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PubMed2002

A case of advanced esophageal cancer with extensive lymph node metastases successfully treated with multimodal therapy.

Advanced esophageal cancer patients with extensive lymph node metastases show extremely poor prognosis and the long-term outcome is poorer with the involvement of more lymph nodes. We report here a long-surviving case of advanced esophageal cancer with histologically 34 lymph node metastases, in which surgical resection with three-field lymphadenectomy followed by adjuvant chemotherapy and radiotherapy was performed. A 53-year-old male was diagnosed as advanced middle esophageal cancer with multiple regional lymph node metastases such as paraesophageal, pretracheal, tracheobronchial and bifurcational lymph nodes and three intramural metastatic lesions. Subtotal esophagectomy with three-field lymphadenectomy was performed for the tumor. Histopathologically, the tumor was poorly differentiated squamous cell carcinoma and 34 lymph nodes including ligamentum arteriosum lymph nodes and pretracheal lymph nodes were proved to be metastatic. Numerous tumor cells were found in the lymphatic vessels near the metastatic lymph nodes. Chemotherapy [3000 mg of 5-fluorouracil (5-FU), 50 mg of cisplatin (CDDP) and 30 mg of methotrexate (MTX)] was administered in two courses, followed by radiation therapy (field size 21 x 20 cm in mediastinum, 10 MV X-rays, 2 Gy/fr, 5 fr/week, total 46 Gy). Subsequently, 1000 mg of 5-FU and 200 mg of CDDP were administered every 3-4 months without any significant toxicities. The patient has been alive and well without recurrence for 5 years following operation. For treatment of advanced esophageal cancer with extensive lymph node metastases, a wide resection of the tumor and regional lymph nodes should be performed, followed by adjuvant chemotherapy and radiotherapy.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1999

Touch imprint cytological analysis of sentinel lymph nodes for detecting axillary metastases in patients with breast cancer.

BACKGROUND: Sentinel lymph node biopsy is a procedure that examines the first tumour-draining lymph node. Touch imprint cytology may provide a quick method for intraoperative screening of sentinel lymph nodes for the presence of metastases. METHODS: Touch imprint cytological analysis of sentinel lymph nodes was compared prospectively with the findings obtained on routine paraffin sections. Touch imprint slides from 55 patients with breast cancer were prepared during operation from multiple sections of sentinel lymph nodes, stained with haematoxylin and eosin. A cytopathologist blinded to the histological results interpreted the smears. RESULTS: The concordance between touch imprint and paraffin sections of sentinel lymph nodes was 98 per cent (54 of 55). When touch imprint analysis of sentinel lymph nodes was compared with paraffin sectioning of all lymph nodes from the axillary node dissection, the concordance was 95 per cent (52 of 55). The sensitivity and specificity of sentinel lymph node touch imprints in detecting metastases were 82 and 100 per cent respectively. The positive and negative predictive values were 100 and 93 per cent respectively. CONCLUSION: Touch imprint cytology is potentially useful for the intraoperative evaluation of sentinel lymph nodes in patients with breast cancer.

Axilla↗

PubMedDate not supplied

[Anatomy and topography of external iliac lymph nodes in adults].

The investigation of the external iliac lymph nodes has been performed in 152 preparations of corpses of mature persons of both sex, who died from causes not connected with any disease of the lymphatic system, lower extremities and pelvic organs. The external iliac lymph nodes and their afferent and efferent lymphatic vessels have been revealed by means of interstitial injection of the lower extremities and pelvic organs, as well as by means of direct injection of Gerota mass into the lymphatic vessels. Form, amount, dimensions and topography of common iliac lymph nodes have been studied. Lymphatic vessels, running from certain parts and organs of the body to various subgroups of the external iliac lymph nodes have been described, as well as efferent lymph vessels of these nodes. The external iliac lymph nodes are constant formations; the largest of them--lymph nodes of the lacuna--are nodes of the I step for the lower extremity lymph vessels. In 54% of cases in persons of both sex positive (right-sided) asymmetry has been revealed. Total amount of the iliac lymph nodes prevails in men, while their size is greater in women. The size of these nodes in persons of both sex is greater to the left than to the right. There are connections (in 3% of cases) between the external iliac lymph nodes and aortal and lumbar nodes of the opposite side.

Adult↗

PubMed1998

Breast carcinoma associated with necrotic granulomas in axillary lymph nodes.

From a series of 100 consecutive breast carcinomas with axillary lymph node metastases, two cases of necrotic granulomas in the nodes are presented. Lymph nodes in each case were characterized by areas of necrosis surrounded by a palisade of cells resembling histiocytes as seen in a rheumatoid nodule. Although the initial impression was that of a reactive granuloma, when immunostained for keratin and EMA, the areas of necrosis showed positive staining for keratin and EMA in a cytoplasmic pattern. The surrounding palisade of cells stained with histiocyte markers, while the necrotic area itself was negative. Staining for both estrogen and progesterone markers was also negative. Staining of nine lymph nodes with caseating granulomas not associated with carcinoma with the same panel of antibodies revealed no staining except for irregular, noncellular staining with EMA. This pattern of necrosis in axillary lymph nodes from two cases of breast carcinoma was interpreted as evidence of necrotic metastatic tumor cells. Necrosis in axillary lymph nodes associated with invasive breast cancer should arouse suspicion for metastasis.

Axilla↗

PubMedDate not supplied

The role of pre-operative B mode ultrasound in the evaluation of the axillary lymph node metastases in the initial staging of breast carcinoma.

The lymph node status of a breast cancer is one of the main prognostic criterias. This status is very important to determine the therapeutic approach. Physical examination alone is not sufficient to assess axillary metastases. Mammographic examination can give us an idea about breast cancer and axillary involvement. Ultrasonographic evaluation can improve the sensitivity of clinical and mammographic examination in assessing axillary lymph node status. 42 patients operated on for breast cancer between January 2000-January 2003 were included in this prospective study. In the study, we used axillary B mode ultrasound to evaluate the axillary lymph nodes. There are several sonographic features to categorize them. Axillary B mode ultrasound was performed to evaluate the axillary lymph nodes for metastatic involvement. In the evaluation of lymph nodes, the sonographic criteria were centric echogenity, thickening of cortex, length/width ratio (L/W) and the diameter of lymph nodes. Hyperechogenic hilus was accepted as a benign finding. The thickening of the cortex less than 50% of the thickening of the centric echogenic hilus was also accepted as a benign finding. L/W ratio below 2 and parameters above 2 cm were accepted as malignant findings. 168 lymph nodes in 42 patients were evaluated pre-operatively with axillary B mode ultrasound. As a result, these lymph nodes were defined as benign in 19 patients (45.2%) and malignant in 23 patients (54.8%). Axillary lymph node status was found as benign in 18 patients (42.9%) and malignant in 24 patients (57.1%) pathologically . Comparative results of ultrasound and axillary lymph node status can be seen on Table III. As a result, the sensitivity of axillary B mode ultrasound to show the metastases was found as 79.1%, specificity was 77.7%, positive predictive value 82.6% and negative predictive value 73.6%. We think some better results may be obtained in the future and these developments may affect the surgeon's decisions concerning axillary dissection for breast cancer operations.

Adult↗

PubMed1976

[Anatomo-topographic features of the deep lymph nodes of the neck in adult humans].

Profounod cervical lymph nodes were studied on 35 corpses and 30 complexes of organs of the head and neck in adult man by method of dissection after a preliminary injecting the lymphatic vessels and nodes. Under study were the lymph nodes of the anterior part (prelaryngeal, prethyroid, pretracheal and paratracheal groups) which are disposed under the pretracheal lamina of the cervical fascia. The lymph nodes of the lateral area of the neck are concentrated along the internal jugular vein, accessory nerve and the transversal artery of the neck. The lymph nodes disposed along the internal jugular vein are divided into 3 groups: superior, medial and inferior. The lymph nodes disposed in the lateral area of the neck are of different types. The obtained data can be used for decoding data of lymphography.

Adult↗

PubMed2005

Sentinel lymph node mapping for adenocarcinoma of the colon does not improve staging accuracy.

PURPOSE: This study was designed to: determine the efficacy of sentinel lymph node mapping in patients with intraperitoneal colon cancer; and create an algorithm to predict potential survival benefit by using best-case estimates in favor of sentinel node mapping and lymph node ultraprocessing techniques. METHODS: Forty-one patients with intraperitoneal colon cancer undergoing colectomy with curative intent were studied prospectively. After mobilization of the colon and mesentery, 1 to 2 ml of isosulfan blue dye was injected subserosally around the tumor. The first several nodes highlighted with blue dye were identified as sentinel nodes. Additional nodes were identified by the pathologist in routine fashion by manual dissection of the mesentery. All nodes were processed in routine fashion by bivalving and hematoxylin and eosin staining. To create an algorithm to predict potential survival benefit of sentinel node mapping and lymph node ultraprocessing techniques, assumptions were made using data from the literature. All bias was directed toward success of the techniques. RESULTS: Three of 41 patients (7 percent) did not undergo injection of dye and were excluded from further analysis. Stage of disease in the remaining 38 patients was: I, n = 10 (26 percent); II, n = 15 (39 percent); III, n = 11 (29 percent); IV, n = 2 (5 percent). At least one sentinel node was identified in 30 of 38 patients (79 percent). The median number of sentinel nodes identified was two (range, 1-3). Median total nodal retrieval was 14 (range, 7-45). All nodes were negative in 26 of 38 patients (68 percent). Sentinel nodes and nonsentinel nodes were positive in 2 of 38 patients (5 percent). Sentinel nodes were the only positive nodes in 1 of 38 patients (3 percent). Sentinel nodes were negative and nonsentinel nodes were positive in 9 of 38 patients (24 percent). Thus, sentinel node mapping would have potentially benefited only 3 percent, and failed to accurately identify nodal metastases in 24 percent of the patients in our study. To create a survival benefit algorithm, we assumed the following: combined fraction of Stage I and II disease (0.5); fraction understaged by bivalving and hematoxylin and eosin staining that would have occult positive nodes by more sophisticated analysis (0.15); fraction of occult positive nodes detected by sentinel node mapping (0.9); and survival benefit from chemotherapy (0.33). Thus, the fraction of patients benefiting from sentinel lymph node mapping and lymph node ultraprocessing techniques would be 0.02 (2 percent). CONCLUSIONS: Sentinel node mapping with isosulfan blue dye and routine processing of retrieved nodes does not improve staging accuracy in patients with intraperitoneal colon cancer. Even using best-case assumptions, the percentage of patients who would potentially benefit from sentinel lymph node mapping is small.

Adenocarcinoma↗

PubMed2000

Localization of initial lymph node metastasis from carcinoma of the thoracic esophagus.

BACKGROUND: Most surgeons consider esophageal carcinoma with lymph node involvement a systemic disease. However, it is possible that the disease may be localized in the earlier phases of lymphatic metastasis. The distribution of involved lesions in the initial phase of lymph node metastasis has not been thoroughly investigated yet. METHODS: Among 329 patients that underwent curative (R0 International Union Against Cancer [UICC]) esophagectomy with systematic mesoesophageal dissection, 51 cases of patients with only 1 involved lymph node (solitary involvement) were retrospectively investigated and compared with patients with multiple involved lymph nodes. The regional lymph nodes were divided into the thoracocervical junction group (lower deep cervical and recurrent nerve lymph nodes), perigastric group, and intrathoracic group. RESULTS: Lymph node involvement was limited to a solitary lymph node in 46% of lymph node positive patients with esophageal carcinoma confined to the wall (T1 and T2, UICC) and in 17% of lymph node positive patients with cancer that invaded the extramural layer (T3 and T4, UICC). Of patients with solitary involvement, 82% had a positive thoracocervical junction or perigastric lymph node. The 5-year survival rate in solitary involvement cases was 61%, and 65% when solitary involvement was not intrathoracic. Most of the 5-year survivors had involvement of a thoracocervical junction or perigastric lymph node and had not received systemic chemotherapy. CONCLUSIONS: Solitary involvement was not rare and not directly associated with a disseminated disease. Solitary involvement was commonly located in the thoracocervical junction or abdomen that are accessible without thoracotomy. Systematic dissection of the regional lymph nodes including thoracocervical junction and perigastric groups is recommended for resectable esophageal carcinoma at this time. However, less extensive dissection may be performed in selected cases if the sentinel lymph node concept proves valid.

Esophageal Neoplasms↗

PubMed2004

Submandibular lymph node enlargement due to cysticercosis infestation.

Lymph node enlargement due to cysticercus infestation has not been reported in human subjects. A 7-y-old girl presented with seizures and a right submandibular lymph node enlargement. Investigations showed inflammatory granulomas in the brain. Fine needle aspiration cytology from submandibular lymph node and enzyme-linked immunosorbent assay of serum and cerebrospinal fluid showed the presence of cysticercosis infestation. The case underlines the potential of fine needle aspiration cytology for establishing diagnosis in patients having enlarged lymph nodes.

Albendazole↗

PubMed1984

Lymph node metastases. Indicators, but not governors of survival.

Regional lymph node filter function has traditionally been assumed to be critical in the prevention of the systemic spread of malignant cells shed from the primary cancer. However, in a multitude of clinical studies involving a variety of cancers, prophylactic removal of such regional lymph nodes, with or without metastases, does not improve cure rates compared with the observation of these lymph nodes. Furthermore, laboratory studies indicate that lymph node filter function may not be either complete or effective, and that many lymphatic and lymphaticovenous shunts exists that bypass regional lymph nodes and allow both lymphatic and hematogenous dissemination of malignant cells. These facts emphasize that regional lymph node metastases are indicators, but not governors, of survival in cancer. The timing of the clinical appearance of regional lymph node metastases and their number are, with few exceptions, excellent indicators of the biologic behavior of the primary cancer and the cells that are shed from it. This shedding of cells into the vascular and lymphatic vessels undoubtedly occurs simultaneously in the vast majority of cancers, but the later progressive growth of cells and micrometastases distributed hematogenously to vital organs is the ultimate governor of survival.

Breast Neoplasms↗

PubMed1980

[Anatomy and topography of adult human mesenteric lymph nodes].

Topography, number and age changes of the mesenteric lymph nodes in the small intestine have been studied in 40 corpses of both sex at the age of 21-90 years. The mesenteric lymph nodes, their afferent and deferent vessels have been revealed by the method of intersticial injection of coloured masses into the small intestinal wall, as well as by a direct injection of the lymph nodes studied in the mesentery. Variability in the total number of the mesenteric lymph nodes has been demonstrated; topographic borders of separate groups of the mesenteric lymph nodes have been stated; topography of the lymph nodes as regards the mesenteric blood vessels has been described. Quantitative changes (total and group) in the mesenteric lymph nodes with age in grown-up persons have been demonstrated.

Adult↗

PubMed1999

Secondary lymph node involvement from primary cutaneous large B-cell lymphoma of the leg: sentinel lymph nodectomy as a new strategy for staging circumscribed cutaneous lymphomas.

BACKGROUND: Primary cutaneous large B-cell lymphoma of the leg (LBCLL) is a recently defined type of non-Hodgkin's lymphoma. It forms a separate category in the new classification of primary cutaneous lymphomas elaborated by the European Organization for Research and Treatment of Cancer. It is associated with a less favorable prognosis than the most frequently occurring types of primary cutaneous B-cell lymphoma. METHODS: The authors present four patients with the typical clinicopathologic constellation of LBCLL. Three of them died during the years 1993-1996. The authors reviewed their courses. The fourth patient was staged by sentinel lymph nodectomy (SLNE), i.e., the selective surgical removal and histologic examination of the first draining lymph node associated with the cutaneous tumor. RESULTS: The courses of the three previous patients were characterized by secondary involvement of regional lymph nodes followed by systemic dissemination of the lymphoma in a third step. Although the conventional staging of the fourth patient had been negative for any extracutaneous lymphoma manifestation, the SLNE revealed initial regional lymph node involvement, which had decisive implications for the choice of therapy. CONCLUSIONS: SLNE may gain a prominent role in the staging of circumscribed cutaneous lymphomas, in addition to its already established position in melanoma management. Further positive effects of SLNE are 1) better distinction of primary cutaneous lymphomas with secondary lymph node involvement from primary lymph node lymphomas with skin manifestation, and 2) better insight into the biology of different primary cutaneous lymphoma types.

Aged↗

PubMed1999

Evaluation of the ratio of lymph node metastasis as a prognostic factor in patients with gastric cancer.

BACKGROUND: Lymph node metastasis in patients with gastric cancer is one of the important prognostic factors. However, there is no consensus concerning the best classification for lymph node metastasis as a prognostic factor. So, to evaluate the ratio of the number of metastatic lymph nodes to the total number of dissected lymph nodes (the ratio of LN meta) as a prognostic factor, we compared the ratio of LN meta with lymph node status according to the Japan Classification of Gastric Carcinoma and the total number of metastatic lymph nodes with multivariate analysis.METHODS: Between 1991 and 1997, a total of 360 patients with primary gastric cancer who underwent gastrectomy with D2 or more extended lymph node dissection were included in this study. Ten kinds of prognostic factors and three types of different classifications for lymph node metastasis were analyzed by multivariate analysis using the Cox regression.RESULTS: The average number of dissected lymph nodes and metastatic lymph nodes were 55.0 (range, 11-184) and 2.6 (range, 0-86), respectively. There were significant differences of the 5-year cumulative survival rates among each group of the ratio of LN meta (0%, 1%-9%, 10%-24%, and more than 25%). Age, tumor size, curability, and the ratio of LN meta were selected as independent prognostic factors by forward stepwise selection. The ratio of LN meta showed the highest hazard ratio by Cox regression.CONCLUSION: The ratio of LN meta appears to be an important prognostic factor and the best classification factor for lymph node metastasis.

Journal Article↗

PubMed2000

Sentinel lymph node dissection as a means of managing breast cancer.

Sentinel lymph node dissection is a minimally invasive procedure designed to identify and remove specific lymph nodes suspected of containing metastatic cancer cells. First, a surgeon maps sentinel lymph nodes by tagging them with a radioisotope. He or she then uses a hand-held gamma probe intraoperatively to identify lymph nodes likely to contain metastases of primary lesions (e.g., cancers of the breast, prostate, and parathyroid; melanomas). Sentinel lymph node dissection is precise and considerably less traumatic for the patient than the traditional surgical treatment of complete lymph node dissection. This article discusses the use of sentinel lymph node dissection as a diagnostic tool and treatment for breast cancer.

Axilla↗

PubMed2001

Sentinel lymph nodes study in 30 cases of melanoma.

In 30 cases of melanoma, we attempted to detect sentinel lymph nodes using 1-2% patent blue dye and were able to detect them in 27 cases (90%): 19 cases out of 21 cases in the groin area (90%), 5 out of 5 cases in the axilla area (100%), and 3 out of 4 cases in the neck area (75%). The numbers of sentinel lymph nodes were one in 16 cases, two in 7 cases, three in 2 cases, and four in 2 cases. The cases with three and four nodes were all in the groin area. In 22 cases, tumor metastasis was negative in sentinel lymph nodes. Sentinel lymph nodes were detected in 36 out of 174 samples, and tumor metastasis was negative except in these sentinel lymph nodes (false negative 0%). In the groin area, sentinel lymph nodes were located around the femoral and great saphenous vein junction. In the axilla area, sentinel lymph nodes were located in the central, lateral and subscapular lymph nodes. In the head and neck area, sentinel lymph nodes were found in the submandibular and occipital lymph nodes. The positions of sentinel lymph nodes differed a little with tumor location. By accumulating cases, it should become possible to predict the positions of sentinel lymph nodes before operations. Sentinel lymph node biopsy is easy and requires only a small incision.

Adult↗

PubMed2004

[Distribution of sentinel lymph nodes in gastric cancer and factors correlated with its metastasis].

OBJECTIVE: To investigate the distribution of sentinel lymph nodes in gastric cancer, and evaluate clinicopathologic characteristics leading its metastasis. METHODS: The location of metastatic lymph nodes was analyzed retrospectively in 27 patients of gastric carcinoma with solitary lymph node metastases, and in 80 cases metastasis was limited to only 1 station in Japanese nodal classification. The clinicopathologic characteristics of the patients with solitary lymph node metastases and 111 cases without lymph node metastases were compared. RESULTS: Twenty-five in 27 cases with solitary lymph node metastases were limited in level I. Skip metastasis occurred in 2 cases. Sentinel lymph nodes of 16 cases in 21 patients with the tumors in the lower and middle third stomach were located in less curvature (No. 3) and in greater curvature (No. 4). Sentinel lymph nodes of 3 cases in 6 patients in the upper third stomach were located in right cardia (No. 1). Multivariate analysis showed that the frequency of sentinel lymph node metastasis of pT(3) lesion was significantly higher than that of pT(1) lesion with an odds ratio of 4.926 (P < 0.01). The frequency of sentinel lymph node metastasis in the tumor located in the upper third stomach was significantly higher than that in lower third stomach, with an odds ratio of 4.381 (P < 0.05). Early gastric cancer had lower risk for sentinel lymph node metastasis than that in Borrmann type I cancer, with an odds ratio of 0.082 (P < 0.05). CONCLUSIONS: Majority of sentinel lymph nodes are located in the regional perigastric lymph node groups close to the tumor. Skip metastasis is rare. Depth of invasion and location of tumor are correlated with sentinel lymph node metastasis. Sentinel lymph node assessment can instruct to determine extent of lymph node dissection for gastric cancer.

Adult↗

PubMed2002

Lymphatic mapping and gamma probe guided laparoscopic biopsy of sentinel lymph node in patients with clinical stage I testicular tumor.

PURPOSE: We attempted to detect lymphatic drainage and sentinel lymph node with radioactive tracer in patients with testicular tumor. We then tried to determine if sentinel lymph node biopsy with gamma probe guided laparoscopic procedure was feasible as a staging tool for patients with clinical stage I testicular tumor. MATERIALS AND METHODS: Technetium-labeled phytate was injected around the tumor in 15 consecutive patients with clinical stage I testicular tumor. Lymphatic drainage and sentinel lymph nodes were imaged by a gamma camera. Localization of the sentinel lymph node was confirmed with a handheld gamma probe. After we confirmed that sentinel lymph nodes were detected in the initial 10 patients, gamma probe guided laparoscopic sentinel lymph node biopsy was performed after routine orchiectomy in the next 4. To confirm whether the radioactive node was really a sentinel lymph node the final patient in this series underwent laparoscopic retroperitoneal lymph node dissection with a unilateral template. RESULTS: Sentinel lymph nodes were detected in all patients by lymphoscintigraphy and handheld gamma probe, and each node varied. Right tumors in sentinel lymph node were detected at the inter-aortocaval, paracaval or common iliac region. Para-aortic lymph nodes were detected as sentinel lymph node in cases of left tumor. In the 4 patients who underwent gamma probe navigated laparoscopic procedure sentinel lymph nodes were easily detected and safely removed for pathological examination. In the last patient who underwent laparoscopic lymph node dissection micrometastasis was found only at the sentinel lymph node. CONCLUSIONS: Sentinel lymph node can be detected by lymphoscintigraphy and handheld gamma probe. Gamma probe guided laparoscopic biopsy of sentinel lymph node is technically possible. These techniques may have a role in the management of clinical stage I testicular tumor but further trials are required for establishment of the concept of sentinel lymph node in testicular tumor.

Adolescent↗

PubMed1999

The feasibility and accuracy of the sentinel lymph node biopsy for breast carcinoma.

As the procedure of sentinel lymph node biopsy for breast cancer becomes more widely available, the practicality of it in the hands of general surgeons should be assessed. This is a study of the accuracy and use of this procedure. A prospective study was conducted at two university-affiliated teaching hospitals. Ninety-one patients with invasive breast cancer were enrolled in the study. Twelve patients were excluded from analysis. The remaining 79 patients were injected peritumorally with technetium-99m-labeled sulfur colloid and isosulfan vital blue dye. The sentinel lymph node was located and excised using a gamma probe, and the definitive breast cancer operation was completed, including an axillary dissection. Histology of the sentinel lymph node specimen was compared with that of the axilla. Sentinel lymph nodes were located in 64 (81.0%) of the 79 patients. Sentinel lymph nodes and axillary nodes were benign in 44 (68.8%) of the 64 patients; these patients could potentially have been spared the axillary dissection. Fourteen (21.9%) patients had metastatic cancer to the sentinel nodes only, and five (7.8%) patients had axillary metastasis beyond the sentinel lymph node. Among the 64 patients, there was one false negative. Sensitivity and specificity when a sentinel lymph node was found were 95.0 per cent and 100 per cent, respectively. The sentinel lymph node accurately predicted the axillary contents 98.4 per cent of the time. This study demonstrates that the sentinel lymph node can be identified and is reliable in predicting axillary node status. This study also shows that the procedure has a notable learning curve, but can be used by general surgeons with a commitment to the care of breast cancer patients.

Adult↗