exhibited a cervical nodal recurrence, 3 of them occurring less than two years post-operatively. Routine neck dissection seems not to be justified in the surgery of non medullary differentiated thyroid carcinoma, in as much as late occurrence of cervical node metastases is uncommon and does not obviously impair life-expectancy.

Carcinoma, Papillary↗
PubMed1993

[A case report of pulmonary metastasis of malignant fibrous histiocytoma (MFH) accompanied by mediastinal lymph node metastasis].

Mediastinal lymph node metastasis associated with pulmonary metastasis is rarely seen in soft tissue sarcoma. A case is presented in which investigation of primary lung cancer (cT2N2M0) in a 78-year-old woman with a history of MFH of the left thigh revealed pulmonary metastasis of MFH accompanied by paratracheal (#2) and anterior mediastinal (#3a) lymph node metastases.

Aged↗
PubMed1998

Lymph node staging in non-small-cell lung cancer with FDG-PET scan: a prospective study on 690 lymph node stations from 68 patients.

PURPOSE: To compare the accuracy of computed tomography-(CT) scan and the radiolabeled glucose analog 18F-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) visually correlated with CT (PET + CT) in the locoregional lymph node (LN) staging of non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: Sixty-eight patients with potentially operable NSCLC underwent thoracic CT, PET, and invasive surgical staging (ISS). Imaging studies were read prospectively and blinded to the surgical and pathologic data. A five-point visual scale was used for the interpretation of LNs on PET. Afterwards, with knowledge of the pathology, the relationship between standardized uptake values (SUVs) and the presence of metastasis in LNs was explored in a receiver operating characteristic (ROC) analysis, and the likelihood ratios (LRs) for SUVs of LNs were determined. RESULTS: ISS was available for 690 LN stations. CT correctly identified the nodal stage in 40 of 68 patients (59%), with understaging in 12 patients and overstaging in 16 patients. PET + CT was accurate in 59 patients (87%), with understaging in five patients and overstaging in four patients. In the detection of locally advanced disease (N2/N3), the sensitivity, specificity, and accuracy of CT were 75%, 63%, and 68%, respectively. For PET + CT, this was 93%, 95%, and 94% (P = .0004). In the ROC curve, the best SUV threshold to distinguish benign from malignant LNs was 4.40. The analysis with this SUV threshold was not superior to the use of a five-point visual scale. The LR of a SUV less than 3.5 in an LN was 0.152; for a SUV between 3.5 and 4.5, it was 3.157; and for a SUV greater than 4.5, it was 253.096. CONCLUSION: PET + CT is significantly more accurate than CT alone in LN staging of NSCLC. A five-point visual scale is as accurate as the use of an SUV threshold for LNs in the distinction between benign and malignant nodes. The very high negative predictive value of mediastinal PET could reduce the need for mediastinal ISS in NSCLC substantially.

Adult↗
PubMed1988

Comparative histology of malignant lymphomas in lymph node and bone marrow.

Lymph node and bone marrow biopsies of 226 patients with malignant lymphomas were available for evaluation and comparison. 120 of the 226 lymphoma patients had classifiable infiltration in both lymph node and bone marrow and these were used for comparison. Congruence in the histologic subtypes in lymph node and bone marrow was found in 91 patients (76%). The majority of the 29 cases with divergent histologies showed ML of low grade malignancy in the bone marrow even with long time intervals between the two biopsies. The most notable in this group were seven cases who had ML centroblastic/centrocytic in the lymph node biopsy and ML immunocytic in the bone marrow, although none had a serum M-component. 65 of the 106 patients excluded from comparison had involvement in only one organ, the others had unclassifiable or equivocal histologies in either lymph node or bone marrow or in both. The findings are discussed with respect to the histologic behaviour of the lymphomas. The results show that comparison between lymph node and bone marrow findings in patients with ML is feasible and clinically relevant.

Bone Marrow↗
PubMed1996

Mucosal or targeted lymph node immunization of macaques with a particulate SIVp27 protein elicits virus-specific CTL in the genito-rectal mucosa and draining lymph nodes.

The major routes of HIV transmission are through the rectal and cervico-vaginal mucosa. To prevent dissemination of HIV to the regional lymph nodes (LNs), an effective vaccine may need to stimulate CTL in the rectal or genital tract and the draining LNs. We report that mucosal immunization by the recto-oral and vagino-oral route or s.c. immunization targeting the iliac LNs with a particulate SIVp27:Ty-VLP vaccine elicits SIVgag-specific CTL in the regional LNs as well as in the spleen and PBMC. Targeted LN immunization with this vaccine elicited MHC class I-restricted CD8+ CTL responses, and the highest frequency of CTL was found in the iliac LNs. Moreover, SIVgag-specific CTL activity was detected in short term T cell lines established in mononuclear cells eluted from the rectal and cervico-vaginal mucosa. The relative frequency of CTL in short term cell lines prepared from the rectal mucosa (21/113 or 18.6%) was similar to that obtained from the cervico-vaginal mucosa (16/79 or 20.3%). Examination of the relative frequency of CTL to the T cell epitopes residing within SIVp27 showed a higher frequency in iliac LN cells to peptide aa 41-70 than in that to peptide aa 121-150, and this was significant after both recto-oral (chi-squared 6.500, p < 0.02) and vagino-oral (chi-squared = 10.391, p < 0.01) immunization. In contrast, the relative frequency of CTL in PBMC to peptide aa 41-70 (15.5%) was comparable to that elicited by peptide aa 121-150 (17.6%). This study provides novel evidence that mucosal or targeted LN immunization can generate anti-SIV CTL in the rectal and genital mucosa, in the draining LNs, and in the central lymphoid system.

Animals↗
PubMed1985

Lymphocyte emigration from lymph nodes by blood in the pig and efferent lymph in the sheep.

Two types of experiment using local labeling of lymph nodes with FITC showed that lymphocytes emigrate from lymph nodes, predominantly in blood in the pig and in efferent lymph in the sheep. In the first type of experiment with the pig, few cells emigrated via the lymph, while the number of labelled cells in the blood increased progressively and the indices in mesenteric blood were always higher than in jugular blood in simultaneously-drawn samples. However, in the sheep, when efferent lymph flowed freely, very low numbers emerged in blood and continuing large numbers of lymphocytes emerged in efferent lymph. In the second type of experiment carried out wholely under anaesthetic on mesenteric lymph nodes in pigs and sheep, and on superficial inguinal lymph nodes in pigs, the lymph node was isolated, the lymph and venous drainage collected and only the arterial supply maintained. Large numbers of FITC+ lymphocytes emigrated via the vein in pigs with either node cannulation (i.e. up to 7% blood lymphocytes were labelled with an emigration rate of approximately 10(8) cells/hr) but in sheep, while lymph contained approximately 30-80% labelled cells and the emigration rate was also approximately 10(8) cells/hr, the mesenteric blood contained very few labelled cells (approximately 0.2%, giving a mean venous emigration rate of 2.7 X 10(6)/hr). Study of the type of lymphocytes emerging from labelled pig lymph nodes and spleen during the phase of major emigration showed that sIg+ B and E rosette-forming T cells, but almost no Null cells, are involved.

Animals↗
PubMed1982

Tumor immunity in rat lymph nodes following transplantation.

Inguinal lymph nodes in the Buffalo rat were autotransplanted to the popliteal fossa by an intact vascular pedicle or by microvascular anastomosis. These revascularized nodes had normal histology and made spontaneous afferent and efferent lymphatic reconnection with surrounding lymphatic vessels, as documented by ink and silicone rubber injection studies. Lymphoscintigraphy with 99mTc antimony sulfide colloid correctly predicted the 44 of 120 node transplants that had made afferent reconnection. To demonstrate immunologic activity of lymph nodes following transplantation, a cellular adherance assay was employed to detect cell-mediated cytotoxicity of lymph node cells isolated from rats sensitized to an allogeneic gliosarcoma. Cytotoxicity was detected in nontransplanted regional nodes sensitized to tumor (p less than 0.01) and in nodes transplanted by vascular pedicle and then sensitized to tumor (p less than 0.001). This study demonstrates that lymph nodes can be transplanted with restoration of functional lymphatic anatomy, and that following transplantation, lymph nodes retain the ability to mount an immune response against tumor.

Animals↗
PubMed1977

The influence of the lymph node on the protein concentration of efferent lymph leaving the node.

1. Experiments have been performed in sheep to determine the contribution of lymph formed within a lymph node to the total protein output in lymph leaving the node. 2. The lymphatic duct leaving the popliteal lymph node was cannulated and the protein and lymphocyte output in efferent lymph determined. The afferent lymph flow to the popliteal node was then diverted and lymph formed only within the lymph node collected from the efferent cannula. It appeared from the results that the popliteal lymph node forms lymph at the rate of approximately 1 ml. per hour and may contribute 30-50% of the protein output observed in efferent lymph. 3. The importance of lymph formation within the lymph node varied between nodes found in different regions of the body. This was due in part to the different protein concentrations in the afferent lymph to the different nodes. 4. A positive correlation was found between the protein and lymphocyte concentrations in efferent lymph from the popliteal lymph node in seven out of eleven sheep and in lymph formed within the popliteal lymph node in two out of three sheep. It is suggested that this relationship may be due to an increased transfer of plasma proteins through the post-capillary venules in the lymph node accompanying the continual traffic of lymphocytes across the wall of these vessels. The results indicated that the protein transfer across the post-capillary venules was not an indiscriminate transfer of plasma per se but a selective transport from the blood plasma compartment based on molecular size.

Animals↗
PubMed1980

Dermatopathic lymphadenopathy and lymph node involvement in mycosis fungoides.

Lymph node involvement in mycosis fungoides (MF) is associated with a poor prognosis, Histologically, in most cases of clinical lymphadenopathy the excised lymph node shows dermatopathic lymphadenopathy (DL). The diagnosis of MF involvement can readily be made when the lymph node tissue has partly or wholly been replaced by atypical lymphoreticular tissue. Early involvement of a dermatopathic lymph node by MF may be difficult to diagnose. A histologic study was performed on 30 lymph nodes from 24 patients with MF. Most of these lymph nodes had been excised as part of the staging procedure. The maximal follow-up period was five years. A classification of lymph node involvement into four categories is suggested and correlations with clinical courses and results of DNA cytophotometry of lymph node imprints are shown. Lymph nodes showing the histologic picture of DL can be divided into two groups: a group with MF involvement (category I) and a group with MF involvement (category II). The latter group is considered to represent early involvement of lymph nodes by MF. Partial or complete replacement of lymph node tissue by atypical lymphoreticular tissue corresponds with cagegories III and IV, respectively.

Adult↗
PubMed1995

Outpatient pelvic lymph node dissection.

PURPOSE: Staging pelvic lymph node dissection is an important part of the evaluation of most patients with prostatic carcinoma. While laparoscopic pelvic lymph node dissection provides an alternative to standard pelvic lymph node dissection, it has been associated with a significant learning curve, high major complication rate, frequent hospitalization and greater expense. We sought to modify the technique of pelvic lymph node dissection to allow its performance as an outpatient procedure. MATERIALS AND METHODS: Pelvic lymph node dissection was performed through bilateral 3 cm. incisions overlying the obturator fossa in 11 patients. RESULTS: Nodes sampled ranged from 5 to 26 per patient that differed insignificantly from those undergoing standard pelvic lymph node dissection. Four patients had lymph node metastases. Nine procedures were performed entirely on an outpatient basis. One complication (external vein injury) was repaired with a single suture after extending the incision to 6 cm. CONCLUSIONS: Outpatient pelvic lymph node dissection through small incisions provides an attractive alternative to standard or laparoscopic lymph node dissection. With further experience it may become the procedure of choice for staging prostatic carcinoma in patients with a high risk of pelvic lymph node metastases.

Aged↗
PubMed1979

Doppler ultrasound examination of pathologically enlarged lymph nodes.

Pathologically enlarged lymph nodes have been examined with a commercially available 10 MHz continuous-wave Doppler flowmeter. Many enlarged lymph nodes gave rise to significant Doppler-shift signals indicating increased blood flow. The signals have been spectrum analysed and the large diastolic flow components suggest that there is considerable arterio-venous shunting within lymph glands involved in leukemia, lymphoma and carcinoma. It also seems that the signals tend to diminish in response to treatment. The Doppler signals have been used in an imaging system to produce a vascular map of the region of the enlarged gland. It is suggested that these findings might be applicable to the detection of neoplastic tissues in less accessible sites.

Doppler Effect↗
PubMed1996

Inflammatory pseudotumor of pelvic lymph nodes.

Inflammatory pseudotumor of lymph nodes (IPT) is a rare, recently described benign cause of lymphadenopathy. The IPT is composed of a proliferation of spindle cells, small vessels and inflammatory cells without atypia and formed by high and poor cellular areas. This study reports a case of IPT. It was a 50-years-old man in whom the abdominal mass was an incidental finding during exploratory laparatomy. The mass was a lymphadenopathy measuring 12 x 10 x 5 cm in diameters. Histologic examination revealed IPT of the lymph nodes. The patient has remained asymptomatic for more than 10 months following surgery without any treatment. In conclusion, IPT of the lymph nodes is being recognized increasingly and should be considered in the differential diagnosis of lymphadenopathies. Inflammatory pseudotumor (IPT) of the lymph nodes resembling the IPT of other organs was recently described as a possible cause of lymphadenopathy. Histologically, the process showed a proliferation of spindle cells associated with a mixture of polymorphic inflammatory cells and small blood vessels involving the connective tissue framework (hilum, trabecula, capsule) of the lymph node. In this report, the case of a patient with IPT of pelvic lymph nodes is presented with the clinical and pathological features.

Cell Division↗
PubMed1981

The results of node resection for clinically enlarged lymph nodes in malignant melanoma.

Patients with malignant melanoma who require a block dissection for clinically enlarged lymph nodes have a relatively good prognosis if only one node is involved histologically and the primary is on the lower limb. Sixty per cent of these patients with single nodes show a 10 year disease-free survival rate, compared with 9% for those with multiple node involvement. The local recurrence rate at the resection site of hyperplastic nodes was 26% but fell to 10% when only a single node was involved. The disease-free interval and the survival time are a useful measure of the effectiveness of node resection.

Axilla↗