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PubMed1986

[Vascular invasion, lymph node metastasis and extraglandular extension of well-differentiated carcinoma of the thyroid].

Forty-five surgically removed thyroid glands with well-differentiated carcinoma were histologically analyzed to clarify the relationships among vascular invasion, lymph node metastasis and extraglandular extension. Using Victoria blue-HE stain, vascular invasion can be detected as the evident finding of circular elastic fibers surrounding the cancer cluster. In our series, 60% of the subjects were positive for vascular invasion. Patients with vascular invasion tend to show lymph node metastasis and/or extraglandular extension. This correlation was statistically significant. Therefore, in a patient with lymph node metastasis and/or extraglandular extension, there is a greater possibility of vascular invasion being present as well.

Adult↗
PubMed1998

Classification of regional lymph node metastasis from gastric carcinoma. German Gastric Cancer Study Group.

BACKGROUND: Classification of lymph node metastasis from gastric carcinoma was based on the localization (International Union Against Cancer/American Joint Committee on Cancer [UICC/AJCC] 1992). The authors analyzed the data of the German Gastric Cancer Study (GGCS) to determine whether the number of involved lymph nodes related to the prognosis independent of their anatomic localization (UICC/AJCC 1997). METHODS: For 477 patients of the GGCS resected for cure (UICC/AJCC R0 resection) who had involved regional lymph nodes and no evidence of distant metastases, the 1992 UICC/AJCC classification was compared with the new UICC/AJCC classification (1997) based on the number of involved lymph nodes (ILN). RESULTS: Two hundred fifty-eight patients (54.1%) had 1-6 ILN, 137 patients (28.7%) had 7-15, and 82 patients (17.2%) had more than 15. When the 1992 and 1997 UICC/AJCC classifications were compared, the prognosis of patients classified as pN1 (n = 187) in the 1992 pN classification was homogeneous, whereas there was a marked lack of homogeneity among the patients classified as pN2 (n = 290). For 103 of 290 patients with 1-6 ILN, the prognosis appeared to be more favorable (5-year survival rate, 45.5%), whereas 137 of 290 patients with 7-15 ILN had an intermediate prognosis (5-year survival rate, 29.7%). Eighty-two of 290 patients had a dismal prognosis, with a 5-year survival rate of 10.4%. There was a highly significant difference in survival (P < 0.0001). Within the groups with 1-6, 7-15, and more than 15 ILN, the localization of ILN did not significantly alter the prognosis. CONCLUSIONS: The UICC/AJCC classification based on the number of involved regional lymph nodes allows for an estimation of prognosis superior to the 1992 classification. In addition, the new classification can now be applied without methodologic problems and seems more reproducible.

Carcinoma↗
PubMed2000

Predication of axillary lymph node metastasis by intravenous digital subtraction angiography in breast cancer, its correlation with microvascular density.

Accurate predication of axillary node status by non-invasive diagnostic method would be of great value in cases of breast cancer. There have been few reports advocating digital subtraction angiography (DSA) as specifically advantageous for the detection of lymph node metastasis. IV (intravenous)-DSA was carried out on 42 patients with breast carcinoma using a DSA system with a matrix of 1024 x 1024 pixels. When a mass became stained in the axilla, it was considered to be metastatic. An immunohistochemical technique with JC70 antibody to platelet/endothelial cell adhesion molecules was used to evaluate the microvascular density (MVD) of the axillary lymph nodes. IV-DSA achieved a 76.2% sensitivity, 85.7% specificity, and 81.0% accuracy. The average MVD with JC70 antibody was 97.7 +/- 44.4 in metastatic and 62.9 +/- 23.6 in nonmetastatic nodes. MVD was significantly higher in the cancerous than in the noncancerous regions within lymph nodes. The MVD was 105 +/- 38.4 in DSA-N(+) cases and was 57.8 +/- 21.9 in DSA-N(-) cases, and the difference was statistically significant. In conclusion, IV-DSA is a useful diagnostic modality for detection of axillary lymph node metastasis. This new modality predicts lymph node status by assessing the neovascularization of the lymph node.

Adult↗
PubMed1985

[Quantitative and qualitative analysis on the lymph node metastasis of carcinoma of the esophagus].

The results of quantitative and qualitative analysis of lymph nodes dissected during resection of the esophageal carcinoma are as follows. The rate of positive lymph nodes per number of cases was 51.3% (120/234 patients). The rate of positive lymph nodes per number of nodes examined was 15.9% (406/2548 nodes). The correlation between the n-number and the average number of positive lymph nodes for a patient is shown. In the cases in which tumors disappeared from the adventitia of the esophagus by pre-operative radiation, the rate of positive lymph nodes per number of cases and of nodes examined were less than other cases. The metastases in the distant lymph nodes were much less. In the cases in which tumors reached the surgical margin on the adventitia side of the esophagus, the rate of positive lymph nodes per number of cases and of nodes examined were more than others. The metastases in the distant lymph nodes were much more. The pre-operative radiation had no influence on the spreading of the lymph node metastasis. The n-number, the number of positive lymph nodes and of dissected nodes, and the rate of them for each patient had great influence on long-term results.

Adult↗
PubMed1996

[Genetic diagnosis of pelvic lymph node metastasis using fine needle aspiration samples in prostate cancer].

We have developed a highly sensitive method to detect pelvic lymph node metastasis using the reverse transcriptase-polymerase chain reaction (RT-PCR) with primers specific for prostate-specific antigen (PSA) gene. Fine needle aspiration biopsy (FNAB) of pelvic lymph nodes was performed in 24 patients with prostate cancer. Each aspirated sample (0.05-0.1 ml) was divided into 2 parts; one for RNA extraction and RT-PCR to detect the fragment of PSA mRNA, and the other to smear on a slide glass for conventional cytology. The PSA gene was detected by RT-PCR in 11 FNAB samples which included not only all 6 cytologically positive and 2 cytologically class III cases but also 3 of 16 cytologically negative cases. The PSA gene was not detected by RT-PCR of FNAB samples in any of the 20 cases of bladder cancer. Thus RT-PCR for detection of the PSA gene in FNAB samples may be useful as a new diagnostic technique for detection of early lymph node metastasis in prostate cancer and an additional tool for cytological diagnosis of prostate cancer.

Aged↗
PubMed1987

[A case of spontaneous peripelvic extravasation associated with ureteral stenosis caused by retroperitoneal lymph node metastasis of ascending colon cancer].

A case of spontaneous peripelvic extravasation associated with ureteral stenosis caused by retroperitoneal lymph node metastasis of the ascending colon cancer is reported. A 47-year-old woman complained of colic on right costa-vertebral angle. Excretory urograms showed right peripelvic extravasation and CT-scan showed urinoma formation around right kidney. Subsequent examination of right retrograde pyelo-ureterograms showed ureteral stenosis at sacro-iliac region. Operative findings revealed ureteral stenosis caused by retroperitoneal lymph node metastasis of ascending colon cancer, which was regarded as inoperable. There are a few reports of spontaneous peripelvic extravasation caused by a malignant tumor in Japanese literature. Twenty of them are reviewed.

Adenocarcinoma↗
PubMed2003

Adrenocorticotropin-producing pulmonary tumorlets with lymph node metastasis.

A case of pulmonary tumorlets with ectopic adrenocorticotropin (ACTH) production and lymph node metastasis in a bronchiectatic patient is reported. A 65-year-old man underwent right lower lobe lobectomy because of a sudden attack of cough and hemoptysis. Histological study revealed multiple discrete uniform small nests of tumor cells surrounding dilated bronchioles. Tumor nests were also found in the hilar lymph node. Immunohistochemically, the proliferating cells were confirmed to be neuroendocrine in origin with ectopic ACTH production, despite being clinically silent. The findings in the present case suggest that the clinical behavior of pulmonary tumorlets may be like a carcinoid, and need to be treated as tumor-like lesions. Ectopic hormonal production in the present case suggests pulmonary tumorlets should be considered in the differential diagnosis of Cushing's syndrome.

Adrenocorticotropic Hormone↗
PubMed1986

[Cytophotometric DNA analysis of gastric carcinoma--relationship between DNA ploidy and lymph node metastasis].

Two hundred forty-four cases of gastric carcinoma were subjected to cytophotometric DNA analysis. DNA distribution patterns were roughly classified into low and high ploidies. The ratio of high ploidy was 55.7% (44/79) in the positive group of lymph node metastasis, which was significantly higher than 31.5% (52/165) in the negative group (P less than 0.01). The incidence of lymph node metastasis increased rapidly in the high ploidy cases with the progression of carcinoma, while it increased slowly in the low ploidy cases. DNA ploidy was well correlated with lymph node metastasis, and the mode of metastasis seemed to be different between the low and high ploidy groups.

Cytophotometry↗
PubMedDate not supplied

Association of tumor cell proliferation with lymph node metastasis in early gastric cancer.

Recently, many studies have reported on the relationship between malignant potential of neoplasms and cell proliferation. Proliferating cell nuclear antigen (PCNA) is an auxiliary protein of DNA polymerase delta and is considered to correlate with the cell's proliferative state. In this study, we investigated the correlation between tumor cell proliferation and nodal status of early gastric carcinoma. One hundred two endoscopically biopsied specimens from patients with early gastric carcinoma prior to operation were investigated by an immunohistochemical study, using anti-PCNA monoclonal antibody. Correlation of PCNA labeling index (percentage of positive cells per over 500 tumor cells) with nodal status were studied. PCNA labeling index in patients with lymph node metastasis was significantly higher in those without metastasis. Moreover, multivariate analysis indicated that PCNA labeling index is an independent significant factor for lymph node metastasis. As a result of this study, PCNA labeling index was suggested to be effective as one of the predictors of lymph node metastasis.

Adult↗
PubMed1999

All patients with small intramural rectal cancers are at risk for lymph node metastasis.

PURPOSE: Although local excision can be curative in patients with early-stage rectal cancer, approximately 20 percent of patients will develop local recurrence, many as a result of unrecognized and unresected regional lymph node metastases. Our objective was to determine if standard pathologic factors can predict lymph node metastases in small intramural rectal cancers and provide a basis for patient selection for nonradical surgery. METHODS: Between June 1986 and September 1996, 318 patients with T1 or T2 rectal cancers underwent radical resection at our institution. Of these, 159 patients (48 T1 and 111 T2) were potentially eligible for curative local excision (< or =4 cm in size, < or =10 cm from the anal verge, no synchronous metastases), and the prevalence of lymph node metastases based on T stage and other pathologic factors was analyzed in this group. RESULTS: The overall frequency of lymph node metastasis was 15 percent (24/159 patients). T stage (T1, 10 percent; T2, 17 percent), differentiation (well-differentiated or moderately differentiated, 14 percent and poorly differentiated, 30 percent), and lymphatic vessel invasion (lymphatic vessel invasion-negative, 14 percent and lymphatic vessel invasion-positive, 33 percent) influenced the risk of lymph node metastasis. However, only blood vessel invasion (blood vessel invasion-negative, 13 percent and blood vessel invasion-positive, 33 percent) reached statistical significance as a single predictive factor (P=0.04). Tumors with no adverse pathologic features (low-risk group) had a lower overall frequency of lymph node metastasis (11 percent) compared with the remaining tumors (high-risk group, 31 percent; P=0.008). However, even in the most favorable group (T1 cancers with no adverse pathologic features) lymph node metastases were present in 7 percent of patients. CONCLUSION: In rectal cancer patients potentially eligible for local excision, the overall risk of undetected and untreated lymph node metastases is considerable (15 percent). The use of pathologic factors alone after local excision does not reliably assure the absence of lymph node metastases.

Adenocarcinoma↗
PubMed2005

Pre-tracheal lymph node metastasis in squamous cell carcinoma of the thoracic esophagus.

AIMS: To clarify the incidence of pre-tracheal lymph node metastasis in squamous cell carcinoma of the esophagus, and their impact on survival. METHODS: A cohort of 101 patients with squamous cell carcinoma of the thoracic esophagus who underwent esophagectomy together with 2-field lymphadenectomy including the pre-tracheal region was analysed, retrospectively. The p-TNM staging included stage I in 9, stage IIa in 33, stage IIb in 4, stage III in 43, and stage IV in 12 cases. RESULTS: Nodal metastases were identified in 56 patients (55.4%). Subcarinal lymph node and pre-tracheal lymph-node metastases were found in 24 patients (23.8%) and 15 patients (14.9%), respectively. The 5-year cumulative survival rates were 26.5 and 2.5% in nodal negative and nodal positive patients, respectively. Patients with pre-tracheal nodal metastasis all died within 2 years. Cox proportional hazards model in patients with nodal involvement revealed T-factor (p=0.0017), pre-tracheal nodal involvement (p=0.0055) and distant metastasis (p=0.0024) as independent prognostic factors. CONCLUSIONS: Our findings suggest that pre-tracheal lymph node metastasis indicates a dismal prognosis. Its occurrence is not unusual, especially in tumour of upper or middle thoracic esophagus. The subcarinal node cannot be regarded as a sentinel node of the pre-tracheal nodal station. Complete lymphadenectomy excluding the pre-tracheal lymph nodes in treating esophageal cancers is only a myth.

Adult↗
PubMed2000

A model for pretest probability of lymph node metastasis from cutaneous Melanoma.

Although many statistical models have been developed to predict survival in cutaneous melanoma, few predict the end point of regional lymph node metastasis shortly after the diagnosis of melanoma. We used routine clinical and histologic data from 573 patients referred to the Duke University Melanoma Clinic, Durham, NC, during the 1980s and 1990s who underwent lymph node resections during the first year after the diagnosis of primary cutaneous melanoma. The outcome we modeled (using the logistic regression model) was the probability of lymph node metastasis. We found that tumor thickness was the variable most significantly associated with the probability of nodal metastasis, and the presence of ulceration and tumor location also were significant, but age, sex, and mitotic rate were not. When the resulting logistic model predicted that the probability of nodal metastasis was more than .6, 93 of 115 patients had nodal metastasis. When the model predicted that the probability was less than .3, just 32 of 88 patients had positive nodes. Furthermore, after the result of the node sampling was known, Cox model analysis demonstrated that the pretest probability added significant information about subsequent survival.

Biopsy↗
PubMed2006

Coexpression of VEGF-C and Cox-2 in human colorectal cancer and its association with lymph node metastasis.

PURPOSE: Several lines of experimental evidence indicated that over-expression of vascular endothelial growth factor-C and cyclooxygenase-2 genes promotes angiogenesis and lymphangiogenesis, both of which are essential for the growth and spreading of tumor cells. This study was designed to evaluate the coexpression of vascular endothelial growth factor-C and cyclooxygenase-2 in human colorectal carcinoma to determine their relationships and correlations with lymph node metastasis and prognosis. METHODS: Tissue samples of primary tumors and metastatic lymph nodes from 150 patients undergoing intentionally curative surgical resections for colorectal adenocarcinoma were immunohistochemically examined for vascular endothelial growth factor-C, cyclooxygenase-2, and CD34 expressions. Then, we analyzed their relationships and correlations with clinicopathologic findings and patients' survival time. RESULTS: The positivity rate of vascular endothelial growth factor-C and cyclooxygenase-2 in the primary tumor was 68 and 72.7 percent, respectively, and in the metastatic lymph nodes was 93.3 and 80 percent, respectively. A significant correlation was found between the expression scores of vascular endothelial growth factor-C and cyclooxygenase-2 (P < 0.0001), and both also were correlated to microvessels density and several clinicopathologic parameters, including primary tumor size, lymph node metastasis, lymphatic invasion, and TNM stage. Patients with vascular endothelial growth factor-C-positive and/or cyclooxygenase-2-positive tumors had a significant shorter survival time than those with negative tumors did. However, in a multivariate analysis, only cyclooxygenase-2 expression was recognized as an independent prognostic factor (P = 0.0412; relative risk ratio, 3.067; 95 percent confidence interval, 1.046-8.994). CONCLUSIONS: These data show that in human colorectal carcinoma, vascular endothelial growth factor-C and cyclooxygenase-2 are coexpressed and significantly associated with lymph node metastasis and prognosis.

Adenocarcinoma↗
PubMed2002

[Relationship between lymph node metastasis and the expressions of E-cadherin, N-cadherin, and matrix metalloproteinase in breast carcinoma].

BACKGROUND & OBJECTIVE: There is little ideal predictor available on evaluating the lymph node metastatic potential of breast carcinoma. This study was designed to determine the expression of gene products of E-cadherin (epithelial), N-cadherin (nerve), and matrix metalloproteinase-9 (MMP-9) in breast carcinoma tissue and investigate their association with the invasion and metastasis of breast carcinoma. METHODS: The authors examined the expressions of E-cadherin, N-cadherin, and MMP-9 in 72 cases of breast carcinoma(39 cases with lymph node metastasis and 33 cases without lymph node metastasis) by immunohistochemistry. Multivariable Cox proportional hazards model was used to analyze the patients' prognosis. RESULTS: The average ranks of E-cadherin in lymph node metastasis group and no lymph node metastasis group were 29.19 and 45.14, respectively, with significant difference (P < 0.001). The expression of E-cadherin was correlated inversely with the metastasis of breast carcinoma. The average ranks of N-cadherin and MMP-9 were 40.04 and 42.97 in lymph node metastasis group, and 32.32 and 28.85 in no lymph node metastasis group, both with significant difference (P < 0.05), and these expressions were positively correlated with the lymph node metastasis of breast carcinoma. The patients who had high expression of E-cadherin had a longer survival time. CONCLUSION: Expression of E-cadherin, N-cadherin, and MMP-9 are associated strongly with lymph node metastasis of breast carcinoma. These proteins are indicators of metastasis potential and prognosis of breast carcinoma.

Adult↗
PubMed2005

[Polymorphisms of thymidylate synthase gene and correlation of its protein expression to lymph node metastasis of esophageal squamous cell carcinoma].

BACKGROUND & OBJECTIVE: Thymidylate synthase (TS) is a key enzyme in DNA synthesis. The 28-bp tandem repeat in the 5'-untranslated region (UTR) of TS gene and the G/C single nucleotide polymorphism (SNP) of TS gene may modify the expression and activity of TS protein, therefore, may change the susceptibility and prognosis of tumors. This study was to explore the correlations of TS 5'-UTR polymorphism to lymph node metastasis of esophageal squamous cell carcinoma (ESCC) and the expression of TS protein. METHODS: Peripheral leucocyte DNA was extracted from 232 ESCC patients and 348 age-and gender-matched healthy controls. TS 5'-UTR tandem repeat and the G/C SNP genotype was detected by polymerase chain reaction (PCR) and PCR-restriction fragment length polymorphism (PCR-RFLP), respectively. TS expression in 51 specimens of ESCC was detected by SP immunohistochemistry. RESULTS: The frequencies of 3G/3G, 3G/3C, 3C/3C, 2R/3G, 2R/3C, 2R/2R, and other genotypes were 17.5%, 17.3%, 29.3%, 12.9%, 17.8%, 3.7%, and 1.5% in the healthy controls, and 16.0%, 16.0%, 29.3%, 13.8%, 17.6%, 4.3%, and 3.0% in the ESCC patients; whereas the frequencies of 3G, 3C, 2R, and other alleles were 32.8%, 47.0%, 19.5%, and 0.7% in the healthy controls, and 31.2%, 46.8%, 20.5%, and 1.5% in the ESCC patients, respectively. Compared with 3G/3G genotype, 2R/3G genotype significantly increased the risk of lymph node metastasis of ESCC [age and gender adjusted odds ratio (OR), 11.53; 95% confidence interval (CI), 2.67-49.74]. TS protein expression was significantly related to TS 5'-UTR genotype (P<0.05), but was not related to gender, age, lymph node metastasis and clinicopathologic stage. CONCLUSION: TS 5'-UTR tandem repeat and G/C SNP genotype, but not TS expression, might be a candidate molecular marker to predict lymph node metastasis of ESCC.

Adult↗
PubMedDate not supplied

Low risk endometrial cancer: a study of pelvic lymph node metastasis.

The aim of our study was to find preoperative or intraoperative pathologic indicators that would discriminate a subgroup of early corpus cancers that would not require lymphadenectomy. A retrospective review of the medical records of 107 patients with endometrioid adenocarcinoma, FIGO grade 1 or 2 tumor, myometrial invasion <or=50%, and no intraoperative evidence of macroscopic extrauterine spread was performed. Clinicopathologic risk factors were analyzed with Fisher 's exact test with regards to pelvic lymph node metastasis. The median age of the patients was 54 years. Pelvic lymph node metastasis was observed in five of 107 patients (4.7%), where two patients with small tumors of 2 cm or less had positive pelvic lymph nodes. The presence of positive pelvic lymph nodes did not correlate with depth of invasion, histologic grade, cervical invasion, peritoneal cytology, menopausal status, preoperative serum CA125 level, or primary tumor diameter. Only lymphvascular space involvement (P < 0.0001) was significantly correlated to pelvic lymph node metastasis. We suggest that all patients with endometrial cancer who are taken to the operating room for primary therapy should be prepared to undergo extended surgical staging, except when clinical or operative factors increase patients' morbidity.

Adenocarcinoma↗
PubMedDate not supplied

Lymph node metastasis is infrequent in patients with highly-methylated colorectal cancer.

In this study, the combined methylation status of p16, p14, HLTF, CDH13 and RUNX3 was examined in 59 resected primary colorectal cancers using methylation-specific PCR and the methylation status was correlated with the clinicopathological features of the affected patients. A significant difference was found in lymph node metastasis (p = 0.0359) on comparing the methylation status in colorectal cancers with lymph node metastasis to those without. There was also a significant gender difference (p = 0.0248) when the methylation status was compared. Colorectal cancer without lymph node metastasis frequently exhibited aberrant methylation of the p16, p14, HLTF, CDH13 and RUNX3 genes.

Adult↗