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PubMed1992

Intramammary lymph nodes.

AIMS: To determine the prevalence and pathology of intramammary lymph nodes in breast specimens. METHODS: All breast specimens examined by a single pathologist over 70 months in a large teaching hospital were studied retrospectively. All the surgical pathology reports were reviewed. Relevant glass slides from cases in which intramammary lymph nodes were identified were also reexamined. RESULTS: Breast specimens (n = 682) were examined. Seven lymph nodes were found in five patients. The specimens comprised 533 biopsy specimens, 29 segmental resections, 22 reduction mammoplasties, 77 modified radical mastectomies and 20 gynecomastia mastectomies. No clinically relevant microscopical abnormalities were found in four lymph nodes and slight sinus histiocytosis was seen in two nodes. One node contained metastatic adenocarcinoma and benign glandular epithelial inclusions. CONCLUSION: Although rare, intramammary lymph nodes may be detected by careful gross examination of breast specimens even in the absence of clinical identification. They can occur in any quadrant of the breast and can display a variety of pathological conditions. Pathologists should be alert to the existence and potential importance of these lymph nodes.

Adenocarcinoma↗

PubMed2000

Sentinel lymph node dissection for primary cutaneous melanoma: a community hospital's initial experience.

Management of the regional lymph nodes remains the most controversial aspect of treating patients with intermediate-thickness cutaneous melanoma. Prospective studies have failed to demonstrate a significant survival advantage for patients undergoing elective lymph node dissection. The sentinel lymph node dissection (SLND) technique has been proposed as a method of accurately identifying patients with occult metastases in whom a regional lymph node dissection would be indicated. The majority of studies evaluating this technique have come from academic centers, most with dedicated melanoma clinics. This report describes the initial experience with SLND at a community hospital. Fifteen patients with intermediate-thickness primary cutaneous melanoma underwent preoperative lymphoscintigraphy with 99Tc-sulfur colloid. In addition, intraoperative lymphatic mapping using intradermally injected isosulfan blue was performed. Dissection was guided by radioactivity levels (in counts per second) as measured by a hand-held gamma probe. The resected lymph node or nodes were evaluated for micrometastases using routine hematoxylin and eosin staining and immunohistochemistry with S-100 and HMB-45. All patients were followed clinically for any evidence of recurrence. A sentinel node(s) was identified on preoperative lymphoscintigraphy in all 15 patients (100%). A single sentinel node was identified in 11 of 15 (73%), two nodes in 3 (20%), and one node in 1 (6.7%). The hand-held gamma probe reading correlated well with the site marked the "hot spot" (600-15,320 cps for the hot spot versus 10-350 cps for background). The sentinel lymph node was successfully identified and resected in all 15 patients. Blue-stained lymphatics and/or lymph nodes were present in 8 of 15 (53%) cases. Histopathology was negative for evidence of occult micrometastases in all patients. At mean follow-up of 221 days, all 15 patients remain with no evidence of disease. The outcomes for mapping and harvesting the sentinel node at a community institution compare favorably with results at major academic institutions. SLND may therefore be offered to patients with intermediate-thickness cutaneous melanoma in the community hospital setting with regional lymph node dissection and adjuvant interferon alpha-2b as options for patients with nodal micrometastases.

Adult↗

PubMed1992

Pathways of lymph flow through intestinal lymph nodes in the horse.

In the horse, several thousand lymph nodes receive lymph from the intestine, part of which is very large and contains microorganisms that enable the animal to utilize refractory dietary constituents such as cellulose. The aim of this study was to describe the pathways by which lymph is delivered into, traverses, and is drained from these lymph nodes. These pathways were studied with either Microfil or methacrylate casting materials and with light and electron microscopy. The afferent lymphatic vessel delivering lymph into one of the nodes divides over the capsular surface and within trabeculae into terminal branches, and these are continuous with the subcapsular and trabecular sinuses through rounded holes up to 30 microns across. Lymph is conveyed from the subcapsular and trabecular sinuses through the cortex by four types of sinuses: trabecular sinuses, cortical tubular sinuses, tubule-like sinuses with a network of stellate cell processes, and sinuses between cortical cords. It is conveyed through the medulla by sinuses both within and between medullary cords. Lymph is drained from these sinuses by initial efferent lymphatics of three types: those between medullary cords, those within the subcapsular sinus overlying medullary or cortical cords, and those within trabeculae. All three types are continuous with surrounding sinuses through holes 5-30 microns across. These three alternative routes for lymph drainage may ensure adequate lymph flow during different intranodal conditions that may exist when the node is responding to microorganisms or other foreign materials.

Animals↗

PubMed1991

Angiofollicular lymph node hyperplasia of the parotid.

Angiofollicular lymph node hyperplasia (AFLNH) is a condition of uncertain aetiology usually presenting with mediastinal lymphadenopathy. Occasionally other lymph node groups are affected and there may be associated wide ranging systemic manifestations. A case of AFLNH affecting parotid lymph nodes is presented. The histological features of AFLNH and its variants are discussed, and current ideas on its pathogenesis are summarised.

Adenoma, Pleomorphic↗

PubMed1985

Infectious mononucleosis. Appendiceal lymphoid tissue involvement parallels characteristic lymph node changes.

Appendectomy with mesenteric lymph node biopsy was performed in an 18-year-old man because of acute abdominal pain that was subsequently attributed to infectious mononucleosis. The appendix demonstrated intense hyperplasia of the lymphoid tissue with marked expansion of the interfollicular lamina propria by a mixed diffuse proliferation of immunoblasts including Reed-Sternberg-like forms, together with large and small lymphoid cells. Germinal centers were reactive but inconspicuous. This pattern was distinguishable from malignant lymphoma and, like the characteristic lymph node changes, may be strongly predictive of infectious mononucleosis. Involvement of gut-associated lymphoid tissue may contribute importantly to abdominal symptomatology in this infection.

Adolescent↗

PubMed2006

Complications of nerve sparing retroperitoneal lymph node dissection.

Nerve sparing retroperitoneal lymph node dissection is standard treatment method for early stage non-seminomatous germ cell tumor. However, an alternative approaches (surveillance policy, adjuvant and primary chemotherapy) have approximately the same capability for cure. Therefore, the current debate is to decide which is less morbid for the patient at risk. We assessed associated complications of nerve sparing retroperitoneal lymph node dissection in 33 patients (25 with clinical stage I and 8 with clinical stage IIA) treated at our center from June 1996 to November 2005. There were 7 (21%) complications (2 intraoperative, 4 early minor and 1 early major) in 6 out of the 33 operated patients. There were no late complications. Antegrade ejaculation was preserved in 30 patients (91%). Postoperatively 19 out of 33 patients were classified as pathological stage I and 14 as pathological stage IIA. Both groups were balanced with respect to distribution of complications. The data indicate that nerve sparing RPLND is a well tolerated urologic procedure with a low early and no late morbidity.

Adult↗

PubMed1976

Electrophoretic studies of non-histone proteins from pig lymph nodes.

Purified chromatin from pig lymph nodes has been prepared and used for the isolation of chromatin proteins and non-histine proteins. Saccharose nuclei from this tissue have been used for the preparation of nuclear phenol-soluble phosphoproteins. The isolated proteins have been compared by analytical electrophoresis in polyacrylamide gel in sodium dodecyl sulfate. Most chromatin non-histone proteins and nuclear phosphoproteins of pig lymph nodes have a molecular weight about 40 000 daltons and show a significant degree of homology of molecular range from 40 000 to 90 000 daltons. The phosphoproteins have been also analyzed by isoelectric focusing in polyacrylamide gel over the pH range of 3-10. They are distributed throughout the pI range of 5.8-9.0. The chromatin non-histone proteins and phosphoproteins are of acidic nature and contain 0,97 per cent tryptophan.

Amino Acids↗

PubMed1991

Virchow-Troisier's lymph node in hepatocellular carcinoma.

Virchow-Troisier's lymph node is rarely found in patients with hepatocellular carcinoma. When present, it may or may not accompany spread of the tumor to mediastinal lymph nodes. In a 20-year-old South African black man with hepatocellular carcinoma, a Virchow-Troisier's node was evident clinically and confirmed at necropsy. Mediastinal lymph nodes were not involved by tumor, and the malignant cells probably gained access to the thoracic duct by way of lymphatic spread to the hepatic lymph nodes in the porta hepatitis and the celiac nodes, both of which were seen at necropsy to be extensively invaded by tumor.

Adult↗

PubMed1998

Primary vascular neoplasms of lymph nodes in the dog.

Primary vascular neoplasms of lymph nodes are rare, and appear not to have previously been reported in domestic animals. This report describes hemangiomas and a lymphangioma in lymph nodes of aged Beagle dogs. Eight hemangiomas (4.8%) and one lymphangioma were present in 165 examined popliteal lymph nodes, and one hemangioma occurred in a hepatic lymph node. The hemangiomas were cavernous and benign.

Age Factors↗

PubMed1990

Evaluation of abdominal lymph nodes by ultrasound.

To evaluate the significance of sonographically detected abdominal lymph nodes, the medical records of 100 consecutive patients with abdominal lymphadenopathy were reviewed. The number of lymph nodes, their localizations, dimensions, shape, and architecture were recorded. One hundred ninety-four lymph nodes were found in 63 patients known to have a malignancy; 68 lymph nodes were found in 37 patients with benign diseases. The localization, size, shape, and architecture of all lymph nodes were evaluated. Of the different variables we studied in the evaluation of the abdominal lymph nodes, echogenicity, shape, age of the patient, and a periaortic localization are helpful in the differentiation between benign and malignant involvement. There remains a considerable overlap; in these cases fine-needle aspiration biopsy is the method of choice to establish the diagnosis.

Abdomen↗

PubMed1982

[Lymph outflow pathways from the uterus and its regional lymph nodes in the rat at various stages of pregnancy].

From the body of the rat uterus, the lymph outflows into the caudal lymph nodes and when the latter are absent--into the iliac lymph nodes. From the medial and middle parts of the uterine horn the lymph out flows into the iliac lymph nodes, and from the lateral part of the uterine horn--into the renal lymph nodes. Some parts of the lymph outflows into corresponding contralateral lymph nodes. If the mass of the caudal lymph nodes in pregnant animals does not significantly differ from those in nonpregnant animals, the mass of the iliac and renal nodes increases with pregnancy. Maximal increase of the iliac and renal lymph nodes mass coincides with completion of the alantoic placenta formation. It is probable that there is a positive correlative dependence between the number of embryos in the uterus and the mass both of the iliac and renal lymph nodes.

Animals↗

PubMed2002

Prognostic factors for the survival of patients with esophageal carcinoma in the U.S.: the importance of tumor length and lymph node status.

BACKGROUND: The current TNM classification system does not consider tumor length or the number of lymph nodes in the staging and classification scheme for patients with esophageal carcinoma. Using data from the National Cancer Institute SEER Program, the authors explored the effect of tumor length and number of positive lymph nodes on survival in patients with esophageal carcinoma. METHODS: Patients with esophageal adenocarcinoma or squamous cell carcinoma were subgrouped according to historic stage with localized, regional, or distant disease. Demographic factors (age at diagnosis, race, and gender) and tumor characteristics (morphology, histologic grade, tumor length, primary site, depth of invasion, number of positive lymph nodes, proportion of positive lymph nodes dissected, and distant metastatic sites) were examined. RESULTS: Overall factors that were associated with an increased mortality risk included increasing age at diagnosis, black race versus white race, histologic grade, primary tumor site in the lower esophagus and abdomen versus upper regions, and increasing depth of invasion. Among patients with regional disease, the number of positive lymph nodes (>/= 5 vs. < 5) was related to an increasing risk (hazard ratio [HR], 1.29; 95% confidence interval [95%CI], 1.06-1.56). The proportion of positive lymph nodes compared with the number of lymph nodes dissected conferred an increased risk (HR, 1.63; 95%CI, 1.26-2.11). Among patients with distant disease, sites other than distant lymph nodes implied an increased mortality risk (HR, 1.37; 95%CI, 1.37-1.65). Tumor length was an independent predictor of mortality when controlling for depth of invasion in patients with localized disease (HR, 1.15; 95%CI, 1.08-1.21). CONCLUSIONS: Tumor length, the number of involved lymph nodes, and the ratio of positive lymph nodes are important prognostic factors for survival in patients with esophageal carcinoma. A revised TNM classification system for patients with esophageal carcinoma might consider adding tumor length and number of positive lymph nodes as two important prognostic factors.

Adenocarcinoma↗

PubMed1996

A developmental switch in lymphocyte homing receptor and endothelial vascular addressin expression regulates lymphocyte homing and permits CD4+ CD3- cells to colonize lymph nodes.

IN adult mice, the dominant adhesion molecules involved in homing to lymph nodes are L-selectin homing receptors on lymphocytes and the peripheral lymph node addressins on specialized high endothelial venules. Here we show that, from fetal life through the first 24 hr of life, the dominant adhesion molecules are the mucosal addressin MAdCAM-1 on lymph node high endothelial venules and its counterreceptor, the Peyer's patch homing receptor, integrin alpha 4 beta 7 on circulating cells. Before birth, 40-70% of peripheral blood leukocytes are L-selectin-positive, while only 1-2% expresses alpha 4 beta 7. However, the fetal lymph nodes preferentially attract alpha 4 beta 7-expressing cells, and this can be blocked by fetal administration of anti-MAdCAM-1 antibodies. During fetal and early neonatal life, when only MAdCAM-1 is expressed on high endothelial venules, an unusual subset of CD4 + CD3- cells, exclusively expressing alpha 4 beta 7 as homing receptors, enters the lymph nodes. Beginning 24 hr after birth a developmental switch occurs, and the peripheral node addressins are upregulated on high endothelial venules in peripheral and mesenteric lymph nodes. This switch in addressin expression facilitates tissue-selective lymphocyte migration and mediates a sequential entry of different cell populations into the lymph nodes.

Animals↗

PubMed1994

Laparoscopic pelvic lymph node dissection for staging of prostatic cancer.

Assessment of the pelvic lymph node status is a major concern in prostatic cancer staging. In spite of a normal abdominopelvic CT scan examination in patients with organ-confined disease, 7-30% will have lymph node metastases at pathological examination and will not benefit from radical prostatectomy. Laparoscopy enables pelvic lymph node dissection via a minimally invasive approach. Twenty-nine patients underwent laparoscopic pelvic lymph node dissection (LPLND) for prostatic cancer staging. The average duration of the bilateral dissection was 90 +/- 40 min (range 35-180 min). One patient died of a stroke on postoperative day 1, without local complication. The peroperative complications were 1 injury of the external iliac vein, 1 ileal injury, 1 ureteral injury, all 3 (11%) requiring immediate or delayed laparotomy. One patient had a self-resolving bilateral obturator nerve paresis. A previously irradiated patient had perineal lymphedema for 4 weeks. The average number of lymph nodes removed was 8.4 +/- 3.4 (range 4-17) for bilateral LPLND. Five patients had lymph node metastases. The median length of stay for patients undergoing LPLND as a single procedure was 2 days (range 2-11 days). After an operational period, during which the complication rate was relatively high, we now consider LPLND as a safe and effective procedure for the staging of patients with organ-confined prostatic cancer, but considering the increased risk of complications during the application period, we do not encourage the generalization of this technique which should remain restricted to some particular strategies, as in combination with perineal radical prostatectomy.

Aged↗

PubMed2001

[Mycobacterial spindle cell pseudotumor of lymph nodes].

OBJECTIVE: To study the clinicopathological of mycobacterial spindle cell pseudotumor in lymph nodes. METHODS: Two cases of spindle cell pseudotumor in the lymph nodes of infants were examined using light microscopy. The sections were stained with HE, Ziehl-Neelsen and studied immunohistochemically. RESULTS: Both infants were 1 year of age and had a history of Bacilli Calmette Guerin (BCG) vaccination before discovery of their lymph node lesions. Clinically, the patients presented fever and enlarged lymph nodes. Histopathologically, the lesions showed proliferation of spindle cells arranged in bundles, storiform patterns with abundant capillaries and lymphocyte, plasma cell and neutrophil infiltration forming a spindle cell pseudotumor. Most of the spindle cells were phagocytic cells which contained large amounts of mycobactrium as observed by Ziehl-Neelsen staining. Immunohistochemical staining showed strongly positive result for Mac387 and lysosome, but negative for S-100 in spindle cells and histocytes. CONCLUSIONS: Mycobacterial spindle cell pseudotumor of lymph nodes may occur not only in immunodeficient patients (such as AIDS) but also in infants after BCG vaccination. The lesions may mimic spindle cell tumor in lymph nodes, therefore it is very important to recognize these lesions in order to treat the patient properly.

BCG Vaccine↗

PubMed2001

Technical report: lymph node enhancement at MRI with MnDPDP in primary hepatic carcinoma.

AIMS: To report two cases of lymph node enhancement in primary hepatic carcinoma following the administration of Mangafodipir trisodium (MnDPDP, Teslascan(R), Nycomed Amersham U.K.), an hepatocyte specific magnetic resonance imaging (MRI) contrast agent. To review our experience with this contrast agent and the literature to establish if such enhancement occurs in normal lymph nodes or has been previously described in hepatocellular carcinoma (HCC) or other lesions. MATERIALS AND METHODS: The radiological reports of all MnDPDP enhanced abdominal MRI examinations were reviewed for lymph node enlargement. The MR images from examinations with reported nodal enlargement were re-evaluated for evidence of nodal enhancement and the hospital notes and histological reports were reviewed. Nodal enhancement was considered present if lymph node signal intensity was greater than that of the spleen following MnDPDP. Literature searches were performed on Medline and PubMed for previous descriptions of lymph node enhancement following MnDPDP. RESULTS: The reports of 90 MnDPDP abdominal MRI examinations were reviewed. Of 18 cases of lymph node enlargement, two had evidence of lymph node enhancement following MnDPDP. These two cases had hepatocellular carcinoma and fibrolamellar hepatocellular carcinoma, respectively, confirmed on liver biopsy. No reports of lymph node enhancement following MnDPDP were identified in the literature. CONCLUSION: Two cases of lymph node enhancement following MnDPDP have been presented. Although histological confirmation of the lymph nodes was not obtained, the authors propose that the lymph node enhancement was due to functioning hepatocytes in lymph node metastases from the patients' histologically confirmed hepatocellular carcinomas. Burkill, G. J. C., Mannion, E. M. & Healy, J. C. (2001). Clinical Radiology56, 67-71.

Adult↗

PubMed1990

Differential response of B cells in the lymph node and the spleen to bacterial lipopolysaccharide.

In vivo polyclonal activation of B cells in the lymph nodes and the spleens of mice injected with bacterial lipopolysaccharide (LPS) was compared. The peak of anti-trinitrophenylated sheep red blood cells plaque-forming cell (PFC) response in the lymph node was reached 6-8 days after the injection of LPS while that in the spleen was reached at 2 days. The maximal increase in the total number of Ig-producing cells in the lymph node also occurred at the later stage. These differences in time courses of polyclonal activation of B cells between the lymph node and the spleen were not due to the absence of B cells in the lymph node, migration of PFC from the spleen to the lymph node, or qualitative differences of B cells. This phenomenon was dependent on the environmental difference between the lymph node and the spleen, because B cells from the lymph node could respond to LPS rapidly in the spleen. Further, the polyclonal activation of B cells was accelerated in the lymph nodes of mice receiving prior injection of LPS. In in vitro cultures of lymph node cells of those mice, a significant amount of interleukin-1 could be detected by stimulation of LPS. It was possible that the delayed activation of B cells in the lymph node was due to the time lag necessary for construction of the environmental condition suitable for activation of B cells, whereas in the spleen this condition can be provided without delay.

Animals↗

PubMed1997

Lymph node sonography versus palpation for detecting recurrent disease in patients with malignant melanoma.

The aim of this study was to examine the efficacy of lymph node palpation versus high resolution lymph node sonography for the detection of lymph node metastases in patients with malignant melanoma. We retrospectively evaluated 2256 pairwise lymph node examinations of the cervical, axillary and inguinal region by palpation and sonography in 264 patients with resected melanomas greater than 0.75 mm of invasion thickness. Lymph node metastases occurred in 50 patients (19%) which were detected in 38 (76%) by both methods in agreement. In 7 cases (14%) palpation failed, in 3 cases (6%) sonography failed and in 2 cases both methods failed to identify metastases. The overall sensitivity of detecting metastatic disease was 82% for palpation and 90% for sonography which was statistically not different. The overall specificity by sonography (99%) was significantly better than for lymph node palpation (88%). Taking into account the results of this analysis, we conclude that patients with a negative result by lymph node palpation do not need further sonography for verification. However, any suspect result by palpation should be additionally evaluated by lymph node sonography in order to rule in or out metastatic disease.

Adolescent↗