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PubMed1995

Mediastinal lymph node dissection for lung cancer. The Memorial experience.

A mediastinal lymph node dissection as opposed to lymph node sampling should be an integral part of the operation in all patients with resectable lung cancers. A systematic mediastinal node dissection affords the most accurate staging and a long-term survival in some patients when the positive regional nodes are also removed. It is safe and easy to do, adds only 20 to 30 minutes to the surgical procedure, and morbidity is minimal. Our reported survival data have been based on the routine use of mediastinal lymph node dissection in conjunction with pulmonary resection. Techniques of lymph node dissection for both right- and left-sided tumors are described along with a historical background of their evolution.

Humans↗
PubMed2003

[Intraoperative evaluation of axillary lymph nodes for micrometastases using immunohistochemistry--preliminary study].

The increase of utilization of sentinel lymph nodes concept for breast carcinoma has made intraoperative evaluation of immunohistochemistry using epithelial markers attractive. At present the optimal procedures for intraoperative detection of micrometastasis of axillary lymph nodes has not been established. The purpose of this study is to evaluate the immunohistochemistry for intraoperative diagnosis of axillary lymph nodes in patients with breast cancer. Lymph nodes from 170 patients(1048 lymph nodes) were examined immunohistochemistry using anti cytokeratin, compared with intraoperative frozen section of same lymph nodes with H & E staining. Tumor metastases were found in 50 patients(92 lymph nodes) in H & E staining section, compared with 64 patients(113 lymph nodes) stained with anti-cytokeratin. Of 14 patients whose metastases were detected by immunohistochemistry. Routine intraoperative frozen diagnosis using H & E stainings significantly underestimates lymph nodes metastases. The insufficient diagnosis may be overcome by immunohistochemistry using anti-cytokeratin and careful examination of routine sections with good qualities. The true clinical significance of these micrometastases will be determined by long term follow up studies.

Adult↗
PubMed1981

Lymph node biopsy in mycosis fungoides.

Ninety lymph node biopsy specimens from 76 patients with mycosis fungoides (MF) were reviewed. Dermatopathic lymphadenopathy was the most common change found in biopsies of palpable lymph nodes obtained from patients with MF. The paracortical expansion and histiocytes with elongated, folded, and delicate nuclei were characteristic. Lymph node involvement by MF lymphoma had a broad spectrum of histologic appearance. Most commonly, MF lymphoma was composed of atypical, often hyperconvoluted, lymphoid cells showing a wide variation in size. The pretreatment biopsies from 38 patients were graded according to the number of atypical small lymphocytes (AL) in the paracortical region and the results were correlated with survival. No significant differences in survival were found among the various grades, which ranged from dermatopathic lymphadenopathy without AL to frank involvement by MF lymphoma. Patients with more extensive skin disease tended to have a higher grade and to do poorly.

Biopsy↗
PubMed1984

Fine-needle aspiration effects on benign lymph node histology.

The histology of 28 lymph nodes with benign hyperplasia were assessed for evidence of the effects of fine-needle aspiration prior to biopsy. Only 43% of the lymph nodes showed evidence of prior aspiration. This consisted of needle tracts occupying less than 5% of any one section in ten cases, and 10% in two cases. In none of the 28 lymph nodes did prior fine-needle aspiration interfere with the histologic evaluation. The authors conclude that fine-needle aspiration does not interfere with subsequent histologic evaluation of lymph-adenopathy.

Biopsy, Needle↗
PubMed1987

Isolation and culture of high endothelial cells from rat lymph nodes.

The isolation and culture of an enriched population of cells from rat lymph nodes that have several properties of high endothelial cells are described. High endothelial cells synthesize a unique sulphated glycolipid. This macromolecule in high endothelial cells was labelled with 35SO4 prior to cell isolation and was used to identify high endothelial cells after isolation. Collagenase digestion of pre-labelled lymph nodes yielded primary lymph node cultures in which two different cell types accounted for greater than 90% of non-lymphoid cells isolated. The majority (greater than 70%) were 20-30 microns diameter, round and 35S-labelled and were therefore high endothelial cells. The remaining unlabelled cells were 10-15 microns diameter and were identified as macrophages by phase-contrast microscopy. Isolated cells proliferated after 1-2 days and cultures were enriched for high endothelial cells as macrophages did not persist beyond 7-10 days. Small clumps (2-3 cells) of microvascular endothelial cells and/or adventitial fibroblasts were occasionally seen in primary cultures (angle 1% of isolated cells) but neither cell type proliferated. The identity of high endothelial cells was further substantiated using a polyclonal antiserum raised against lymph node cultures, which stained high endothelium in cryostat sections of lymph nodes. At confluence primary lymph node cultures bound lymphocytes as efficiently as high endothelium in lymphoid tissue and 40-fold more efficiently than rat aortic endothelial cells. It is concluded that lymph node cultures contain high endothelial cells and that these cells continue to express surface determinants for lymphocytes in vitro.

Animals↗
PubMed2003

Increased tumour necrosis factor alpha production in mesenteric lymph nodes of cirrhotic patients with ascites.

BACKGROUND: Cytokines produced in mesenteric lymph nodes of cirrhotic rats with bacterial translocation may participate in circulatory alterations of cirrhosis. AIM: To investigate whether cirrhotic patients present an increased local generation of cytokines in mesenteric lymph nodes. METHODS: Mesenteric lymph nodes from 26 cirrhotic and 10 control patients were assessed for tumour necrosis factor alpha (TNF) and interleukin 6 mRNA and protein expression by competitive reverse transcription-polymerase chain reaction, and by enzyme immunoassay and immunohistochemistry, respectively. RESULTS: Interleukin 6 levels were not different between cirrhotics and controls. Protein and mRNA TNF levels in mesenteric lymph nodes from cirrhotics were higher than in controls (p<0.05). Tissue expression of TNF by immunohistochemistry was more abundant in cirrhotics. Ascitic patients showed higher TNF levels (47 (34-54) pg/mg protein) than patients without ascites (18 (17-25) pg/mg protein) (p<0.001). Elevated TNF levels (>28 pg/mg protein) in cirrhotics were associated with a higher Child-Pugh score, the antecedent of ascites, a lower prothrombin rate, and higher bilirubin and blood TNF levels. The strongest association, confirmed by multivariate analysis, was with the presence of ascites (p<0.001). Bacterial infections after transplantation, mainly by enteric bacteria, were only detected in patients with high TNF levels in mesenteric lymph nodes (33% of patients; p=0.05). CONCLUSION: Patients with advanced liver cirrhosis, and especially with ascites, have increased local production of TNF in mesenteric lymph nodes that, in common with experimental cirrhosis, may also be induced by bacterial translocation.

Ascites↗
PubMed2001

Effect of a matrix metalloproteinase inhibitor on a lymph node metastatic model of gastric cancer cells passaged by orthotopic implantation.

Lymph node metastasis is the most frequent type of tumor recurrence and is known to be one reason for the poor prognosis in patients with digestive cancer. However, the mechanisms of lymph node metastasis are not clearly understood and a metastatic model will be useful for elucidating factors associated with lymph node metastases. In this study, we investigated the effect of R-94138, a matrix metalloproteinase (MMP) inhibitor, on the lymphnodal metastatic ability of gastric cancer cells using an in vivo orthotopic implantation model in nude mice. Injection of a gastric cancer cell line, MKN-45, into the gastric wall resulted in lymph node metastasis 8 weeks after inoculation. The number of lymph node metastases and the amount of body weight loss significantly decreased by intraperitoneal administration of R-94138. Histologically, lymphatic invasion of cancer cells was found in primary gastric tumors of control mice with lymph node metastasis. However, no lymphatic invasion was observed in the gastric wall of R-94138-treated mice without lymph node metastasis. These findings suggested that the MMP inhibitor, R-94138, could be used in adjunctive therapy for lymph node metastasis in gastric carcinoma.

Acetamides↗
PubMed1975

Irradiation of clinically uninvolved cervical lymph nodes.

Of 402 patients with cancers of the oral cavity, oropharynx, and supraglottic larynx treated at Stanford between 1957 and 1972, 164 had clinically uninvolved cervical lymph nodes prior to the initiation of radiation therapy. Lymph node metastases developed later in 38 per cent of patients with primary oral cavity carcinomas who were treated with interstitial radium implants alone. No late cervical lymph node involvement was found in those patients who received high dose external irradiation to at least the primary site and first echelon lymph nodes. Lymph node failures were ultimately noted in 20 of the 140 patients (14 per cent), who received partial or complete neck irradiation, but 18 of these occurred in patients with uncontrolled primary lesions, suggesting that re-seeding of cervical lymph nodes had taken place rather than failure of the initial irradiation to control subclinical metastases. Our present policy is to treat the primary lesion and adjacent lymph nodes with high dose megavoltage techniques, combined with interstitial irradiation if possible. Bilateral supplemental inferior neck radiation ports are added for patients with advanced primary neoplasms and for those with clinically involved cervical lymph nodes. All other patients undergoing radiation therapy for stage T1 primary lesions and clinically negative necks also receive ipsilateral low neck irradiation. In addition, cervical lymph nodes are electively irradiated when the primary lesion has been resected. When these policies are adopted, the incidence of cervical lymph node failures is extremely low in patients whose primary sites remain controlled, and morbidity from the cervical radiation fields is negligible.

Humans↗
PubMed1986

Studies on hepatobiliary lymph flow with radioactive colloid--for lymph node metastasis resection of carcinoma of the bifurcation of hepatic duct.

Hepatobiliary lymphoscintigraphy by Technetium 99m-rhenium colloid (99mTc-Re colloid) using a fine needle guided by ultrasonography was performed on 12 patients who underwent resection of the hepatoduodenal ligament lymph nodes. Histological examination revealed no lymph node metastasis in 8 patients. In 4 patients in whom 99mTc-Re colloid was injected into the left medial inferior hepatic segment, periarterial lymph nodes showed higher isotope uptake count than periductal nodes, and lymph nodes around the common hepatic artery revealed higher values than superior posterior pancreatoduodenal nodes. On the contrary, in 3 patients in whom the isotope was injected into the right anterior inferior segment, periductal lymph nodes had higher values than periarterial nodes, and superior posterior pancreatoduodenal lymph nodes showed higher values than those around the common hepatic artery. In one patient in whom the isotope was injected into both right and left segments, superior posterior pancreatoduodenal lymph nodes showed similar values to those around the common hepatic artery. Periportal lymph nodes tended to have values between those of periarterial and periductal ones. Lymph node metastases were confirmed in 4 patients in whom the relationships mentioned above was not always observed, and periportal lymph nodes showed the highest values among the three.

Adenocarcinoma↗
PubMed2001

[Optimal lymph node dissection for colorectal cancer].

Previous studies on the distribution of positive lymph nodes have revealed that the colon should be resected 10 cm from the tumor on both sides and that the intermediate nodes along the main vessel should be dissected in patients with colon cancer. In rectal cancer, superior lymphatic spread along the inferior mesenteric artery (IMA) is the main metastatic route. The IMA should be dissected immediately after the bifurcation of the left colic artery, and the intermediate lymph nodes should be removed. The positive rate of the lateral lymph nodes is about 10%. The rate of local failure is high and the prognosis is poor in patients with positive lateral lymph nodes, even if the lateral lymph nodes have been dissected. However, it has been reported that lateral lymph node dissection combined with excision of the internal iliac vessels results in good disease-free survival in patients with positive lateral nodes. Therefore the indications for lateral node dissection remain controversial. Lymphatic spread into the mesorectum on the anal side has been shown to be an important factor in local failure. The mesorectum should be resected for up to 4 or 5 cm from the inferior tumor margin in middle rectal cancer, and the entire mesorectum should be removed in lower rectal cancer. Nerve tissue preserved in pelvic autonomic nerve-preserving surgery contains a small amount of lymphoid tissue and lymph nodes. Therefore the extent of lymph node dissection and the area of autonomic nerves to be preserved based on tumor site or tumor penetration remain controversial.

Colonic Neoplasms↗
PubMed1977

The effect of pregnancy on lymph node weight in the mouse.

Lumbar and renal lymph nodes, inguinal lymph nodes and spleen weights were recorded during pregnancy in mice after mating with males of the same (syngeneic) or a different (allogeneic) strain. The weights of these nodes increased during pregnancy. Spleen weights increased up to the fifteenth day of pregnancy and then decreased in weight. There was no consistent correlation of any of these measurements with the extent of the antigenic dissimilarity between mother and conceptus.

Animals↗
PubMed2004

Tuberculosis of the cystic duct lymph node.

Tuberculosis of the cystic duct lymph node associated with cholelithiasis is rare. We report a case of a 40 year-old woman with this pathology. She presented with anorexia, biliary colic, postprandial fullness and fever. Imaging studies revealed cholelithiasis and several visible portal lymph nodes. Cholecystectomy was performed and histopathological examination showed tuberculosis of the cystic duct lymph node without affecting the gallbladder. The presence of gallstones and lymphadenopathy in computed tomography, associated with persistent fever and symptoms that resemble cholecystitis, should cause suspicion of tuberculosis. However, diagnosis is usually achieved by microscopic appearance of caseating granulomas and isolation of Mycobacterium tuberculosis. The treatment in this case consisted of cholecystectomy and antitubercular chemotherapy.

Adult↗
PubMed1997

[The difficulty of ultrasound diagnosis of lymph node metastases of malignant melanoma in protracted tumor growth].

Lymph node ultrasound examinations are performed during the follow-up of cutaneous melanoma in order to early recognise regional metastases. The excision of regional metastases is the only way to inhibit disseminated metastasis in a certain percentage of cases. Lymph node ultrasound has a sensitivity of 95% in the diagnosis of pathological lymph node changes. Sonographic findings normally show typical features of malignancy; only in some doubtful cases are further control examinations warranted over a period of 4-6 weeks. In violation of this rule, two cases are presented with a delayed onset of metastases causing difficulties in the diagnosis of malignant transformation. Four years after the excision of a nodular melanoma with 0.8 mm tumor thickness at the right lower leg, a suspicious lymph node change in the right groin was sonographically detected which did not fulfill all criteria of malignancy. Control examinations over a period of 1 year found only a further growth of 3 mm. Excision after 1 1/2 years showed a lymph node metastasis. The second case presented 9 years after the excision of a superficial spreading melanoma with 0.76 mm tumor thickness with a suspicious lymph node in the right axilla which similarly grew very slowly. The subsequent excision showed likewise a melanoma metastasis. A protracted growth may occur in thin malignant melanomas with late development of ultrasound features of malignancy. In doubtful cases an early biopsy is recommended.

Aged↗
PubMed1986

Automated cytochemistry in non-Hodgkin's lymphoma: a new method for determination of cells from lymph node biopsy.

Cell suspension prepared from the lymph node biopsy of patients with non-Hodgkin's lymphoma (NHL), metastatic carcinoma (MC) and non-neoplastic lymphadenopathies (NL) were analyzed by the Hemalog D, automated differential counter. The preparation of lymph node cells is described first in this study. The results show that the percentage of large cells (diameter greater than 13.5 micron) stained negatively with peroxidase (LUC, large unstained cells) was remarkably increased in patients with NHL (mean +/- SEM = 18.6 +/- 3.1%) and was particularly increased in the subgroup, diffuse histiocytic type (31.1 +/- 5.3%). Patients with MC had a raised percentage of nonspecific esterase-positive cells (9.2 +/- 1.4%) compared to patients in the NHL and NL groups. Patients in the NL group had low percentages of both LUC (5.3 +/- 0.7%) and nonspecific esterase-positive cells (1.8 +/- 0.2%). Quantitation of cells in the lymph node by using the Hemalog D may assist in the diagnosis of lymph node diseases.

Biopsy↗
PubMed1995

Extracapsular growth of lymph node metastases in squamous cell carcinoma of the vulva. The impact on recurrence and survival.

BACKGROUND: Patients with squamous cell carcinoma of the vulva who present with multiple positive groin lymph nodes have poor survival. Growth of cancer through the capsule of the groin lymph nodes recently has been identified as an important prognostic factor for survival in that patient group. The objective of this study was to determine the influence of several clinicopathologic parameters on the pattern of recurrence and survival. METHODS: A review of 71 patients with squamous cell carcinoma of the vulva and positive lymph nodes was performed to assess the independent prognostic value of a number of variables for survival. Variables analyzed included tumor size, stage, number of positive lymph nodes, extracapsular growth of lymph node metastasis, the greatest dimension of tumor in the lymph nodes, the percentage of replacement of the lymph nodes by tumor, clinical lymph node status, and laterality of positive lymph nodes. RESULTS: Using the Mantel-Cox test, extracapsular growth of lymph node metastases (P = 0.00), two or more positive lymph nodes (P = 0.02), and greater than 50% replacement of lymph nodes by tumor (P = 0.03) were predictors of poor survival. No difference was found between the groups with two positive lymph nodes and those with three or more. Extracapsular growth of lymph node metastases was the most significant independent predictor for survival. Distant metastases occurred in 7 of 15 patients (48%) who had a combination of extranodal spread, lymph node replacement greater than 50%, and three or more positive lymph nodes. CONCLUSION: Extracapsular growth of lymph node metastases in the groin is the most important predictor for poor survival in patients with squamous cell carcinoma of the vulva. Because of the predominant distant failure pattern in a subgroup of patients who have a combination of extranodal spread, multiple positive lymph nodes, and lymph nodes replaced by tumor greater than 50%, a future study of the effectiveness of systemic therapy for vulvar cancer must include these patients.

Adult↗
PubMed2000

[The future of retroperitoneal lymph node dissection].

Over the past decades, retroperitoneal lymph node dissection has been included in most gynecology oncological surgeries. Today, its usefulness is questioned. Recent studies on cervical, ovarian and endometrial cancer have attempted to redefine the role of retroperitoneal lymph node dissection. Despite theses studies, it appears obvious that dissection only has a minor impact on survival while increasing morbidity to a certain extent. The future of these procedures appears to be related to their prognostic value. The immediate goals today would be to target and remove only the necessary lymph nodes and to decrease the morbidity associated with the procedures. To reach these goals, two new approaches are presently studied: laparoscopic dissection and sentinel lymph node identification.

Endometrial Neoplasms↗
PubMed1995

Prognostic significance of clinically false positive cervical lymph nodes in patients with laryngeal carcinoma.

BACKGROUND: A significant proportion of clinically positive palpable cervical lymph nodes in patients with head and neck cancer are histologically benign. The biologic and prognostic significance of this reactive lymph node enlargement has not been fully clarified. METHODS: In this study, the incidence of clinically positive microscopically negative cervical lymph nodes in a series of 902 patients who had neck procedures as a part of their primary treatment for N0-2 laryngeal cancer was analyzed and survival rates of 342 patients with true negative lymph nodes (N0- necks) were compared with those of 106 patients with clinically false positive lymph nodes (N1-2b- necks). In 86 patients with false positive lymph nodes, a histopathologic analysis was performed to determine the histomorphologic pattern of the enlarged lymph nodes and to evaluate which parameters, if any, correlated with 5-year patient survival. RESULTS: Overall actuarial survival did not differ significantly in the two groups. However, the actuarial survival curves in the false positive group were clearly better compared with those of the true negative group with more advanced laryngeal cancers, particularly T4 lesions (P < 0.05). Interestingly, the analysis of pattern of recurrence showed a higher incidence of distant metastases in false positive patients with advanced stage laryngeal cancer than in true negative subjects. In addition, the histologic examination of 375 enlarged hyperplastic cervical lymph nodes from 86 neck specimens showed the prevalence of sinus histiocytosis in the false positive group and its favorable prognostic significance. No statistically significant differences with regard to the number and size of enlarged lymph nodes were found. On the contrary, lymph node location seems to have a prognostic impact on survival and the reactive benign enlargement of a digastric lymph node is a possible poor prognostic factor. CONCLUSIONS: Survival of patients with clinically false positive, histologically benign hyperplastic cervical lymph nodes who have more advanced laryngeal carcinoma is higher than clinically negative patients, suggesting that the presence of palpable benign nodes may be a sign of the host's immune activation, with favorable prognostic significance.

Actuarial Analysis↗