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PubMed1982

Plasmacytoma arising in giant lymph node hyperplasia.

Giant lymph node hyperplasia (GLNH) is generally thought to represent a benign process. A patient with GLNH of the chest wall had part of the lymph node replaced by large nodules of infiltrating plasma cells, and a serum paraprotein of the IgG lambda type. A peroxidase-antiperoxidase immunocytochemical technic showed that the plasma cells within areas of typical appearing GLNH were polyclonal, whereas those making up the nodular infiltrates were monoclonal. The observation of a plasmacytoma arising in this lesion demonstrates the neoplastic potential of GLNH.

Humans↗
PubMed2001

Anatomic study of the lymph nodes of the mesorectum.

PURPOSE: Lymph node involvement is the most important prognostic factor when staging patients with colorectal cancer. The probability of detecting metastasis grows with the number of nodes examined. However, the number of nodes found in surgical specimens varies substantially. We have therefore determined the number and distribution of lymph nodes in the mesorectum by cadaveric dissection. METHODS: Twenty formalin-fixed cadaveric pelvises were dissected (13 males). The search for lymph nodes was performed in a systematic way, from the division of the superior rectal artery following the smallest visible branches to the level of the anorectal ring. RESULTS: A total of 168 lymph nodes were found in 20 mesorectal blocks, with a mean (standard deviation) number per specimen of 8.4 (4.45). Lymph node size ranged from 2 to 10 mm. Distribution of lymph nodes in mesorectum was as follows: 120 nodes (71.4 percent) were found around the branches of the superior rectal artery proximal to the peritoneal reflection, and 48 nodes (28.6 percent) were found distal to the peritoneal reflection. Fourteen specimens (70 percent) had lymph nodes at the division of the superior rectal artery. CONCLUSIONS: The mean number of lymph nodes found in the mesorectum distal to the superior rectal artery division was 8.4. Most of these lymph nodes were proximal to the peritoneal reflection. The range found in the number of lymph nodes per case should be considered for use in the formulation of guidelines in anatomicopathologic studies of surgical specimens obtained after mesorectal excision.

Aged↗
PubMed1976

Mucocutaneous lymph node syndrome.

Mucocutaneous lymph node syndrome represents a series of clinical findings that has been observed primarily in Japanese children. The disease now appears to be migrating to this country. It involves the cervical lymph nodes, the skin, and mucus membranes. Although the course is usually benign and self-limiting, a number of deaths have resulted from coronary artery disease.

Acute Disease↗
PubMed1990

[Decision-making for lymph node excision in surgery of thyroid cancer. Extemporaneous examination of the external supraclavicular lymph nodes].

UNLABELLED: Modified neck dissection (MND) is not recommended for surgery of thyroid carcinoma (TC) in the absence of grossly involved nodes, except for medullary thyroid carcinoma, and clinical node recurrence in uncommon at follow-up (3% for us). But several authors report metastatic cancer in non-palpable nodes up to 70% on MND specimens. The fear of overlooking occult metastatic nodes prompted us to sample even normal appearing nodes and to rely on frozen sections (FS) to make a decision whether or not a MND should be done. PATIENTS AND METHODS: 130 among 300 consecutive patients operated for TC were submitted to supraclavicular node sampling with FS. All pathological varieties were covered. In 170 cases, sampling was not done purposely (lack of intraoperative diagnosis of carcinoma: 75) or for other reasons (absence of obvious nodes: 77; unavailable pathologist: 14; miscellaneous: 4). All specimens were reviewed by paraffin sections (PS). RESULTS: Among the 130 patients; 25 had gross metastatic node involvement, confirmed by FS+ and PS+; 1 had grossly equivocal nodes with FS- and PS+; 104 had grossly normal nodes. In 101 (97%) this was confirmed by FS- and PS-. In 3 (3%) FS was +, leading to MND, and PS confirmed metastatic involvement in 2. All 32 specimens of routine node sampling done in 1988 have been reviewed by serial cross sections, one each millimeter (331 sections). One only disclosed one occult metastatic invasion. CONCLUSION: No more than 3% of the grossly normal supraclavicular nodes are metastatic at the time of surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma↗
PubMed2000

Regional lymph node dissections in malignant melanoma.

Considerable controversy surrounds the application of regional lymphadenectomy in the treatment of cutaneous melanoma in patients with clinically negative nodes; however, therapeutic lymph node dissection for clinically positive nodes has shown clear benefits. Opponents of elective lymph node dissection (ELND) for clinically negative nodes believe that because 80% of patients with clinical Stage I disease have histologically negative nodes at the time of resection of the primary tumor, prophylactic excision of the regional nodes is unnecessary. Some clinicians have failed to demonstrate a survival advantage for ELND. With the recent introduction of sentinel lymph node dissection, it may be possible to select patients who are likely to benefit from ELND. The authors recommend ELND based on the identification of metastatic cells within the sentinel lymph node in all patients with primary melanomas with a thickness of at least 1.0 mm.

Elective Surgical Procedures↗
PubMed1997

Cords, channels, corridors and conduits: critical architectural elements facilitating cell interactions in the lymph node cortex.

The lymph node cortex is a critical site for encounter between recirculating T cells and their specific antigens. Due to its extreme plasticity, little is understood of the underlying functional unit of the lymph node cortex, the paracortical cord. The idealized paracortical cord (approximately 100 microns by 1000 microns) stretches from a medullary cord to the base of a B-cell follicle. In cross-section, a cord can be visualized as a set of nested cylinders consisting of spaces bounded by cells. The spaces are: i) the lumen of the high endothelial venule (HEV), ii) perivenular channels-narrow potential spaces (0.1 micron) tightly encircling the HEV, iii) corridors-broad spaces (10-15 microns) constituting the majority of the parenchyma, and iv) the cortical sinus. In addition to these spaces for cell traffic, the conduit (fifth space) is a special delivery system for the transit of soluble factors to the HEV and emigrating lymphocytes. The cellular barriers between these spaces are high endothelium, fibroblastic reticular cells, or sinus-lining cells. This review describes the spaces of the paracortical cord and their cellular boundaries, outlines the movement of cells and fluids through these spaces, and discusses how this anatomy affects the efficiency of surveillance by T cells.

Animals↗
PubMed1992

The enveloping of intercellular collagenous fibrils by reticular cell processes in postnatal development of rat lymph nodes.

In the lymph nodes of adult rats reticular fibers are known to be covered by the processes of reticular cells. This study aims to visualize the sequence of the envelopment of reticular fibers by reticular cells during development. Rat popliteal lymph nodes of one to twenty-three days after birth were examined by electron microscopy. At the earliest stages, collagenous protofibrils were found in the intercellular space between studded mesenchymal cells. The protofibrils clustered around the plasma membrane of immature reticular cells and then became arranged into microfibrils of 30-40 nm in diameter. Bundles of the fibrils which might be called reticular fibers were surrounded by processes of more than one reticular cell. Then the reticular fiber came to be enclosed by the cytoplasmic process of a single reticular cell. Finally at 16-23 days after birth, the reticular fiber was completely ensheathed by the thick cytoplasmic process of a single reticular cell closed with a junctional complex. Throughout these periods, basal lamina-like materials existed between the reticular fiber and cytoplasmic process. Clumps of fibrils were rarely in contact with leukocytes, including lymphocytes. Immature elastic fibers appeared among collagenous fibrils of the reticular fiber when the fiber came to be enclosed by processes of some reticular cells. It was shown that the enclosure of the reticular fiber by the reticular cell did not result from physical pressure due to the increase of the number of lymphocytes, but the reticular cell actively enclosed the reticular fiber.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

[The characteristics of the bronchopulmonary lymph nodes situated along the pathway of lymph flow from human lungs at different periods of postnatal ontogeny].

Histological slices of the bronchopulmonary lymph nodes have been stained after van Gieson, azur-II eosin, hematoxylin-eosin, silver nitrate impregnation after Foot. Certain peculiarities of their structure have been revealed. For intersegmental lymph nodes a narrow lumen of the marginal sinus (13.2 +/- 1.3 mcm), small amount of lymphoid noduli in the cortex (10.8 +/- 1.0 per section) are specific. Lobular and portal lymph nodes have a wider lumen of the marginal sinus (15.9 +/- 1.6 mcm) and greater amount of the lymphoid noduli in the cortex (17.5 +/- 1.6 per section), the latter situating in two or three rows.

Aging↗
PubMed2001

Use of in situ spermatic cord patch for inguinal lymph node dissection.

Inguinal lymph node dissection for diagnosis of metastatic squamous cell carcinoma of the penis can cause significant morbidity and mortality for patients due to local wound breakdown, lymphedema, and vascular erosion. Various methods have been described to cover exposed femoral vessels to preserve their integrity, the most common being transposition of the sartorius muscle. We describe the successful use of in situ spermatic cord for coverage of the femoral artery and vein after inguinal lymph node dissection for squamous cell carcinoma of the penis in two patients. To our knowledge, this has not been previously described and is a simple and successful alternative way to cover the femoral vessels after inguinal lymphadenectomy.

Aged↗
PubMed1975

Electrophoretic fractionation of guniea pig lymphocytes: evidence for different subsets of T and B cells in spleen and lymph node.

Guinea pig lymph node and blood lymphocytes have been physically fractionated in preparative cell electrophoresis into two functionally viable populations, the high mobility cell population (HMC) and the low mobility cell population (LMC). By using cell surface markers and functional tests known to be specific for T and B lymphocytes, respectively, it is shown that the T lymphocytes localize in the HMC population and the B lymphocytes in the LMC population. The spleen lymphocytes do not separate into the two populations. They move into one single broad peak containing both T and B cells. This finding indicates the presence of electrokinetically different subsets of T and B lymphocytes in the spleen on one hand and in the lymph node and blood on the other hand.

Animals↗
PubMedDate not supplied

Accuracy of pathologic techniques for the diagnosis of metastatic melanoma in sentinel lymph nodes.

BACKGROUND: Sentinel lymph node (SLN) biopsy can accurately predict the presence of metastatic melanoma (MM) and has been used to identify patients with occult metastases. We present an analysis of the sensitivity and specificity of standard pathological techniques including intraoperative frozen section, permanent section, and immunohistochemistry in diagnosing MM within the SLN. METHODS: Sixty-nine consecutive patients with primary malignant melanoma thickness of >1.0 mm or thinner lesions invading the reticular dermis (Clark level IV) who underwent SLN biopsy were reviewed. Lymph nodes were examined intraoperatively by frozen section (FS), permanent section (H&E), and by immunohistochemistry (IH) for S-100 protein and HMB45. RESULTS: MM was found in 14 of 69 cases (20%). Permanent section H&E was performed in all cases, FS in 64 cases, and IH in 65 cases. FS analysis diagnosed MM in 4 of 14 cases (29%), was suspicious in 2 of 14 (14%), and falsely negative (FN) in 8 of 14 (57%) ultimately found to be positive with further workup. Within the FN group, MM was identified on review of the original FS slides in 3 of 8 cases (38%). Furthermore, within the FN group, the remaining 5 cases were identified as positive for MM by either permanent and/or deeper H&E sections and IH. IH alone with permanent H&E sections would have diagnosed MM in only 8 of 10 cases (80%) that were FS negative or suspicious. In no cases was MM identified by IH alone with the permanent and deeper H&E sections being negative. It is noteworthy that no false-positive cases were identified. CONCLUSIONS: Intraoperative FS has low sensitivity in identifying MM within the SLN. IH alone does not increase the diagnostic yield. A combination of permanent H&E sections with deeper levels and S-100 and HMB45 IH dramatically increases the overall diagnostic sensitivity of SLN biopsy. Definitive diagnosis should await permanent H&E sections and IH staining.

Adult↗
PubMed1994

The unique ultrastructure of high-endothelial venules in inguinal lymph nodes of the pig.

Lymph nodes in pigs are unique in their inverted structure, with the medulla in the periphery and the cortex in central areas. Furthermore, in this species most migrating lymphocytes do not use the classical route via efferent lymphatics to leave the lymph node. High-endothelial venules (HEV) are the entry sites for lymphocytes and in pigs probably also the exit site for recirculating lymphocytes. Therefore, the blood vessels and especially the HEV of the pig superficial inguinal lymph node were investigated as to whether morphological peculiarities could be found in the vascular system, using vascular casting, transmission- and scanning electron microscopy. A thin layer of capillary network surrounded the periphery of the lymph node and HEV branched acutely. The endothelial cells of HEV possessed well developed cytoplasmic organelles, interdigitated with each other, and demonstrated local cell-cell contacts. There were unusual cells bridging the adluminal wall of HEV. These cells were called intravascular bridging cells. They were characterized by an often invaginated nucleus, few pinocytotic vesicles, many microvilli on the surface, wide, flat, cytoplasmic processes like a pseudopod, Weibel-Palade bodies and local cell-cell contacts with endothelial cells. The pseudopod-like processes ramified over the endothelial junctions and covered lymphocytes. Lymphocytes were seen in different phases of migration between endothelial cells and in the intercellular junctions. The previous functional studies on the peculiar route of lymphocyte recirculation in pig lymph nodes are extended by these morphological data, showing a unique structure of HEV in pigs.

Animals↗
PubMed1987

[An anatomical and pathological study of autopsy material on the metastasis of pancreatic cancer to para-aortic lymph nodes].

The purpose of the present study was to clarify the anatomy of the lymphatic system of the para-aortic region with special reference to lymphatic pathways from the pancreas, and the incidence and extent of lymphatic metastases of pancreatic cancer to para-aortic lymph nodes. Lymph nodes were found mostly on the bilateral and anterior sides of the aorta, and rarely on its posterior side. Lymphatic vessels from the pancreas (peripancreatic nodes) were closely related to the para-aortic lymph nodes on the bilateral and anterior surfaces of the aorta ranging from the root of the celiac artery and that of the inferior mesenteric artery. Out of 10 autopsy cases of relatively small pancreatic cancer, 4 cases were found to have microscopic metastases in a few para-aortic lymph nodes. The localization of involved para-aortic nodes was compatible with that of anatomically related para-aortic lymph nodes. Lymph node dissection of the para-aortic region, if carried out in a patient with a possibility of radical resection of the primary pancreatic cancer, should be an en bloc resection of lymph nodes and surrounding soft tissues in the area ranging between the root of the celiac artery and that of the inferior mesenteric artery.

Aged↗
PubMed1981

The sequence of changes in blood flow and lymphocyte influx to stimulated rat lymph nodes.

The rat popliteal lymph node was studied from 1 hr to 8 days after the footpad injection of either sheep erythrocytes or syngeneic rat erythrocytes. The following were measured relative to the contralateral (unstimulated) lymph node: (i) blood flow; (ii) lymph node weight; (iii) influx of lymphocytes from the blood; (iv) [3H]-thymidine incorporation; (v) [35S]-sulphate incorporation into macromolecular form (chiefly by high endothelial venules). After the arrival of sheep erythrocytes all five quantities showed substantial increases which began in a definite sequence. The blood flow started to rise first and may have been the main factor contributing to the later increase in lymphocyte influx. Increased sulphate incorporation began later than the rise in lymphocyte influx. After the injection of rat erythrocytes a small increase in lymphocyte influx was found without a corresponding increase in blood flow. In rats irradiated before the footpad injections lymphocyte influx increased three-fold after sheep erythrocytes, rat erythrocytes or PBS, again without a corresponding increase in blood flow. Thus while variation in blood flow to high endothelial venules is one important factor in determining the supply of lymphocytes to the lymph node other factors are operative in certain situations.

Animals↗