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At least 811 records · Page 45Linked to original sources
PubMed2006

Intraoperative pathological investigation of recurrent nerve nodal metastasis can guide the decision whether to perform cervical lymph node dissection in thoracic esophageal cancer.

Three-field lymph node dissection has been widely used to treat thoracic esophageal cancer, but is very invasive and can cause serious complications. Whether cervical lymph node dissection should be performed in all patients with thoracic esophageal cancer remains controversial. We pathologically examined the recurrent nerve lymph nodes during surgery in patients with thoracic esophageal cancer to determine the presence or absence of lymph node involvement. In patients without recurrent nerve nodal involvement, cervical lymph node dissection was not performed. Treatment outcomes were analyzed to evaluate whether intraoperative pathological investigation was a useful procedure. Among 71 patients with thoracic esophageal cancer who underwent 3-field lymph node dissection, the rate of cervical lymph node metastasis was 40.9% in patients with recurrent nerve nodal metastasis on intraoperative pathological investigation, as compared with 10.2% in patients without recurrent nerve nodal metastasis (p=0.007). Multiple logistic-regression analysis showed that recurrent nerve nodal metastasis was a strong predictor of cervical lymph node metastasis (odds ratio, 2.98; 95% confidence interval, 1.139-7.775; p=0.03). Among 41 patients who underwent intraoperative pathological investigation, 10 had recurrent nerve nodal metastasis and underwent cervical lymph node dissection. Two of these patients had histological evidence of cervical lymph node metastasis. The remaining 31 patients had no recurrent nerve nodal metastasis on intraoperative pathological examination and therefore did not receive cervical lymph node dissection. None of these patients had cervical lymph node recurrence on follow-up. We compared patients who underwent intraoperative pathological investigation with those who underwent conventional 3-field lymph node dissection (without performing intraoperative pathological investigation). The rates of cervical lymph node recurrence were similar among the groups (2.6% vs. 6.7%), but the 3-year survival rate was significantly higher in the patients who underwent intraoperative pathological dissection (83.3%) than in those who underwent 3-field dissection (57.2%; p<0.05). Although this was a retrospective study, our results suggest that outcomes of patients undergoing cervical lymph node dissection according to the results of intraoperative pathological investigation are at least as good as those in patients undergoing 3-field lymph node dissection. We conclude that intraoperative pathological investigation of recurrent nerve nodal metastasis is useful for determining whether cervical lymph node dissection should be performed in patients with thoracic esophageal cancer.

Aged↗
PubMed2000

Controversies in sentinel lymph node biopsy for breast cancer.

Sentinel lymph node biopsy, validated in melanoma staging, is currently under investigation for breast cancer staging. Reports suggest that the sentinel lymph node has a high predictive value in determining the presence of axillary metastases. Identification of a sentinel lymph node that is free of metastatic tumor cells may eliminate the necessity of performing a standard axillary lymph node dissection with its attendant morbidity. Numerous techniques are utilized to identify the sentinel node with approximately the same success rate. This paper will address some of the controversial areas of sentinel lymph node biopsy and offer an option for physicians who want to develop a sentinel lymph node program in their hospital.

Breast Neoplasms↗
PubMed2006

Characteristic features of B cells in murine cervical lymph nodes.

CONCLUSION: B cells in cervical lymph nodes correspond to typical conventional B cells (B-2). OBJECTIVE: The special status of cervical lymph nodes in relation to the oropharynx, and the need to maintain the integrity of the oropharnygeal mucosal barrier, suggest the possibility that cervical lymph node B cells located in the oropharynx may behave differently from B cells located elsewhere. In this study we examined the symmetry or lack thereof between cervical lymph node B cells and other B-cell subsets. MATERIAL AND METHODS: We isolated B cells from murine cervical lymph node tissue and evaluated them in vitro according to several criteria. RESULTS: We found that cervical lymph node B cells expressed typical B-cell phenotypic markers and proliferated normally in response to mitogenic stimulation. They did not spontaneously secrete immunoglobulin and, in keeping with this, did not express elevated levels of either CD138 (Syndecan-1), a marker for plasma cells, or BLIMP-1, a putative master regulator of B-cell differentiation.

Animals↗
PubMed2001

Value of systematic mediastinal lymph node dissection during pulmonary metastasectomy.

BACKGROUND: Systematic mediastinal lymph node dissection is the accepted standard when curative resection of bronchial carcinoma is performed. However, mediastinal lymph node dissection is not routinely performed with pulmonary metastasectomy, in which only enlarged or suspicious lymph nodes are removed. The incidence of malignant infiltration of mediastinal lymph nodes in patients with pulmonary metastases is not known. METHODS: Sixty-three patients who underwent 71 resections through a thoracotomy for pulmonary metastases of different primary tumors were studied prospectively. Selected patients showed no evidence of tumor progression or extrathoracic metastases and pulmonary metastasectomy was planned with curative intent. All patients underwent preoperative helical computed tomography (CT) scanning. Only patients with no evidence of suspicious mediastinal lymph nodes on the CT scan (less than 1 cm in the short axis) were included in this study. A mediastinal lymph node dissection was performed routinely with metastasectomy. RESULTS: In 9 patients (14.3%) at least one mediastinal lymph node revealed malignant cells in accordance with the resected metastases. When compared with the preoperative CT scan, additional pulmonary metastases were detected in 16.9% of performed operations. There was a trend toward an improved survival rate in patients without involvement of the mediastinal lymph nodes. The number of pulmonary metastases had no influence on survival. CONCLUSIONS: On a patient-by-patient basis, the frequency of misdiagnosed mediastinal lymph node metastases is about the same as compared with non-small cell bronchial carcinomas. Systematic mediastinal lymph node dissection reveals a significant number of patients, who otherwise are assumed free of residual tumor. The knowledge of metastases to mediastinal lymph nodes after complete resection of pulmonary metastases could influence the decision for adjuvant therapy in selected cases.

Adult↗
PubMed1987

The histology of reactive lymph nodes.

For histological evaluation of a lymph node specimen, it is essential to understand the morphology of the reaction patterns in the normal lymph node after challenge with antigen. The four different immunological reaction patterns seen in the lymph node each take place in their own compartment. Thus the follicle (or germinal) center cell reaction takes place in the follicle, the plasma cell reaction takes place in the medullary cords, the specific cellular response takes place in the paracortex, while in the sinuses, a histiocytic reaction may be observed. Often one reaction is followed or accompanied by another. Furthermore, because different antigenic challenges stimulate the four reactions in different ways, lymph node histology is highly variable and dependent on the kind of antigenic stimulation. Each of the four different reactions (and thus each of the four lymph node compartments) is described morphologically and immunohistologically. Markers identify the B-cell (follicle, medullary cords), T-cell (paracortex), or histiocytic (sinuses) nature of the compartments. A number of malignant conditions that can resemble benign lymph node lesions are discussed briefly, and morphologic and marker criteria for differential diagnosis are reviewed. Recognition of the four different reaction patterns with the addition of marker studies should allow a high percentage of accurate diagnoses.

Dendritic Cells↗
PubMed1995

[Evaluation of missing diagnosis of metastatic lymph node in gastric cancer].

The missing diagnosis rate of metastatic lymph nodes in 38 cases of radical gastrectomy specimens by methylene blue staining and serial histologic section was evaluated as compared to that by routine examination of one histologic slide of palpable enlarged lympy nodes. The results showed that after 1251 lymph nodes had been picked up by palpation method, 1004 additional minute lymph nodes were dissected out following methylene blue staining with an average of 59.3 lymph nodes in each case. The methylene blue-stained lymph nodes accounted for 44.5% of the total lymph nodes, in which 32 were found to have metastasis which accounted for 13.8% of metastatic lymph nodes. The 2046 metastasis negative lymph nodes according to routine histologic examination were then serially sectioned at 45 microns distance and 25 sections were observed for each lymph node specimen. Minute metastatic foci were found in 23 lymph nodes, accounting for 9.9% of the metastatic lymph nodes. Therefore, 23.7% metastatic lymph nodes escaped detection by the routinely used histologic examination.

Coloring Agents↗
PubMed2001

[Pathological features of lymph node metastasis. 2) From morphological aspects].

Lymph node metastasis is important because of its early appearance and prognostic significance. In this paper the mechanism of development of metastasis, tissue reaction with metastatic cells, and role of lymph node metastasis in cancer spread are described briefly. Lymph node metastasis proceeds when cancer cells invade lymphatic vessels. These cells lodge in the lymphatic sinus where tumor cells adhere to and breach the sinusoidal walls and migrate into the parenchyma. Integrin(s), CD44, and/or carbohydrates of tumor cells and extracellular matrix components such as laminin and type IV collagen, hyaluronic acid, and lectins of the sinus wall become involved in the adherence of cancer cells. Their binding may induce matrix metalloproteinase production from cancer cells, resulting in degradation of surrounding reticular fibers. Lymph nodes sometimes react with tumors, exhibiting follicular hyperplasia, sinus histiocytosis, lymphoid cell depletion, fibrosis, and angiogenesis of lymph nodes. Such tissue reactions may suppress cancer spread but in turn may augment the aggressiveness of cancer cells. It is not yet possible to determine which reaction will occur. In early cancer, lymph node metastasis occurs based on mainly anatomical-mechanical factor, while in advanced cancer, seed-soil factor plays an important role on development of the metastasis.

Female↗
PubMed2006

Popliteal lymphadenectomy on sentinel lymph node melanoma metastasis.

Popliteal lymph node dissection is a procedure that surgeons rarely perform and, therefore, scarcely represented in bibliography. In this paper we present the case of a patient with melanoma metastasis to popliteal sentinel lymph nodes showing the surgical procedure and discussing some epidemiological and technical issues.

Aged↗
PubMed2001

Significance of lymphoscintigraphic mapping with Tc-99m human serum albumin and tin colloid in sentinel lymph node biopsy in breast cancer.

Sentinel lymph node biopsy (SLNB) in breast cancer is considered in order to spare node-negative patients from axillary lymph node dissection. To assess the clinical significance of lymphoscintigraphic mapping in SLNB, we analyzed the lymphatic drain to the sentinel lymph nodes (SLNs) in terms of the pattern and direction of the hot spot. Twenty-three breast cancer patients were enrolled for SLNB. Before surgery, lymphoscintigraphic mapping of SLN was performed using Tc-99m human serum albumin (HSA) and tin colloids, and the hot spot was marked. The Tc-99m HSA and tin colloids were subcutaneously injected above the tumor and peritumor sites, respectively, and lymphoscintigraphic scanning was monitored every 5 to 10 min, for up to 2 h after injection. The SLN was identified using a combination of a blue dye, indigocalmine, and a gamma probe during surgery. The hot spot pattern and direction of the lymphatic drains were evaluated in 21 of 23 cases. Two cases did not have a hot spot. Single, double, and multiple hot spots were observed in 12 cases (52.1%), 8 cases (34.7%), and 1 case (4.3%), respectively. The positions of the hot spots were: axillary (n=17, 80.9%), axillary and sternal (n=3, 14.2%), and phrenic (n=1, 4.7%). The sensitivity and specificity rates in SLNB were 66.6% and 100%, respectively, and the overall predictive rate was 85.7%. Lymphoscintigraphy produced false negatives in three cases (33.3%), including one on the phrenic side. Lymphoscintigraphic mapping with Tc-99m HSA and tin colloids is useful for determining the SLN, and avoiding a false negative. The pattern and direction of the lymphatic drain to the SLN in scintigraphy need to be considered for the elimination of axillary lymph node dissection in node-negative patients with breast cancer.

Adult↗
PubMed1999

The prognostic significance of lymph node micrometastasis in patients with esophageal carcinoma.

BACKGROUND: Lymph node metastasis is a well known feature of poor prognosis in patients with esophageal adenocarcinoma and squamous cell carcinoma. However, a significant proportion of apparently lymph node negative patients die early of metastatic disease. The aim of this study was to determine the prevalence and prognostic significance of occult lymph node metastasis in patients with esophageal adenocarcinoma and squamous cell carcinoma. METHODS: Lymph node sections from esophagectomy specimens of 78 patients with lymph node negative esophageal carcinoma (49 patients with adenocarcinoma and 29 with squamous cell carcinoma) were cut serially, it toto, and immunostained with the cytokeratin antibody AE1/AE3 and evaluated for occult lymph node metastasis. The results were correlated with the clinical and pathologic features and with patient survival. RESULTS: Fifteen of 49 patients (31%) with adenocarcinoma and 5 of 29 patients (17%) with squamous cell carcinoma had occult lymph node metastasis detected by cytokeratin staining. In the adenocarcinoma patients, the presence of occult lymph node metastasis showed a significant correlation with increasing depth of invasion, but was not associated significantly with any other clinical or pathologic feature. In the squamous cell carcinoma patients, the presence of occult lymph node metastasis did not correlate significantly with any clinical or pathologic parameter, except that patients with occult lymph node metastasis were more likely to have received preoperative chemotherapy or radiation therapy. Occult lymph node metastasis did not correlate with poorer survival rates in patients with either adenocarcinoma (Cox proportional hazards ratio: 1.42; P - 0.46) or squamous cell carcinoma (Cox proportional hazards ratio: 0.86; P = 0.90). CONCLUSIONS: Occult lymph node metastasis is not an independent poor prognostic feature in esophageal adenocarcinoma or squamous cell carcinoma. Therefore, the authors do not recommend extensive lymph node sectioning with keratin immunostaining for prognostication of patients with these malignancies.

Adenocarcinoma↗
PubMed1978

Mucocutaneous lymph node syndrome.

Mucocutaneous lymph node syndrome (MLNS) is a recently described disease entity of unknown etiology that mainly affects children. The disease is characterized by fever, oral mucosal changes, cervical lymphadenopathy and a peripheral skin rash with induration of hands and feet and subsequent desquamation. Thromboarteritis of the coronary vessels causes death in 1 to 2 percent of the patients. Over 7,000 cases have been reported in Japan and increasing numbers are reported in the United States. No specific treatment is available.

Child↗
PubMed1989

Signet ring cell sinus histiocytosis. A previously unrecognized histologic condition mimicking metastatic adenocarcinoma in lymph nodes.

The axillary lymph nodes in a radical mastectomy specimen from a 70-year-old insulin-dependent diabetic patient contained significantly vacuolated sinus histiocytes. The histologic picture closely resembled metastatic signet ring cell adenocarcinoma. The signet ring histiocytes did not stain with the mucicarmine or periodic acid-schiff stains or any of the immunohistochemical epithelial markers. The differential diagnosis and the possible origin of these vacuolated histiocytes are discussed.

Adenocarcinoma, Mucinous↗
PubMed1980

Ultrastructural differences of interdigitating cells in human lymph nodes.

Eleven axillary lymph nodes from patients with different cutaneous disorders (systemic scleroderma, atopic eczema, psoriasis, hairy cell erythroderma, dermatopathic lymphadenitis) were examined by electron microscopy. In systemic scleroderma interdigitating cells (IDC's) showed typical ultrastructural features as well as intimate contacts with neighboring lymphocytes. In atopic eczema IDC's were characterized by widespread invaginations of the cell membrane, and an increase in tubulo-vesicular structures and microfilaments. Similar observations have been made in dermatopathic lymphadenitis. In psoriasis and hairy cell erythroderma. IDC's showed only a few interdigitations and invaginations of the cell surface. It is supposed that these structural changes in IDC's reflect the different immunological conditions of the diverse cutaneous disorders.

Dermatitis, Atopic↗
PubMed1974

A morphological assessment of immunoreactivity in colonic Crohn's disease and ulcerative colitis by a study of the lymph nodes.

The mesenteric lymph nodes in total colectomy specimens from patients with ulcerative colitis or Crohn's colitis were assessed for immunological reactivity. Despite the suggestion of previous work using different methods that immunological difference between the diseases exist and may be important in pathogenesis, no significant differences were found in this study. Changes were observed in both diseases and when ulceration was present these consisted of both cellular and humoral immune reactivity. There was no evidence of diminished cell-mediated immunity in Crohn's disease and the presence of granulomata did not constitute any special immunological group.

Antigen-Antibody Reactions↗
PubMed1999

Infiltrating breast carcinoma smaller than 0.5 centimeters: is lymph node dissection necessary?

BACKGROUND: The incidence of axillary lymph node metastases from infiltrating breast carcinomas measuring 1.0 cm or smaller reported in the literature varies from 0% (for tumors measuring < or =0.5 cm) to 27.1% (for all tumors < or =1 cm). METHODS: The authors examined all infiltrating breast carcinomas measuring 1.0 cm or smaller with axillary lymph node dissections in patients seen at their institution between January 1990 and March 1997 (117 cases) to determine the incidence of axillary lymph node metastases. All tumors were evaluated for patient age, histologic type of tumor, modified Bloom-Richardson grade, estrogen and progesterone receptor status, ploidy, S-phase fraction, and angiolymphatic vessel invasion, to determine whether there was a relation between the indicators and axillary lymph node metastases. The authors also performed immunohistochemical stains for the basement membrane components laminin and Type IV collagen on the tumors demonstrating metastases and on an equal number of size- and date-matched tumors not demonstrating metastases. RESULTS: Twelve cases of infiltrating carcinoma with axillary lymph node metastases were identified (a 10.3% overall incidence of metastases). Lymph node metastases were not identified in any of the cases with tumors measuring < or =0.5 cm (24 cases). The incidence of axillary lymph node metastases for carcinomas 0.6-1.0 cm was 12.9% (12 of 93 cases). High nuclear grade was found to correlate with the presence of lymph node metastases (P = 0.007). No statistically significant correlation was found between the other indicators examined and axillary lymph node metastases or between basement membrane staining and axillary lymph node metastases. CONCLUSIONS: The authors concluded that infiltrating breast carcinomas measuring < or =0.5 cm are unlikely to have demonstrable axillary lymph node metastases. Lymph node dissections in these women may be unnecessary. Nuclear grade may be the best predictor of lymph node metastases in T1b tumors.

Axilla↗
PubMed1971

Ultrastructure of the normal lymph node.

The "normal" lymph node has been studied by electron microscopy. The lymphoid tissue can be divided into three distinct zones. Zone 1 consists of loosely arranged cells surrounding the lymphatic sinuses and blood vessels. This is the only zone in which plasma cells are present. Zone 2 is surrounded by zone 1 and consists of compactly arranged cells in which lymphocytes predominate. Zone 3 (germinal center) appears only after antigenic stimulation. It is characterized by large, ribosome-rich cells and macrophages containing phagocytosed lymphocytes. These zones are arranged with their longest diameters pointing towards the hilus. Zone 1 is the longest and extends across the cortex, paracortex and medulla. Zone 2 spans across cortex and paracortex. Zone 3 usually is confined to the cortex. Our preliminary studies indicate that zone 1 is mainly bursal dependent, zone 2 is mainly thymic dependent and zone 3 is bursal dependent.

Animals↗
PubMed2003

[A clinical study of ultrasonography for lymph node metastases in head and neck cancer].

Ultrasonography (US) is very useful in evaluating cervical lymph node swelling in head and neck cancers. We studied problems with US in evaluating lymph nodes. Cervical lymph nodes were removed by radical neck dissection or modified radical neck dissection from 79 patients with squamous cell carcinoma in the head and neck. We studied the correlation between preoperative US findings and the histopathological features. Preoperative lymph nodes were measured three-dimensionally. We diagnosed lymph nodes as metastases when they meet two criteria: One is the shortest diameter exceeding 7 mm in level I and II and 6 mm in level III, IV and V. The other is shortest to longest diameter ratio exceeding 0.5. A total of 2004 lymph nodes were removed by neck dissection, and 199 lymph nodes were diagnosed histopathologically as metastases. Of the 199 metastatic lymph nodes, 93 (46%) were diagnosed as metastases by preoperative US findings and 33 (17%) were false negative. Thirty-six cases were diagnosed preoperatively as N0 by US findings, but 15 of these were pN(+) histopathologically. In the 15 cases, 21 lymph nodes were metastases. Of the 21 metastatic lymph nodes, 10 nodes were not detected by US. Thirty-one cases were diagnosed preoperatively as N1 by US findings, but 20 of these were pN2b histopathologically. In the 20 cases, 66 lymph nodes were metastases. Of the 66 metastatic lymph nodes, 46 were not diagnosed as metastases. They often located distant level from the lymph node diagnosed correctly as a metastasis. US is very useful in evaluating cervical lymph node metastasis, but it has the limitations indicated above. If 1 metastatic lymph node is detected by US, there will be multiple metastatic lymph nodes and sometimes they are distant from the original level. Radical neck dissection should be done for positive lymph nodes detected by US findings. If a lymph node is not clearly a metastasis, fine-needle aspiration cytology (FNA) should be done, because it provides more accurate diagnosis for metastatic lymph nodes.

Carcinoma, Squamous Cell↗