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PubMed1995

Lymph pathways of the medial retropharyngeal lymph node in dogs.

In dogs, lymph drains from tissues throughout the head, including the tonsils, along lymphatic vessels to the facial, parotid, lateral retropharyngeal and mandibular lymph nodes. From the mandibular lymph nodes, lymph may flow to the ipsilateral medial retropharyngeal lymph nodes, or along anastomotic connections to the contralateral node. Afferent lymphatics convey lymph from these nodes to defined areas in the medial retropharyngeal nodes. They divide over the surface of the node, and within trabeculae. Terminal afferent lymphatics are connected to the subcapsular and trabecular sinuses either through circular or oval holes in the vessel wall, or terminate at the sinus where the vessel contains a valve adjacent to the point of entry. The subcapsular sinus surrounds the entire node, and is continuous with an interconnecting network of trabecular and cortical sinuses which convey lymph through the cortex. Connective tissue septa extend through the sinuses and lymph flows freely between adjacent sinuses through holes in the septal walls. Initial efferent lymphatic vessels, which arise from the medullary sinuses between medullary cords, converge towards and unite within the network of medullary trabeculae. Other vessels, which contain valve-like flaps, drain lymph from the subcapsular sinus. Efferent vessels emerge along the hilus and coalesce to form the tracheal trunk. The tracheal trunk has several layers of smooth muscle cells, well developed elastic laminae and connective tissue, surrounding the lymphatic endothelium.

Animals↗
PubMed2002

[Assessment of retropharyngeal lymph node by comparing CT with MRI].

BACKGROUND & OBJECTIVES: The incidence of nasopharyngeal carcinoma (NPC) is high as part of malignancy of head and neck in South China. Some of the foreign radiologists investigated on it by comparing CT (computed tomography) with MRI (magnetic resonance imaging), but there was no description for metastatic retropharyngeal lymph node (RPN) of NPC. None of this kind of article published in domestic. The current study was designed to evaluate CT and MRI in identifying retropharyngeal node by comparing the finding of CT and MRI in 56 patients with NPC. METHODS: Fifty-six cases pathologically proven as nasopharyngeal carcinoma were selected from August, 1993 to December, 2000; CT scan were performed by Elscient CT Twin flash, axial scan were parallel to the OM line routinely from soft palate to the supracellar cistern. MRI scan were performed by Philip T5-II super-conducting magnetic resonance imaging system(0.5T). The standard quadrature head coil was used. Routine axial, saggital, and coronal scan with SE sequences were obtained. Scanned field ranged from soft palate to the supracellar cistern. After plain scaned, contrast material were administrated in 40 cases by intravenous injection of Gd-DTPA 0.1 mmol per kilogram body weight. And then repeat axial, saggital and coronal scan. RESULTS: MRI recovered the RPN more exactly than CT (13 cases by CT and 24 cases by MRI) and there was significant differentiation 0(P < 0.05). It is possible to distinguish the metastatic RPN of NPC from the directly infiltration of tumor by MRI. CONCLUSIONS: MRI is more precise than CT in differentiating the RPN from the directly invasion by tumor tissue of NPC, which will affects the 92 Chinese staging systems, for NPC obviously.

Adolescent↗
PubMed1983

Computed tomography of cervical and retropharyngeal lymph nodes: normal anatomy, variants of normal, and applications in staging head and neck cancer. Part I: normal anatomy.

The retropharyngeal and cervical lymph-node-bearing areas in 30 patients were examined with computed tomography (CT) to determine the range of normal variation in these nodal groups. The data agree with those in the pathologic, anatomic, and surgical literature, and indicate that CT can very precisely determine the size and gross morphology of normal nodes in the retropharyngeal region and the neck. This should have important applications in the management of patients with head and neck cancer.

Head↗
PubMed1983

Computed tomography of cervical and retropharyngeal lymph nodes: normal anatomy, variants of normal, and applications in staging head and neck cancer. Part II: pathology.

Forty-one patients were examined (39 prospectively and 2 retrospectively) with computed tomography (CT) to determine its value in staging cervical and retropharyngeal nodal metastases. Precise surgical confirmation of CT findings was available in 25 patients. CT correctly increased the stage of the disease in six necks, and showed extranodal extent more precisely than the clinical examination in six others. The clinical evaluation proved superior to CT at predicting the extent of extranodal disease in two patients. Both CT and the clinical examination failed to detect microscopic tumor in normal-size nodes in two patients and falsely predicted tumor in enlarged nodes in one. CT offers information important for management and prognosis that is not available from the clinical examination in patients who have already been treated for cancer of the neck, and in patients with extranodal spread or retropharyngeal adenopathy. In the untreated neck CT will increase the stage of the disease from N0 to N1 about 5% of the time. Simple criteria for integrating CT into current clinical-diagnostic staging systems based on this and other experience are presented.

Diagnostic Errors↗
PubMed1998

Metastatic melanoma to retropharyngeal lymph nodes causing pharyngeal obstruction.

The finding of melanoma that has metastasized to regional lymph nodes is prognostically unfavorable. Occasionally, lymph nodes beyond the regional lymph node basin are the site of distant melanoma metastases. We present the case of a patient with melanoma who developed nonregional lymph node metastases to retropharyngeal/parapharyngeal lymph nodes, resulting in symptoms of upper aerodigestive tract obstruction. Physical examination of the head and neck, fiberoptic examination, and CT scan were abnormal. The patient underwent unilateral transcervical lymphadenectomy and resection of the obstructing retropharyngeal tumor mass. A sternocleidomastoid muscle flap was used to augment the posterior pharyngeal wall closure. The patient was able to resume full oral intake without need for a tracheostomy. Surgical intervention can play an important role in the palliation of selected patients with nonregional metastatic melanoma to the head and neck.

Adult↗
PubMed2005

Ultrasonographic assessment and ultrasound-guided biopsy of the retropharyngeal lymph nodes in Asian elephants (Elephas maximus).

Endotheliotropic herpesvirus causes a fatal disease in young Asian elephants, but there are no methods for identifying latent carriers of the virus. During the postmortem study of one female African elephant and three male and two female Asian elephants, a lymph node located bilaterally caudoventral to the parotid gland, approximately 1.5 to 5 cm below the skin, was identified as suitable for transcutaneous ultrasound-guided biopsy. An ultrasonographic assessment and two biopsies were performed on 39 Asian elephants, and these lymph nodes were classified ultrasonographically as active, inactive or chronically active. The calculated mean (se) volume of 10 active lymph nodes was 17.4 (6.9) cm(3), and that of three chronically active lymph nodes was 10.6 (1.0) cm(3), whereas the mean volume of 17 inactive lymph nodes was 3.1 (0.6) cm(3). The presence of lymph node tissue in samples obtained by ultrasound-guided biopsy from three animals that were maintained under conditions that allowed for additional sampling was confirmed histologically. The dna extracted from the lymphoid tissue and the whole blood of all the elephants was negative for endotheliotropic herpesvirus by PCR.

Animals↗
PubMed2007

Transoral resection of thyroid cancer metastasis to lateral retropharyngeal nodes.

BACKGROUND: Lymph node metastasis from differentiated thyroid carcinoma may occur outside of the basins at greatest risk of spread, such as the lateral retropharyngeal lymph nodes. The extensive surgery of traditional approaches to the retropharyngeal space are rarely justified in the treatment of metastatic differentiated thyroid cancer. Therefore, a less invasive surgical approach is advantageous in resection of metastatic lateral retropharyngeal nodes. METHODS: To assess feasibility and safety, we report transoral excision guided by preoperative ultrasonography in a series of 3 consecutive patients with differentiated thyroid cancer metastatic to the retropharyngeal space. RESULTS: In all cases, the metastatic lateral retropharyngeal lymph node was successfully removed by transoral retropharyngotomy without complications. CONCLUSIONS: We advocate a transoral approach guided by preoperative ultrasonography for resection of differentiated thyroid cancer metastatic to the retropharyngeal lymph nodes. The approach is feasible, minimally invasive, and safe in achieving the goals in management of regionally metastatic disease.

Adult↗
PubMed2000

Patterns of local-regional recurrence following parotid-sparing conformal and segmental intensity-modulated radiotherapy for head and neck cancer.

PURPOSE: To analyze the patterns of local-regional recurrence in patients with head and neck cancer treated with parotid-sparing conformal and segmental intensity-modulated radiotherapy (IMRT). METHODS AND MATERIALS: Fifty-eight patients with head and neck cancer were treated with bilateral neck radiation (RT) using conformal or segmental IMRT techniques, while sparing a substantial portion of one parotid gland. The targets for CT-based RT planning included the gross tumor volume (GTV) (primary tumor and lymph node metastases) and the clinical target volume (CTV) (postoperative tumor bed, expansions of the GTVs and lymph node groups at risk of subclinical disease). Lymph node targets at risk of subclinical disease included the bilateral jugulodigastric and lower jugular lymph nodes, bilateral retropharyngeal lymph nodes at risk, and high jugular nodes at the base of skull in the side of the neck at highest risk (containing clinical neck metastases and/or ipsilateral to the primary tumor). The CTVs were expanded by 5 mm to yield planning target volumes (PTVs). Planning goals included coverage of all PTVs (with a minimum of 95% of the prescribed dose) and sparing of a substantial portion of the parotid gland in the side of the neck at less risk. The median RT doses to the gross tumor, the operative bed, and the subclinical disease PTVs were 70.4 Gy, 61.2 Gy, and 50.4 Gy respectively. All recurrences were defined on CT scans obtained at the time of recurrence, transferred to the pretreatment CT dataset used for RT planning, and analyzed using dose-volume histograms. The recurrences were classified as 1) "in-field," in which 95% or more of the recurrence volume (V(recur)) was within the 95% isodose; 2) "marginal," in which 20% to 95% of V(recur) was within the 95% isodose; or 3) "outside," in which less than 20% of V(recur) was within the 95% isodose. RESULTS: With a median follow-up of 27 months (range 6 to 60 months), 10 regional recurrences, 5 local recurrences (including one noninvasive recurrence) and 1 stomal recurrence were seen in 12 patients, for a 2-year actuarial local-regional control rate of 79% (95% confidence interval 68-90%). Ten patients (80%) relapsed in-field (in areas of previous gross tumor in nine patients), and two patients developed marginal recurrences in the side of the neck at highest risk (one in the high retropharyngeal nodes/base of skull and one in the submandibular nodes). Four regional recurrences extended superior to the jugulodigastric node, in the high jugular and retropharyngeal nodes near the base of skull of the side of the neck at highest risk. Three of these were in-field, in areas that had received the dose intended for subclinical disease. No recurrences were seen in the nodes superior to the jugulodigastric nodes in the side of the neck at less risk, where RT was partially spared. CONCLUSIONS: The majority of local-regional recurrences after conformal and segmental IMRT were "in-field," in areas judged to be at high risk at the time of RT planning, including the GTV, the operative bed, and the first echelon nodes. These findings motivate studies of dose escalation to the highest risk regions.

Adult↗
PubMed1995

Parotid salivary gland adenocarcinoma with bilateral ocular and osseous metastases in a dog.

A case of primary parotid salivary gland adenocarcinoma is described in a three-year-old entire female great dane. The presenting complaint was sudden onset blindness concomitant with the development of bilateral hyphaema and anterior uveitis. A soft-tissue swelling of the left subaural region and right forelimb lameness were also present. A definitive diagnosis of primary parotid salivary gland adenocarcinoma with bilateral ocular metastases was made on post mortem examination. Metastases were also present in the right proximal humerus, left and right prescapular lymph nodes, left axillary lymph node, left retropharyngeal lymph node, bronchial lymph nodes and all lung lobes.

Adenocarcinoma↗
PubMed1998

[Clinical investigation of lymph node metastasis in carcinoma of the hypopharynx].

Carcinoma of the hypopharynx has a great tendency to metastasize to the neck. In addition it often metastasizes to the upper retropharyngeal lymph nodes (Rouviere's lymph nodes) and to the paratracheal lymph nodes. In this study, in order to determine the pattern of lymph node metastasis, 112 patients with carcinoma of the hypopharynx who had undergone bilateral radical neck dissection, bilateral paratracheal dissection, bilateral dissection of retropharyngeal nodes as an initial treatment between January 1982 and June 1997 in the Kurume University Hospital, were retrospectively reviewed in detail. Special attention was paid to retropharyngeal nodes and paratracheal lymph nodes. In N0 cases neck metastases were seen in more than one-quarter of the patients. Metastasis to retropharyngeal lymph nodes and to the paratracheal lymph nodes was seen in 5.4% and 12.5% of the patients, respectively. The frequency of metastasis to paratracheal lymph nodes had a significantly close relationship with that to the upper and lower jugular lymph nodes. The frequency of metastasis to retropharyngeal lymph nodes also had significantly close relationship with that to paratracheal lymph nodes, while having no relationship with that to other neck lymph nodes. These results suggest the following: 1) In patients with T1 or T2 PS type carcinoma of the hypopharynx, in which the lesion is confined unilaterally and is presumed to have been successfully treated by laser surgery prior to radiotherapy, unilateral neck dissection alone will be sufficient. In all the other patients with carcinoma of the hypopharynx bilateral neck dissection must be performed. 2) In all patients retropharyngeal lymph nodes and paratracheal lymph nodes should be dissected as much as possible and postoperative irradiation to both areas will be necessary.

Female↗
PubMed1999

Bacterial isolation, immunological response, and histopathological lesions during the early subclinical phase of experimental infection of goat kids with Mycobacterium avium subsp. paratuberculosis.

The diagnosis of Mycobacterium avium subsp. paratuberculosis infection is difficult, especially in the early stages of disease. This is due to the long incubation period, the variable lag phase associated with bacterial proliferation, and the multifocal distribution of slowly developing lesions. There are few previous studies of the early stages of experimental paratuberculosis in goats. In the present study, the ability of conventional diagnostic methods to detect M. a. paratuberculosis infection during the early stages of infection was assessed. Eight goat kids were experimentally infected with M. a. paratuberculosis and subjected to a series of immunological and bacteriological tests before being euthanatized at various times postinfection. At postmortem examination, the ages of the kids ranged from 1 1/2 to 12 months. Of the eight goats infected, three had histopathological evidence of paratuberculosis. Two of these goats were positive with bacteriology, but only one was also positive with all immunological tests. One animal had a positive immunological response, but infection could not be demonstrated by bacteriologic or histopathologic examination. Histopathologic lesions were found in the jejunum, in the ileum, and in one mesenteric lymph node, but only the mesenteric lymph nodes and one retropharyngeal lymph node gave positive results following bacteriologic culture. The disparity between the localization of histopathologic lesions and bacteriologic results emphasizes the need for exhaustive sampling to confirm a diagnosis during the early phase of an infection. It also highlights the need for a better understanding of the biology of M. a. paratuberculosis and its interaction with the immune system of the host.

Animals↗
PubMed2007

Retropharyngeal node metastasis from papillary thyroid carcinoma.

BACKGROUND: Papillary thyroid carcinomas commonly metastasize to paratracheal and jugular lymph nodes. Metastasis to the retropharyngeal node is rare for this tumor. METHODS: Five patients underwent surgical treatment for metastasis of thyroid papillary carcinoma to the retropharyngeal lymph nodes that presented as a parapharyngeal or retropharyngeal mass. All patients had a history of total or subtotal thyroidectomy as their initial treatment. Among them, 3 patients had undergone ipsilateral modified radical neck dissection at their initial treatment. The other 2 patients had a history of bilateral or ipsilateral modified neck dissection for their subsequent cervical lymph node metastases. RESULTS: Metastatic retropharyngeal nodes were successfully resected via transcervical approach in all patients. Although aspiration and difficulty in swallowing were observed in 2 patients after surgical treatment for metastatic retropharyngeal nodes, these complications spontaneously resolved within a few months. CONCLUSIONS: This study suggests that neck dissection and/or metastatic cervical lymph nodes might alter the direction of lymphatic drainage to the retrograde fashion, resulting in the unusual metastasis to the retropharyngeal lymph nodes. Although the cases described here are rare, metastasis to the retropharyngeal node should be considered at the follow-up for thyroid papillary carcinoma. Because these metastases will be missed by routine ultrasonography of the neck, periodic CT scan or MRI is recommended for follow-up, especially for patients with a history of neck dissection.

Adult↗