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PubMed1979

Acid alpha-naphthyl acetate esterase (ANAE) activity and DNA synthesis of lymph nodes cells in Hodgkin's disease.

Lymph node and peripheral blood lymphocytes in a case of Hodgkin's disease (mixed cellularity) were studied using May-Grünwald-Giemsa (MGG), acid naphthyl acetate esterase (ANAE), immunoperoxidase staining and lymphocyte surface markers, autoradiographic, and lymphocyte stimulation techniques. According to MGG staining and autoradiographic studies of lymph, node cells, small lymphocytes, intermediate lymphoid cells, and large mononuclear cells resembling in-vitro stimulated immunoblasts, Hodgkin's cells and Reed-Sternberg (RS) cells formed a morphologically continuous DNA synthetizing series. A large majority of small lymphocytes from a lymph node were ANAE positive, thus being T-lymphocytes, and formed rosetts around large mononuclear cells and RS cells. Most RS and large mononuclear cells had ANAE positive spots in the cytoplasm, thus resembling T-lymphocytes more than diffusely staining monocytes. These cells did not contain cytoplasmic immunoglobulin and were muramidase negative. Both lymph node and peripheral blood lymphocytes responded strongly to PHA. The role of T-lymphocytes in Hodgkin's disease and the origin of RS cells are are discussed on the basis of the findings.

Adult↗

PubMed2003

Lymph node infarction. An immunohistochemical study of 11 cases.

CONTEXT: The etiology of lymph node infarction may be difficult or impossible to determine by histologic examination. Lymph node infarction is followed by malignant lymphoma in some but not all patients. The role of immunohistochemistry in the evaluation of lymph node infarction is not well defined. Although it is widely believed that necrotic tissue is not suitable for immunohistochemical study, this view may be inaccurate. OBJECTIVE: To determine whether lymphoid antigens are preserved in infarcted lymph nodes and to determine the utility of immunohistochemical staining in the evaluation of lymph node infarction. DESIGN: Retrospective immunohistochemical study of infarcted lymph nodes using archival formalin-fixed, paraffin-embedded tissue. SETTING: Academic medical center. PATIENTS: Eleven adult patients with lymph node infarction retrieved from pathology files. MAIN OUTCOMES MEASURES: Results of immunohistochemistry, diagnosis of lymphoma. RESULTS: Preservation of lymphoid antigens was observed in 4 of 6 cases of lymph node infarction associated with malignant lymphoma, including 3 of 5 cases of diffuse large B-cell lymphoma and 1 case of peripheral T-cell lymphoma. Nonspecific staining was not encountered. In 1 case, in which an infarcted lymph node showed a benign pattern of lymphoid antigen expression, lymphoma has not developed after 5 years. CONCLUSION: Lymphoid antigens are frequently preserved in cases of lymph node infarction, and immunohistochemical study of infarcted lymph nodes may provide clinically useful information.

Adult↗

PubMed2001

Immunohistochemical analysis of sentinel lymph nodes from patients with Merkel cell carcinoma.

BACKGROUND: Immunohistochemical analysis of sentinel lymph nodes from patients with breast carcinoma and melanoma has been shown to increase the sensitivity for detecting lymph node metastases. To the authors' knowledge, this technique has not been described in patients with Merkel cell carcinoma. METHODS: Lymphatic mapping and sentinel lymph node biopsy was performed on 26 patients with Merkel cell carcinoma between 1997 and 1999. All sentinel lymph nodes were analyzed with conventional hematoxylin and eosin (H&E) staining and then analyzed with immunohistochemical staining to evaluate whether this additional technique would increase the number of patients found to have lymph node metastasis. RESULTS: The median age of the patients in the current study was 67 years and the median tumor size at the time of presentation was 2 cm. Lymph node metastases were identified in 5 of the 26 patients (19%). Three of these five lymph node positive patients were identified with H&E staining. The remaining two patients were identified only after immunohistochemical analysis. The median follow-up in this group of lymph node positive patients was 14 months, with 2 of the 5 lymph node positive patients developing a recurrence. The median follow-up in the 21 patients who were lymph node negative was 19 months, with only 1 patient having developed a recurrence at the time of last follow-up. CONCLUSIONS: Immunohistochemical analysis of sentinel lymph nodes from patients with Merkel cell carcinoma appears to increase the sensitivity of detecting clinically occult lymph node metastases.

Adult↗

PubMed2005

Sentinel lymph node mapping of the pleural space.

STUDY OBJECTIVES: Although the sentinel lymph node (SLN) concept has traditionally been applied to solid organs, we hypothesized that the pleural space might drain into a specific SLN group. The identification of such a nodal group could assist in the staging and treatment of pleural-based diseases, such as mesothelioma, or other lung cancers with visceral pleural invasion. The purpose of this study was to determine whether the pleural space has an SLN group. DESIGN: Sixteen rats underwent right or left pleural space injection of a novel lymph tracer, quantum dots (QDs), which have a hydrodynamic diameter of 15 nm and fluoresce in the near-infrared (NIR) spectrum. Nodal uptake of the entire thorax was imaged with a custom system that simultaneously acquired color video, NIR fluorescence of the QDs, and a merged picture of the two in real-time. Six pigs underwent right or left pleural space injection of QDs and similar imaging. MEASUREMENTS AND RESULTS: In the rat, the QDs drained solely to the highest superior mediastinal lymph node group, corresponding to lymph node station 1, according the regional lymph node classification for lung of the American Joint Committee on Cancer. In one rat, the injection of QDs in the left pleural space resulted in migration to the contralateral station 1 lymph node group. The injection of QDs in the right or left pleural space of the pig resulted in migration solely to the ipsilateral highest superior mediastinal lymph node group. CONCLUSIONS: NIR fluorescence imaging in two species demonstrated that the highest superior mediastinal lymph nodes of station 1 are the SLNs of the pleural space. This study also provides intraoperative feasibility and proof of the concept for identifying lymph nodes communicating with the pleural space on a patient-specific basis, in real-time, and with high sensitivity.

Animals↗

PubMed2001

Sentinel lymph node biopsy for breast cancer.

Sentinel lymph node biopsy (SLNB) is an emerging surgical technique to improve lymph node staging for breast cancer. Despite the rapid development of this technique, there remain aspects of SLNB that need to be further defined to provide a standardized approach. Variables, including patient selection, technical details for the performance of SLNB, extent of pathologic evaluation of the sentinel lymph node, and the impact of micrometastases, are areas of controversy. This paper reviews the controversies and discusses available data as well as personal experience and opinion.

Aged↗

PubMed2002

[The distribution of metastatic cervical lymph nodes in laryngeal carcinoma].

OBJECTIVE: To detect regularity of lymph nodes metastasis of laryngeal carcinomas and determine the best kind of neck dissection. METHOD: The series consist of three parts:the distribution of laryngeal carcinoma with metastasis lymph nodes, the immunohistochemical evaluation of micrometastases after pathologic diagnostic N0, the distribution of recurrence after operation. All 289 cases in these series including 174 cases of supraglottic carcinoma, 113 cases of glottic carcinomas and 2 cases subglottic carcinomas. RESULT: In the first part, there were 242 necks had been conducted neck dissections and the metastases rates from level I to level VI is 2.8%, 98.3%, 32.6%, 15%, 13%, 21.4% respectively. In the second part, 46 (50 necks) of 71 cases of pathologic N0 necks conducted immunohistochemical study in the lymph nodes. 13 lymph nodes harbor micrometastases, which distributes in 11 cases. All the positive lymph nodes located in level II. In the third part, 45 necks of 37 cases were evaluated the cervical metastasis without neck dissection. The metastases rates from level I to level V is 2.2%, 100%, 48.9%, 26.7%, 13.3% respectively. CONCLUSION: The metastatic lymph nodes of laryngeal carcinomas distribute mainly in level II and level III, followed by level IV and level VI, but rarely in submandibular and posterior triangles. The neck dissection of laryngeal carcinomas should be conducted in the regions from level II to level IV. The dissection of level I and level V should be spared unless there is evidence of metastasis to these regions so as to shorten the operation time and avoid postoperative complications.

Adult↗

PubMed2000

Asbestos content in the lymph nodes of nonoccupationally exposed individuals.

BACKGROUND: The thoracic lymph nodes are a part of the clearance system from lung tissue. Accumulation of dust in these nodes are known to occur following some types of exposure. However, no information exists as to asbestos content in lymph nodes from the general population. METHODS: The study cohort consisted of 21 individuals previously defined as nonoccupationally exposed to asbestos. Tissue burden of asbestos obtained from lung analysis by analytical electron microscopy was compared with burden in the lymph nodes. RESULTS: No asbestos fibers were detected in nodes from 8 cases. The majority of the fibers found in lymph nodes were short (<5 microm) and most often noncommercial amphiboles. Ferruginous bodies (FBs) were detected in lymph node from only two samples. CONCLUSIONS: The total asbestos burden in the lung tissue from these individuals was quite low. However, in 12 of the 13 cases that had positive nodes, the tissue burden in the node was appreciably heavier per gram than in the lung. This raises the question as to whether the lymph nodes, though less efficient clearance, may be better indicators of lifetime exposure to dust than lung tissue.

Adolescent↗

PubMed2002

Long-term survival in 2,505 patients with melanoma with regional lymph node metastasis.

OBJECTIVE: To examine the long-term outcomes of patients with melanoma metastatic to regional lymph nodes. SUMMARY BACKGROUND DATA: Regional lymph node metastasis is a major determinant of outcome for patients with melanoma, and the presence of regional lymph node metastasis has been commonly used as an indication for systemic, often intensive, adjuvant therapy. However, the risk of recurrence varies greatly within this heterogeneous group of patients. METHODS: Database review identified 2,505 patients, referred to the Duke University Melanoma Clinic between 1970 and 1998, with histologic confirmation of regional lymph node metastasis before clinical evidence of distant metastasis and with documentation of full lymph node dissection. Recurrence and survival after lymph node dissection were analyzed. RESULTS: Estimated overall survival rates at 5, 10, 15, and 20 years were 43%, 35%, 28%, and 23%, respectively. This population included 792 actual 5-year survivors, 350 10-year survivors, and 137 15-year survivors. The number of positive lymph nodes was the most powerful predictor of both overall survival and recurrence-free survival; 5-year overall survival rates ranged from 53% for one positive node to 25% for greater than four nodes. Primary tumor ulceration and thickness were also powerful predictors of both overall and recurrence-free survival in multivariate analyses. The most common site of first recurrence after lymph node dissection was distant (44% of all patients). CONCLUSIONS: Patients with regional lymph node metastasis can enjoy significant long-term survival after lymph node dissection. Therefore, aggressive surgical therapy of regional lymph node metastases is warranted, and each individual's risk of recurrence should be weighed against the potential risks of adjuvant therapy.

Adult↗

PubMed1990

Cathepsin D assay in primary breast cancer and lymph nodes: relationship with c-myc, c-erb-B-2 and int-2 oncogene amplification and node invasiveness.

In breast cancer, axillary lymph node invasiveness is the major prognostic factor in predicting relapse and metastasis. Nevertheless, since 30% of node-negative tumors also relapse, it is necessary to develop other independent prognostic factors. Oncogene amplification and the level of cathepsin D (cath-D), an acidic lysosomal protease produced and secreted in excess by breast cancer cells, have been proposed as additional prognostic factors. We have compared the cytosolic cath-D level and the amplification of three oncogenes: c-myc, neu-erb-B-2 and int-2 in 140 primary breast carcinomas and 64 axillary lymph nodes collected in 1987 and 1988 at the Cancer Center of Montpellier (Centre Paul Lamarque). None of the patients had previously received hormonal or chemotherapy. The cath-D concentration was measured with an immunoradiometric assay using monoclonal antibodies. DNA purified from the same samples was analyzed by a standard Southern blotting technique to estimate oncogene amplification. No correlation was found between the level of cath-D in the tumor and node invasiveness. Using a cut-off level of 60 pmol/mg protein, the status of cath-D was not correlated with neu-erb-B-2 and int-2 amplification and only correlated with c-myc amplification (P = 0.011). Both c-myc and cath-D are associated with cell proliferation, induced by estrogens in ER+ breast cancer, and constitutively produced in ER- breast cancer. The level of cath-D was significantly higher in the invaded lymph nodes (P = 0.04) than in the histologically non-invaded ones. Nevertheless, some non-invaded lymph nodes contained a high level of cath-D, as confirmed by immunoperoxidase staining. In conclusion, in breast cancer, a high cytosolic cath-D concentration is more frequent in tumors with c-myc amplification but is dissociated from neu-erb-B-2 or int-2 amplification, suggesting that the determination of these three markers will have an additional prognostic value.

Axilla↗

PubMed1998

Distribution pattern and risk factors of pelvic and para-aortic lymph node metastasis in epithelial ovarian carcinoma.

The distribution of lymph node metastasis and the clinicopathologic risk factors for nodal involvement in ovarian carcinoma need to be clarified based on systematic lymph node dissection. We studied 115 patients with ovarian carcinoma who underwent systematic pelvic and para-aortic lymph node dissection between 1987 and 1997. The incidence and distribution of lymph node metastasis are described and the clinico-pathologic risk factors for nodal involvement are investigated. Based on the occurrence of lymph node metastasis in the early stages, the incidence of solitary node involvement and the distribution of lymph node metastasis, we conclude that the primary site of nodal involvement in ovarian carcinoma is the para-aortic node (PAN), especially PAN superior to the inferior mesenteric artery (IMA). By univariate analysis, clinical stage, histologic type (mucinous vs. others), grade, multiple peritoneal metastases, peritoneal cytology, volume of ascites and serum CA125 level were correlated with overall incidence of lymph node metastasis. By performing a multivariate analysis with the clinical stage excluded, it was revealed that grade and peritoneal cytology were independent factors for PAN metastasis (p < 0.0025 and < 0.001, respectively) and that multiple peritoneal metastases and PAN metastasis were significant predictors of pelvic node metastasis (p < 0.01 and < 0.005, respectively). In conclusion, the PANs superior and inferior to IMA should be explored in staging of ovarian carcinoma that appears to be confined to the ovaries. To determine accurately the extent of disease, both the para-aortic and pelvic areas may need to be sampled or dissected in the case of ovarian carcinoma involving the peritoneal surfaces.

Adenocarcinoma, Clear Cell↗

PubMed1972

The size and histological appearances of mesenteric lymph nodes in Crohn's disease.

The size of the related lymph nodes and their histology has been correlated in 34 specimens of Crohn's disease. Granulomata were shown not to affect the maximum diameter of the lymph nodes nor to be more frequent in large nodes. The enlargement of lymph nodes appeared to be due to simple, non-specific, reactive changes. Granulomatous lymph nodes were found in 38% of all our cases of Crohn's disease and in 63% of those cases with granulomata in the bowel wall. One case was found with granulomata in the lymph nodes which were not seen in the bowel wall. The mesenteric lymph nodes of 22 cases of ulcerative colitis were shown to be not significantly different in size from those of Crohn's disease. The diameter of the lymph nodes on the histological section was shown to underestimate the diameter of nodes in the fresh state by a factor of 1.5.

Colitis, Ulcerative↗

PubMed1975

[Individual and sex variation in the inguinal lymph nodes in man].

Under investigation were the lymph nodes on the anterior surface of the femur in the area of the femural triangle in 96 preparations of lower extremities of corpses of people of either sex in the age from 31 to 82 years. The Gerota's mass was injected into the skin of feet, external genitalia and the skin of the lower part of the anterior wall of the abdomen. It was established that the total amount of the inguinal lymph nodes in men was greater than in women, the size of the superficial nodes in women was greater than of those in men, while the size of profound lymph nodes in men was greater than in women. The amount of the inguinal lymph nodes was proportional to the Skerly's index and the dimensions were inversely proportional to their amount. The amount of inguinal lymph nodes in persons of either sex of a dolichomorphic type of figure was greater than in persons of a brachymorphic type. The dimensions of the nodes in persons of brachymorphic type of figure were predominant.

Adult↗

PubMed1999

Rapid peroperative assessment of axillary lymph node status using imprint cytology.

Sentinel lymph node biopsy for invasive breast cancer is a new technique that has been shown to be accurate in staging the axilla. Patients with a positive sentinel node will potentially need a second operation to clear the axilla. A reliable technique for assessing lymph nodes intraoperatively could potentially avoid this second procedure. This study aimed to assess the accuracy of peroperative imprint cytology of axillary lymph nodes in patients with invasive breast carcinoma. A total of 157 nodes were studied. One-hundred and nineteen nodes were both negative on imprint cytology and paraffin section. Thirty-eight nodes were positive on imprint cytology. Of these, 37 were positive on histology. Imprint cytology is a rapid technique that is inexpensive and has been shown to be reliable in this and other studies. It may prove to be of value in patients undergoing sentinel lymph-node biopsy for breast carcinoma.

Journal Article↗

PubMed1992

Comparison of pathologic and clinical evaluation of lymph nodes in prostate cancer: implications of RTOG data for patient management and trial design and stratification.

RTOG 77-06 and 75-06 were studies of nodal irradiation in prostate cancer, for which the status of nodes was determined by lymph node dissection (LND), lymphangiography (LAG), or computer assisted tomography (CT) based on investigator preference. Actuarial 5 year endpoints of survival, NED survival, local recurrence and distant metastasis have been determined by stage for 805 eligible patients with a comparison of pathologic vs clinical (imaging test) determined nodal status. Patients with pathologically negative lymph nodes show significantly improved 5 year survival (Stage T-2 (B) 84% vs 77%, Stage T-3,4 (C) 82% vs 65%) and NED survival (Stage T-2 (B) 72% vs 63%, Stage T-3,4 (C) 64% vs 44%) compared to patients clinically negative. Free of metastasis rates are increased in Stage T-3,4 (C) pathologic negative patients compared to imaging negative patients (75% vs 60%). A comparison of clinical positive versus clinical negative patients shows no difference in survival, NED survival or rate of metastasis, while a similar comparison of pathologic positive versus pathologic negative shows significant difference for all three endpoints (survival: Stage T-2 (B) 84% vs 61%, Stage T-3,4 (C) 82% vs 66%, NED survival: Stage T-2 (B) 72% vs 32%, Stage T-3,4 (C) 64% vs 32%; free of metastasis: Stage T-2 (B) 82% vs 64%, Stage T-3,4 (C) 75% vs 44%). The clinical determination of nodal status, therefore, has no prognostic value in contrast to pathologic determination and should not be used for stratifying patients in clinical trials. The CT scans often used to evaluate nodal status are more useful if delayed until they can be done as part of the treatment planning process where the CT has value. When imaging tests suggest positive lymph nodes in prostate cancer patients, the imaging finding is confirmed by biopsy.

Humans↗

PubMed1994

[Disseminated inflammatory pseudotumor of the lymph nodes].

Inflammatory pseudotumour of lymph nodes is a benign type of lymphadenopathy recently described as a peculiar nodal reaction, which displays distinctive clinical and histological features. The origin of the disease is unknown although an inflammatory etiology has been suggested. We study a new case of inflammatory pseudotumour of lymph nodes which had an unusual clinical presentation, with lymphadenopathy on both sides of the diaphragm and enlargement of liver and spleen. In addition, focal fibrinoid vascular necrosis was observed on histological examination, an unusual finding which makes difficult the differential diagnosis with other lesions, particularly vasculitis.

Abdomen↗

PubMed2005

The number of metastatic lymph nodes in extrahepatic bile duct carcinoma as a prognostic factor.

The number of lymph nodes with metastases is known to be an important prognostic factor in carcinomas of many organs. The insufficient sampling of lymph nodes has also been associated with worse outcome in several types of carcinoma. However, the prognostic significance of lymph node dissection is not well characterized in extrahepatic bile duct (EBD) carcinomas. For 209 patients with EBD carcinoma, the total number of retrieved lymph nodes and the number of metastatic lymph nodes were evaluated, and other clinicopathologic variables were correlated with patient survival. The number of retrieved lymph nodes was not significantly correlated with survival in this study. The presence of metastasis to lymph nodes significantly decreased survival of patients with EBD carcinoma. The patients with 5 or more metastatic lymph nodes had significantly worse survival than those with 4 or less metastatic lymph nodes. To evaluate the prognosis of the patients with EBD carcinomas more precisely, the number of metastatic lymph nodes as well as the status of metastasis to lymph nodes should be examined and reported. Based on the present data, we propose that nodal classification should be divided into N1 (metastasis in 1 to 4 regional lymph nodes) and N2 (metastasis in 5 or more regional lymph nodes).

Adult↗

PubMed1997

Computer-derived nuclear features compared with axillary lymph node status for breast carcinoma prognosis.

BACKGROUND: Both axillary lymph node involvement and tumor anaplasia, as expressed by visually assessed grade, have been shown to be prognostically important in breast carcinoma outcome. In this study, axillary lymph node involvement was used as the standard against which prognostic estimations based on computer-derived nuclear features were gauged. METHODS: The prognostic significance of nuclear morphometric features determined by computer-based image analysis were analyzed in 198 consecutive preoperative samples obtained by fine-needle aspiration (FNA) from patients with invasive breast carcinoma. A novel multivariate prediction method was used to model the time of distant recurrence as a function of the nuclear features. Prognostic predictions based on the nuclear feature data were cross-validated to avoid overly optimistic conclusions. The estimated accuracy of these prognostic determinations was compared with determinations based on the extent of axillary lymph node involvement. RESULTS: The predicted outcomes based on nuclear features were divided into three groups representing best, intermediate, and worst prognosis, and compared with the traditional TNM lymph node stratification. Nuclear feature stratification better separated the prognostically best from the intermediate group whereas lymph node stratification better separated the prognostically intermediate from the worst group. Prognostic accuracy was not increased by adding lymph node status or tumor size to the nuclear features. CONCLUSIONS: Computer analysis of a preoperative FNA more accurately identified prognostically favorable patients than did pathologic examination of axillary lymph nodes and may obviate the need for routine axillary lymph node dissection.

Artificial Intelligence↗

PubMed1981

Pregnancy-induced alterations in graft-versus-host responsiveness of uterine-draining and peripheral lymph node cells toward fetal alloantigens.

The popliteal lymph node assay was used to assess the effects of allogeneic pregnancy on the graft-versus-host (GVH) responsiveness of maternal uterine-draining and peripheral lymph node cells toward fetal alloantigens. These two cell populations were obtained from three groups of female mice: BALB/c virgins, BALB/c females 13 days pregnant by C3H males, and BALB/c females 13 days pregnant by BALB/c males. Recipients of the donor cells were (BALB/c x C3H)F1 and (BALB/c x C57)F1 hybrids. Uterine-draining lymph node (UDLN) cells at day 13 of an allogeneic pregnancy were specifically hyporesponsive toward fetal alloantigens compared to peripheral lymph node cells from the same donors. There was no difference in responsiveness between uterine-draining and peripheral lymph node cells in virgin or syngeneically pregnant mice. Therefore, the local nodes draining the uteri of primigravid mice carrying allogeneic fetuses, but not syngeneic fetuses, showed a specific decrease in GVH activity toward fetal alloantigens.

Animals↗