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PubMed2005

[Clinicopathologic features and prognostic factors of cervical lymph node metastasis in oral squamous cell carcinoma].

BACKGROUND & OBJECTIVE: The cervical lymphatic meta-static rate of oral squamous carcinoma is 50%-59%. The management of cervical lymphatic metastasis relates with prognosis of patients with oral squamous carcinoma. This study was to investigate the clinicopathologic features and prognosis factors of cervical lymph node metastasis in oral squamous cell carcinoma. METHODS: Clinicopathologic data of 191 patients with oral squamous cell carcinoma were retrospectively reviewed. The relationship between histopathologic factors and cervical lymph node metastasis was evaluated by univariate Chi(2) test. Cox regression model was used to analyze impacts of pathologic factors of cervical lymph nodes, such as metastatic status, size and number of positive neck nodes,levels of positive nodes, the lowest involved nodal level, on prognosis. RESULTS: The overall 5-year survival rate of the 191 patients was 48.7%. Univariate Chi(2) test confirmed that only depth of primary tumor infiltration correlated to cervical lymph node metastasis. Cox regression analysis revealed that clinical N stage, cervical lymphatic metastatic status, number of involved levels, and the lowest involved nodal level affected prognosis of patients, the most significant prognostic factors of cervical lymph node were clinical N stage, and the lowest involved nodal level. CONCLUSIONS: Cervical lymph node metastasis is a significant prognostic factor of oral squamous cell carcinoma. The identification of metastatic patterns of cervical lymph nodes, and the management targeting pathologic factors of cervical lymph node affecting survival are critical for improving the treatment effect on oral squamous cell carcinoma.

Adult↗

PubMedDate not supplied

Results of extended lymph node dissection for gastric cancer cases with N2 lymph node metastasis.

The therapeutic value of extended lymph node dissection (D2) for gastric cancer remains controversial. Limited lymph node dissection, however, leaves cancer cells in the second tier of nodes (N2) in patients with N2 metastasis. This retrospective study was, therefore, undertaken to clarify which patients would be most likely to benefit from D2 dissection, even with N2 metastasis. Two groups, N2 cases with (n = 40) and without (n = 24) the development of recurrence after curative surgery, were compared. Borrmann type IV and serosal invasion were significantly related to recurrence. The number of metastatic nodes did not differ significantly between the two groups. All (7/7) of the Borrmann type IV cases with N2 metastasis developed recurrence and died. However, one quarter (7/30) of the cases with serosal invasion and N2 metastasis showed no sign of recurrence. D2 dissection is a surgical treatment which offers the potential to cure gastric cancers, other than Borrmann type IV tumor, with N2 metastasis.

Female↗

PubMed1999

Cooccurrence of reduced expression of alpha-catenin and overexpression of p53 is a predictor of lymph node metastasis in early gastric cancer.

BACKGROUND AND OBJECTIVES: Even though the pathological background contributes to lymph node metastasis, the biological characteristics of tumors have also gained wide attention. In this study, the expression of the cadherin-catenin complex and p53 was studied in early gastric cancer. Their correlation with lymph node metastasis and the predictability of lymph node metastases, by combining these factors, were also discussed. METHODS: One hundred and one specimens obtained from surgery were studied by immunohistochemistry using monoclonal anti-E-cadherin, anti-alpha-catenin and anti-p53 antibodies. RESULTS: Expression of E-cadherin and alpha-catenin was reduced in 50.5 and 64.4%, respectively. p53 protein staining was positive in 29.7%. There was a significant correlation between E-cadherin and alpha-catenin expression, but no correlation was found between p53 expression and E-cadherin or alpha-catenin expression. A reduction in alpha-catenin expression and p53 overexpression correlated to lymph node metastases, respectively. Multivariate analysis showed that cooccurrence of reduced expression of alpha-catenin and overexpression of p53 was an independent factor indicating lymph node metastases. CONCLUSION: A study of both alpha-catenin and p53 expression may be helpful to predict lymph node metastases in early gastric cancer.

Adult↗

PubMed2006

Lymphovascular invasion is associated with lateral cervical lymph node metastasis in papillary thyroid carcinoma.

OBJECTIVES: The objective of this retrospective study to evaluate whether lymphovascular invasion (LVI) is associated with lateral cervical lymph node metastasis and tumor recurrence in papillary thyroid carcinoma (PTC). METHODS: We evaluated the medical records of patients with PTC who had undergone total thyroidectomy and subsequent I remnant ablation at Asan Medical Center, Seoul, Korea, from January 1997 thorough December 2000. RESULTS: A total of 662 patients (585 women and 77 men; mean age, 44.8 years) with PTC were enrolled in the study. Of these patients, 33 were found to have LVI. We found a significant association between LVI and lateral cervical lymph node metastasis at the time of initial surgery (P = .001). Multivariate analyses adjusting for clinicopathologic parameters known to predict recurrence such as age, gender, tumor size, extrathyroid extension, and multifocality also showed a significant association between LVI and lateral cervical lymph node metastasis. For the 633 patients without distant metastasis at the time of initial surgery, LVI was also significantly associated with tumor recurrence during the follow-up period (median, 68 months; range, 3-108 months): 29% versus 13.6% for patients with and without LVI, respectively (P = .048 by log-rank test). However, this association was lost on multivariate analyses adjusting for conventional clinicopathologic predictors of recurrence. CONCLUSIONS: In patients with PTC, LVI is associated with lateral cervical lymph node metastasis and clinical recurrence.

Adult↗

PubMed2005

Elevation of cyclooxygenase-2 is related to lymph node metastasis in adenocarcinoma of uterine cervix.

In a previous study, we demonstrated that elevation of COX-2 is significantly associated with lymph node metastasis in squamous cell carcinoma (SCC) of cervix. The main objective of this study is to characterize the relationship between elevation of COX-2 and its possible clinical role in adenocarcinoma (AC) of cervix. Using immunohistochemistry, we examined COX-2 expression levels in 84 patients with AC of uterine cervix [71 ACs, 13 adenosquamous carcinomas (ASCs)]. Elevation of COX-2 was correlated with clinicopathological variables and p53 expression, as detected by immunohistochemistry. Elevation of COX-2 was detected in 13.0% (11 of 84) of the tumors. Elevation of COX-2 was significantly correlated with histologic type (AC 8.5% vs. ASC 38.5%, P=0.011). Both tumor stage and lymph node metastasis were correlated with elevation of COX-2 with a borderline significance (P=0.062 and 0.068, respectively). Elevation of p53 was not associated with elevation of COX-2. The association between lymph node metastasis and elevation of COX-2 was stronger in cases of AC than in cases of ASC (28.4 vs. 4.3%, P=0.023). According to the results of univariate analysis, elevation of COX-2 was significantly associated with decreased overall survival (P=0.003, log-rank test). However, multivariate analyses revealed that only tumor stage was independently associated with overall survival, suggesting that elevation of COX-2 itself may not be an independent prognostic factor. The present study shows that elevation of COX-2 may contribute to lymph node metastasis in AC of uterine cervix. This suggests that the potential therapeutic role of COX-2 inhibitors should be validated, not only in SCC, but also in AC of uterine cervix.

Adenocarcinoma↗

PubMed2005

[Investigation for cervical lymph node metastasis in unknown primary sites].

In patients with cervical adenopathy, especially, those of cervical lymph node metastasis with no detectable primary tumor, diagnosis and treatment planning can become confused. We evaluated 36 patients with cervical lymph node metastasis of unknown origin between 1985 and 2002. Primary sites were detected in 20 before treatment. The other 36 patients clearly had no primary lesions when treatment started. Primary sites were 5 cases of oropharynx, 2 of the parotid gland, and 1 each of larynx, nasopharynx, hypopharynx, and malignant lymphoma detected in 11 after treatment for cervical lymph nodes. No primary lesion was found in 28 patients. The neck LN stage was N1 in 11 patients, N2 in 29, N3 in 11, and unknown in 8. To detect the primary site, we conducted "random" biopsy, panendoscopy, and radiographic evaluation including FDG-PET. Biopsy sites were the nasopharynx, palatine and lingual tonsil, and piriform sinus. Some 35 patients (59.3%) underwent random biopsy, and primary sites were found this way in 5 patients (14.3%). The 36 who had no primary lesion were treated for cervical lymph nodes, of whom 24 underwent neck dissection. Chemotherapy and radiotherapy were the treatment of choice in many cases. We analyzed 31 patients for 5 year survival. Overall survival was 63.7%, disease-specific survival 69.2%, and disease-free survival 46.8%. In another analysis a statistically significant difference was seen in survival among patients who had neck surgery or not (85.7% vs. 38.9%, p = 0.029; log rank test). Analysis suggested that primary sites should be studied by CT, MRI, FDG-PET, and panendoscopy, including random biopsy. The primary site cannot be detected, treatment should initially involve cervical adenopathy with combined surgery, chemotherapy, and radiotherapy. After treatment, the patient should be followed up carefully to find the primary lesion.

Biopsy, Needle↗

PubMed2006

Candidates for curative resection in advanced gastric cancer patients who had equivocal para-aortic lymph node metastasis on computed tomographic scan.

BACKGROUND: The aim of this study was to determine how to select potential candidates for curative resection among advanced gastric patients with equivocal findings of para-aortic lymph node metastasis on computed tomography (CT). METHODS: We analyzed the clinicopathologic results of 23 advanced gastric cancer patients who were diagnosed as having equivocal findings of para-aortic lymph node metastasis on a CT scan and who underwent gastrectomy with D2 and para-aortic lymph node dissection. RESULTS: Twenty-two patients were male, and one patient was female. The median age of all study subjects was 52 years (range, 31-75 years). Sixteen underwent total gastrectomy, and seven underwent subtotal gastrectomy. The median number of A2 (suprarenal) lymph nodes harvested was 2 (range, 1-5), and that of B1 (infrarenal) lymph nodes was 6 (range, 1-17). Ten (43.5%) of the 23 patients were proven pathologically to have metastasis to para-aortic lymph nodes. Two patients with cT2 cancer had no metastatic para-aortic lymph node, whereas three patients with cT4 disease had metastatic para-aortic lymph nodes (P = .021). Seven (70.0%) of 10 patients with pathologic para-aortic lymph node metastasis experienced recurrence, whereas only 2 (15.4%) of 13 patients without experienced recurrence (P = .008). The Lauren classification was found to be an independent predictor of para-aortic lymph node metastasis (relative risk; .13; 95% confidence interval, .02-.83; P = .03). CONCLUSIONS: More than half of gastric cancer patients with equivocal findings of para-aortic lymph node metastasis on CT are potential candidates for curative resection. The Lauren classification of gastric cancer in patients with equivocal CT findings of para-aortic lymph node metastasis would be helpful when deciding on clinical stage and treatment plans in these patients.

Adult↗

PubMed2004

[Diagnosis of lateral cervical lymph node metastasis of papillary carcinoma of the thyroid by ultrasonography].

No consensus for papillary carcinoma of the thyroid exists on the preoperative diagnosis of lateral cervical lymph node metastasis, indications, or range of neck dissection, so we studied the usefulness and limits of ultrasonography and sufficient dissection by comparing preoperative ultrasonographic and postoperative histopathological diagnosis. Subjects were 45 patients (51 affected sides) with lateral cervical lymph node metastasis of papillary carcinoma of the thyroid who underwent modified neck dissection between July 1997 and July 2003. Preoperative ultrasonographic and postoperative histopathological diagnosis were compared. Specimens excised by neck dissection contained 1,325 lymph nodes. Of these, 198 (15%) detected by preoperative ultrasonography were selected for investigation of diagnostic criteria for metastasis-positive lymph nodes. The best criterion for the diagnosis of metastasis-positive lymph node was 0.5 or greater [minor axis/major axis] with 6 mm or greater minor axis at levels III, IV, or V (7 mm or greater at level II), and sensitivity, specificity, and accuracy were 78%, 100%, and 84% respectively. The lateral cervical lymph node metastasis rate obtained by this diagnostic criterion was 41%. Regional histopathological metastasis positivity was investigated in the lateral cervical region, and high positivity rates were obtained: 57% at level II, 71% at level III, and 84% at level IV. Considering these findings and the preoperative ultrasonographic diagnosis rate of 41%, sufficient dissection at levels II-IV may be necessary for patients in whom lateral cervical metastasis is observed before surgery. The metastasis rate was 10% at level V, but dissection should always be done in lateral cervical metastasis-positive patients because: 1) No trend was observed in age, gender, the number of metastatic lymph nodes, or regional metastasis rate; 2) no anatomical boundary is present between levels II, III, IV and level V; 3) no functional disorder due to preservation of the accessory nerve occurred; 4) the prognosis of patients with advancement to the accessory nerve was poor; and 5) improvement of the prognosis of papillary carcinoma of the thyroid by modified radical neck dissection has been reported.

Adolescent↗

PubMed2001

Lymph node metastasis and preoperative diagnosis of depth of invasion in early gastric cancer.

BACKGROUND: No reports have, to date, focused on the relationship between preoperative determination of the depth of invasion and lymph node metastasis. The present study, under the leadership of the Japanese Gastric Cancer Association, was designed to form a basis for decision making in limited treatment for early gastric cancer (EGC). METHODS: From eight major hospitals in Japan, 2672 gastric cancers whose preoperative depth of invasion was mucosal(M-cancer), and 6209 EGCs, consisting of 3584 mucosal(m-) and 2625 submucosal(sm-) cancers, were collected by questionnaire. All registered patients underwent gastrectomy with D1 or more extensive lymphadenectomy between 1985 and 1998. RESULTS: The accuracy of preoperative diagnosis of depth of invasion of M-cancers was 80.2% (2144/2672). However, of the total of 2432 M-cancers in which no nodal involvement was observed intraoperatively (N0), histological examination of the resected specimens confirmed that lymph node metastasis was absent in 2353 (96.8%). The frequencies of lymph node metastasis in early gastric, m-, and sm-cancers were 8.9%, 2.5%, and 17.6%, respectively. Node involvement was associated with a higher frequency of undifferentiated than differentiated histology, as well as with greater tumor size. The incidences of lymph node metastasis in m-cancers with a diameter of less than 4 cm, and in sm-cancers with a diameter below 1 cm were 1.3% (37/2837) and 4.9% (4/82), respectively. These metastases rarely extended beyond the first tier. CONCLUSION: N0 and M-cancers, m-cancers less than 4 cm in diameter, and sm-cancers no larger than 1 cm in diameter may be appropriate indications for limited surgery.

Chi-Square Distribution↗

PubMed1992

[Immunohistological investigation of type IV collagen in the basement membrane surrounding the cancer nest (cancer nest membrane) of head and neck squamous cell carcinoma--its relation to frequency of cervical lymph node metastasis].

Lymphoducts and blood vessels exist in the stroma, while none can be detected in the cancer nest itself within cancerous tissue. This explains why metastasis of carcinoma cannot occur without the escape of tumor cells through the basement membrane surrounding the cancer nest into the stroma. Accordingly, observation of the continuity of the basement membrane, what we call the cancer nest membrane, is essential for elucidating the first step of metastasis. Since type IV collagen is the most important structure composing the basement membrane, investigation of the immunohistological localization and continuity of type IV collagen is of value in predicting the metastatic aggressiveness of squamous cell carcinoma. We therefore studied biopsy tissues from the advancing lesion of head and neck squamous cell carcinoma in 95 untreated patients. The tissues were fixed in 85% ethanol and embedded in paraffin, and 5-um thin sections prepared were then immunohistochemically stained for type IV collagen by the ABC method for observation of the continuity status of the cancer nest membrane in relation to metastasis. The basement membranes of normal mucosal epithelium and normal interstitial capillaries were utilized as positive controls, and negative controls were obtained by using PBS in place of the primary antibodies for the immunohistochemical reaction. Membrane discontinuity (breaks or absence) correlated significantly with cervical lymph node metastasis, while intact membrane was associated with a low frequency of cervical lymph node metastasis. There was no obvious relation between the clinical T category and the continuity of the membrane; pN (+) carcinomas with membrane discontinuity included even T1 supraglottic and hypopharyngeal carcinomas, as well as T2 or higher oral mucosal carcinomas and T3 or higher glottic carcinomas, suggesting variation with tumor site. Hypopharyngeal and supraglottic carcinoma was associated with membrane discontinuity and a high incidence of cervical lymph node metastasis. On the other hand, glottic and oral carcinoma more often presented with intact membranes and had a lower incidence of metastasis, although carcinomas in these sites that did present with discontinuity of the membrane were associated with a high incidence of cervical metastasis. Therefore, observation of the continuity of the cancer nest membrane by the expression of type IV collagen may be useful in selecting better specific therapies and determining the necessity of prophylactic neck dissection. A correlation between the degree of tumor differentiation and the continuity of the membrane was also found; well-differentiated tumors with discontinuity of the membrane were frequently associated with cervical lymph node metastasis.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed2001

Cathepsin D expression as a possible predictor of lymph node metastasis in submucosal colorectal cancer.

The aim of this study was to clarify the usefulness of cathepsin D expression as a predictor of lymph node metastasis in submucosal colorectal cancer (CRC). Cathepsin D expression was examined immunohistochemically in cancer and stromal cells located at the deepest portion of 254 invasive tumours that had been resected from patients with submucosal CRC. In cancer cells, the expression was classified according to differences in intracellular localisation: polarity positive, apical type (PA); polarity positive, basal type (PB); polarity negative (PN); or no expression (NE). Lesions with PN or NE expression showed a significantly higher incidence of lymph node metastasis than those with PA or PB expression. Alternatively, lesions with positive expression in stromal cells showed a significantly higher incidence of lymph node metastasis than that of those with negative expression. None of the lesions with PA or PB expression and negative expression in stromal cells had metastasised to the lymph node. In conclusion, analysis combining cathepsin D expression in cancer and stromal cells may be a quite useful predictor for lymph node metastasis and may broaden the indications for curative endoscopic treatment of submucosal CRC.

Analysis of Variance↗

PubMed2002

[Rule of lymph node metastasis in the cancer of mouth floor and its treatment].

BACKGROUND & OBJECTIVE: There was little report on the rule of lymph node metastasis in the cancer of mouth floor. The aim of this study was to investigate the rule of lymph node metastasis and investigate the reasonable treatment. METHODS: A total of 79 cases with squamous carcinoma of mouth floor were included into this study retrospectively. The distributive difference of clinical and pathological positive lymph node was compared. The recurrent rate of the patients who were performed with radical neck dissection and supra-half-neck dissection in clinical positive lymph node group were compared with the recurrent rate of the patients who were preformed with radical neck dissection, supra-half-neck dissection, submandibular triangle dissection, and clinical observational group. RESULTS: Clinical and pathological positive lymph node was found mainly in II region (61.8% and 40.0%, respectively), secondly in I and/or III region, and rarely in IV, V, and VI region. In clinical positive lymph node group, the recurrent rate of the patients who performed with radical cervical neck dissection was lower than supra-half-neck dissection, but without statistical significance (chi 2 = 3.403, P = 0.065). In clinical cervical negative lymph node group, the recurrent rates of the patients performed with supra-half-neck, submandibular triangle dissection, and in clinical observational group were 11.1% (1/9), 40.0% (2/5), and 23.5% (4/17), without statistical significance (chi 2 = 1.554, P = 0.46). CONCLUSION: Lymph node metastasis of cancer of floor of mouth mainly distributes in I, II, III region; The patients with negative cervical lymph node should be performed lymph node dissection in I, II, III region (supra-half-neck).

Adult↗

PubMed2005

[Distribution of cervical lymph node metastasis in patients with cN1 supraglottic cancer].

OBJECTIVE: To study the characteristics of the cervical lymph node metastasis of patients with cN1 supraglottic cancer and to elucidate which levels should be involved during neck dissection. METHODS: Modified neck dissections or radical neck dissections were performed for 108 cases (147 sides) of cN1 supraglottic cancer. All the lymph nodes of the samples of 147 operation sides were examined pathologically to identify the metastatic levels. RESULTS: Among samples of 108 cases (147 sides), 126 lymph nodes were metastasis, among which 113 lymph nodes were located in levels II and III (89.7%, 113/126), and 123 lymph nodes in levels II, III and IV (97.6%, 123/126). The 126 metastatic nodes were distributed in the 109 levels and 96 of them were in the levels II and III (88.1%, 96/109) and 106 were in the levels II, III and IV (97.2%, 106/109). Additionally, 45 cases (63 sides) of the 108 patients were pathologically metastasis (41.7%) and bilateral cervical metastasis occurred in 20 cases (18.5%). The cervical recurrent rate was 7.4% (8/108) and occurred in the levels II, III and IV respectively, during five to fourteen years follow-up. CONCLUSION: Levels II, III and IV dissection may be reasonable for patients with cN1 supraglottic carcinomas, levels I and V dissection may be avoidable when pathological evidence of metastasis in levels I and V has not been obtained. Contralateral lymph node dissection at the levels II, III and IV should be performed in the case of ipsilateral pN + or contralateral metastasis cN1.

Adult↗

PubMed2005

Prospective analysis of patients with adenocarcinoma of the gastric cardia and lymph node metastasis in the proximal field of the chest.

BACKGROUND: The extent to which adenocarcinoma of the cardia with lymph node metastasis in the upper mediastinum is amenable to cure by radical surgery is open to debate. It remains unclear whether these relatively distant metastases have an effect on long-term survival. The aim of this study was to identify the incidence of such positive nodes and evaluate their prognostic significance. METHODS: Some 50 patients with adenocarcinoma of the gastric cardia and substantial invasion of the oesophagus (junctional type II), who underwent an extended transthoracic oesophagectomy as part of a prospective randomized trial between 1994 and 2000, were studied. RESULTS: Eleven patients (22 per cent) had lymph node metastasis in the proximal field of the chest. These patients had more positive nodes overall (P = 0.020) and a shorter median survival (P = 0.009) than those without such metastasis. Multivariate analysis identified positive nodes in the proximal field as an independent predictor of poor survival. CONCLUSION: Lymph node metastasis in the proximal field of the chest is common and is an indicator of poor prognosis in patients with adenocarcinoma of the cardia.

Adenocarcinoma↗

PubMed2000

[Characteristics of lymph node metastasis of squamous cell carcinoma of thoracic esophagus and its clinical significance].

OBJECTIVE: To study the characteristics of lymph node metastases of squamous-cell carcinoma of thoracic esophagus and its influence on patients' prognosis and find reasonable dissecting approaches of lymph nodes. METHODS: To analyse retrospectively the clinical materials of 243 patients who had undergone resection of squamous-cell carcinoma of thoracic esophagus. RESULTS: Lymph node metastases was found in 110 of the 243 treated patients (45.3%). In 3,813 lymph nodes dissected, metastases existed in 400 (10.5%). The cancer cells disseminated upward and downward to lymph nodes along the esophagus. Tumor differentiation and the depth of tumor invasion were factors influencing lymph node metastases, but the length of tumor was not. The 5-year survival rate of the patients with lymph node metastasis was 16.4%, being much lower than that of patients with no lymph node metastasis (51.9%). The numbers of lymph node metastases had little influence on patients' prognosis. CONCLUSION: Because of the different upward and downward spreading of esophageal cancer cells to the lymph nodes, different lymph node dissecting approaches should be taken. The thoracic, and abdominal regional (two fields) lymph nodes dissection could be appropriate to esophageal carcinoma of the lower thoracic segment, and the cervical, thoracic and abdominal (three fields) lymph node dissection should be done for patients with earlier esophageal carcinoma of upper or middle thoracic segments.

Adult↗

PubMed2006

Is risk of axillary lymph node metastasis associated with proximity of breast cancer to the skin?

INTRODUCTION: Risk of axillary lymph node metastasis, the most important predictor of disease-free and overall survival in breast cancer patients, is estimated primarily from histologic features of the primary cancer including tumor size, histologic type and grade, and hormone receptor expression. Based upon a clinical impression, and research showing that palpable cancers are more likely to be node positive, we hypothesized that primary breast cancers more proximal to the skin of the breast are more likely to be positive for axillary lymph node metastasis. METHODS: This is a retrospective medical record review of 209 women with stage T1 or T2 (</=5.0 cm) invasive breast cancer who received dedicated breast ultrasound at a single mammography clinic in Columbia, South Carolina, between 1997 and 2002. RESULTS: None of the 26 cancers more than 14 mm from the skin had metastasized to axillary lymph nodes. In logistic regression modeling only tumor size, histologic grade and tumor proximity to the skin (as a categorical variable) were significantly associated with odds of axillary metastasis. Among cancers within 14 mm of the skin, proximity was not an independent predictor. CONCLUSIONS: Stage T1 and T2 breast cancers located less proximally to the skin may be less likely to spread to the axillary lymph nodes. We observed what appears to be a threshold at approximately 14 mm from the skin (based upon this group of patients): none of 26 cancers below this level had spread to axillary nodes. Further research is needed to confirm these provocative findings.

Aged↗

PubMed2003

Minute gastric carcinoid tumor with regional lymph node metastasis.

We report a patient with a minute gastric carcinoid tumor with lymph node metastasis, and a small gastric cancer. A 50-year-old man having a diagnosis of an elevated lesion on the anterior wall of the gastric body, detected by a series of upper gastrointestinal examinations, was referred to the Cancer Institute Hospital. Careful upper fluoroscopy disclosed a small superficial depressed lesion with converging folds and a superficial elevated lesion covered with nonspecific gastric mucosa. With a final preoperative diagnosis of depressed early cancer and minute carcinoid tumor of the stomach, made by upper gastrointestinal examinations including biopsy, the patient underwent segmental gastrectomy and perigastric lymph node dissection. Histological examination of the resected specimen revealed a lymph node metastasis from a gastric carcinoid tumor of 5-mm diameter, in addition to an early gastric cancer of poorly differentiated adenocarcinoma. Small gastric carcinoid tumors have been regarded as being benign neoplasms biologically. However, the case we present suggests that attention should be paid to the possibility of metastasis at the time of treatment for a minute sporadic gastric carcinoid tumor. We therefore discuss the malignant potential of these tumors, mainly from the viewpoint of histopathological classification, to gain understanding so that the patients can be treated adequately.

Adenocarcinoma↗

PubMed2006

Clinical significance of lymph node metastasis of thyroid papillary carcinoma located in one lobe.

BACKGROUND: Previous studies have shown that lymph node metastasis can be of prognostic value. In this study, we investigated the clinical significance of node metastasis focusing on metastasis in the central compartment for patients with papillary carcinoma located in one lobe. PATIENTS AND METHODS: We investigated the frequency of lymph node metastasis in 759 patients with papillary carcinoma to determine whether and how such metastasis affects disease-free survival (DFS). RESULTS: Central node metastasis was observed in 63% of patients, and the frequency was increased in relation to tumor size. The frequency of lateral node metastasis was 62.0%, which was also directly related to tumor size. On multivariate analysis of cases showing tumor larger than 1 cm, central node metastasis was recognized as an independent prognostic factor of DFS. The frequency of metastasis to the paratracheal nodes contralateral to the tumor was drastically elevated for tumors larger than 1 cm, but metastasis to this region did not independently predict worse DFS. CONCLUSION: Central node metastasis independently predicts a worse DFS for patients with papillary carcinoma larger than 1 cm.

Adult↗