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PubMedDate not supplied

Clinical evaluation of pN-stage (TNM) in gastric cancer: an analysis of distribution of regional lymph nodes in node-positive patients.

BACKGROUND: The aims of the present study were to identify the distribution of regional lymph nodes in gastric cancer patients based on the number of nodes and to assess the influence of the examined area of lymph nodes on the determination of node stage according to TNM in node-positive patients with gastric cancer. MATERIALS AND METHODS: A total of 346 node-positive patients with primary solitary carcinoma of the stomach (210 males and 136 females; age range, 27 to 84 years; mean, 58.5 years), who underwent curative gastric resection combined with D2 or more extended lymph node dissection, were enrolled in the present study. The anatomical distribution of regional lymph nodes at each station classified according to the JCGC was assessed from pathology records. RESULTS: The number of first tier and all regional nodes dissected was < 15 in 7 patients (2%) of all patients and <15 in 37 patients (11%), respectively. Metastasis to first tier nodes was found in 2129 nodes (21%) but not in 8199 nodes (79%) and to second tier nodes in 375 nodes (9%) but not in 4028 nodes (91%), representing a significant difference between the two node groups (p<0.0001). No metastasis to first tier nodes was found in 12 patients (5%) out of 229 patients with pN1 tumor. Similarly, the number of metastases to first tier nodes in 15 patients (21%) out of 73 patients with pN2 tumor and in 13 patients (29%) out of 44 patients with pN3 tumor were 1-6 and 7-15, respectively. CONCLUSION: The present findings suggest that the extent of lymph node dissection does affect node stage as classified according to TNM and that restriction of the number of dissected regional lymph nodes (> or = 15 lymph nodes) may not be essential for practical staging of TNM.

Adult↗

PubMed2003

Prognostic significance of lateral lymph node micrometastases in lower rectal cancer: an immunohistochemical study with CAM5.2.

PURPOSE: The aims of this study were to determine the rate of lymph node micrometastases and to evaluate their prognostic value in lateral lymph nodes in lower rectal cancer at or below the peritoneal reflection. METHODS: A retrospective analysis was made of 892 lymph nodes from 66 consecutive patients who had undergone radical resection with lateral lymph node dissection. These lymph nodes were examined immunohistochemically with an antibody against cytokeratins 7 and 8, CAM5.2. RESULTS: Routine hematoxylin-eosin staining revealed 9 patients with positive lateral lymph nodes that were stained consistently with CAM5.2. Among 57 patients in whom lateral lymph node metastases were not detected by hematoxylin-eosin staining, cytokeratin staining was positive in 19 nodes (2.7 percent) from 11 patients (19.3 percent). These 11 patients with micrometastases in lateral nodes showed a significantly high recurrence rate (P = 0.048) and worse overall survival (P = 0.01) than the 46 patients without lateral node metastases. The recurrence rate and overall survival of patients with micrometastases did not differ significantly from those of patients with positive lateral nodes with hematoxylin-eosin staining. Local recurrence developed in 6 of 66 patients, but neither the presence nor the absence of micrometastases in lateral nodes influenced the local recurrence rate. CONCLUSION: The presence of nodal micrometastases leads to a poor prognosis. The survival of patients with micrometastases was not different from that of patients with overt metastases. Therefore, patients with cytokeratin-positive cells in lateral lymph nodes should be regarded as having overt metastases.

Abdominal Cavity↗

PubMed2002

Vulvar melanoma: is there a role for sentinel lymph node biopsy?

BACKGROUND: The objective of this study was to evaluate the author's recent, preliminary experience with the sentinel lymph node procedure in patients with vulvar melanoma and to compare this experience with treatment and follow-up of patients with vulvar melanomas who were treated previously at their institution. METHODS: From 1997, sentinel lymph node procedure with the combined technique (99mTechnetium-labeled nanocolloid and Patente Blue-V) was performed as a standard staging procedure for patients with vulvar melanoma with a thickness > 1 mm and no clinically suspicious inguinofemoral lymph nodes. For the current study, clinicopathologic data from all 33 patients with vulvar melanoma who were treated between 1978 and 2000 at the University Hospital Groningen were reviewed and analyzed. RESULTS: From January 1997 until December 2000, identification of sentinel lymph nodes was successful in all nine patients who were referred for treatment of vulvar melanoma. Three patients underwent subsequent complete inguinofemoral lymphadenectomy because of metastatic sentinel lymph nodes. In follow-up, groin recurrences (in-transit metastases) occurred in two of nine patients, both 12 months after primary treatment. Both patients had melanomas with a thickness > 4 mm and previously had negative sentinel lymph nodes. There was a trend toward more frequent groin recurrences in patients after undergoing the sentinel lymph node procedure (2 of 9 patients) compared with 24 historic control patients (0 of 24 patients; P = 0.06). Five of 33 patients developed local recurrences: Two patients had groin recurrences, and 11 patients developed distant metastases. Twelve patients died of vulvar melanoma. Seventeen patients with a median follow-up of 66 months (range, 9-123 months) are currently alive (overall survival rate, 52%). CONCLUSIONS: Although the numbers were small, this study showed that the sentinel lymph node procedure is capable of identifying patients who have occult lymph node metastases and who may benefit from lymphadenectomy for locoregional control and prevention of distant metastases. However, the data also suggest that the sentinel lymph node procedure may increase the risk of locoregional recurrences (in-transit metastases), especially in patients with thick melanomas. The potential role of the sentinel lymph node procedure as an alternative method of lymph node staging in patients with vulvar melanoma needs further investigation only within the protection of clinical trials and probably should be restricted to patients with melanomas with intermediate thickness (1-4 mm).

Adult↗

PubMed2001

[Clinical analysis of intrapulmonary lymph nodes].

We encountered 12 cases (9 men, 3 women) of intrapulmonary lymph nodes, discovered by chest radiography or chest CT and identified by thoracoscopic lung biopsy (in 10 cases), open lung biopsy (1 case) or lobectomy (1 case). We also studied the literature related to intrapulmonary lymph nodes in Japanese. Many intrapulmonary lymph nodes were found in the lower lung field, few in the upper lung field. All intrapulmonary lymph nodes were spherical and were located under the pleura, but we were not able in some cases to differentiate them from malignancies by the CT scanfindings. We could not diagnose them or rule out malignancy before surgery. Pathological findings revealed that all of them showed anthracosis. Silicotic changes were found in three cases. We consider that thoracoscopy is useful in making a definite diagnosis if peripheral pulmonary lesions cannot be diagnosed. We emphasize that intrapulmonary lymph nodes should be taken into consideration in differential diagnoses of small nodular lesions in the lung.

Aged↗

PubMed1995

[Rational evaluation of different lymph node dissection].

To evaluate the effect and indication of different lymph node dissection (D1+, D2, D3), we performed radical operations for 371 cases of gastric cancer. The results showed that D1+ or D1 lymph node dissection was enough for gastric cancer of Ia stage, D2 was suitable for Ib stage. For localized or massive type gastric cancer of II + III stage, D3, D2 dissection was better than D1+ dissection. For the gastric cancer of the same type in IV stage, the 5-year survival rate after D3 + D2 dissection was 42.9%, but for the gastric cancer of infiltrative type or diffused growth pattern in II + III stage, the effect was not significantly increased even after the D3, D2 dissection. For the gastric cancer of this type in IV stage, the effect was not improved after the extended lymph node dissection. Extended dissection needn't be performed if there was no lymph node metastasis. D3, D2 dissection was better if there was little lymph node metastasis or the metastasis was limited to 1st group. For those metastasized to 2nd group or the quantity was more, D3 was better than D2, D1+. The effect of D3, D2 dissection was not significantly improved in the extensive metastasis case (more than 10 or to the 3rd group).

Adult↗

PubMedDate not supplied

Possibility of pre-operative diagnosis of lymph node metastasis based on morphology.

BACKGROUND/AIMS: The accuracy of pre-operative diagnosis of lymph node metastasis is insufficient. Our aim was to define the possibility of diagnosing metastatic lymph nodes based on morphology. METHODOLOGY: One hundred and fifty-seven patients with pre-operatively untreated esophageal squamous cell carcinoma underwent resection, 5334 lymph nodes were isolated, and the short and long diameters were measured. We tried to construct a linear regression line for metastasis rate versus lymph node size (long diameter classified at intervals of 1 mm) by each location. The ratio of short diameter to long diameter (SL ratio) of metastasis-positive lymph nodes was compared with that of negative ones at each location. RESULTS: Gradient and intercept of overall regression line was 0.0213 and 0.0101, respectively, and the long diameter producing a metastasis rate of 80% (LD80) was 37.1 mm. Metastasis-positive lymph nodes larger than calculated LD80 represented no more than 9.5% of all the corresponding metastasis-positive nodes. The locations with significant difference of SL ratio between metastasis-positive and negative ones were limited to right cardiac, left gastric artery, thoracic paratracheal, bifurcation, and the highest mediastinal nodes. CONCLUSIONS: There is a low possibility that lymph node metastasis can be exactly diagnosed pre-operatively based on the size and morphology.

Carcinoma, Squamous Cell↗

PubMed2002

Decreased axillary lymph node retrieval in patients after neoadjuvant chemotherapy.

BACKGROUND: The purpose of this study was to assess our clinical impression that fewer lymph nodes are retrieved after level I and II axillary dissection after neoadjuvant chemotherapy and whether there is a positive correlation between the total number of lymph nodes retrieved and the number of diseased lymph nodes. METHODS: Patients included those with stage IIB, IIIA, and IIIB breast cancer of whom 77 had neoadjuvant chemotherapy and 58 had initial surgery only. All had modified radical mastectomy with in continuity level I and II axillary dissection. RESULTS: Patients after neoadjuvant chemotherapy had 14.3 +/- 6.7 lymph nodes detected versus 16.9 +/- 8.8 (mean +/- SD; P <0.057) for those with initial surgery only. The number of positive nodes were 3.7 +/- 4.7 versus 6.6 +/- 8.7 (mean +/- SD; P <0.033) respectively and the number of negative nodes were 10.6 +/- 7.5 versus 10.4 +/- 8 (mean +/- SD; P <0.9). The correlation between the number of positive lymph nodes and the total number of lymph nodes was r = 0.58; P <0.001. CONCLUSIONS: It appears that fewer lymph nodes are retrieved after level I and II axillary dissection after neoadjuvant chemotherapy. The total number of lymph nodes retrieved increases directly with the number of positive lymph nodes in patients not treated with chemotherapy.

Antibiotics, Antineoplastic↗

PubMed1976

Microcirculation of the lymph node with metastases.

Microangiographic and histologic examination of the popliteal lymph node was performed on 49 rabbits 3 to 55 days after V2 tumor implantation into the hind paw. Control animals received subcutaneous tissue extract from normal rabbit donors. During the first 10 days after the tumor implant from an allogeneic animal donor, the draining lymph node exhibited a hypervascular response which after 2 weeks gradually subsided. Subsequently, during the early stages of lymph node metastasis there was still hypervascularity adjacent to the metastatic deposit. In about 4 weeks the metastases became more established and surrounded by layers of plasma cells. The hypervascular changes of the surrounding lymph node subsided by this time. In lymph node metastases the microvasculature could be an indicator of the immunologic activity of the host.

Angiography↗

PubMed2000

[T1, T2 squamous or adenocarcinoma of the lung:characteristics of lymph node metastasis and its clinical significance].

OBJECTIVES: To investigate the frequency, distribution and features of lymph node metastasis in T(1)/T(2) squamous or adenocarcinoma of the lung, and to provide evidence for extensive dissection of lymph nodes. METHODS: 254 patients with T(1)/T(2) squamous or adenocarcinoma of the lung underwent R2 surgery plus extensive dissection of hilar, interlobular and mediastinal lymph nodes according to the grouping system proposed by Naruke. RESULTS: 1 685 groups of lymph nodes were dissected. The metastatic rates of N(1) and N(2) was 20.0% and 10.2% respectively. Significant difference existed between T(1) and T(2) tumors (P < 0.01). No N(2) metastasis was found in T(1) squamous cell carcinoma. N(2) metastatic rates were 22.0% in squamous cell carcinoma and 40.9% in adenocarcinoma (P < 0.01). 64.3% of squamous carcinoma spread to only one group of N(2) nodes, and over 3 groups of lymph nodes were positive in 46.2% of adenocarcinoma. Saltatory metastasis accounted for 57.5% of N(2) metastasis. 13.6% of N(2)-positive tumors in upper lobes metastasized to the lower mediastinum, whereas 51.6% of N(2)-positive cancers in the lower lobes spread to the upper mediastinum. CONCLUSIONS: The frequency of lymph nodes metastasis increases with the growth of tumors. Metastasis in adenocarcinoma occurs more frequently than in squamous carcinoma. Tumor at any site can metastasize to the distant mediastinum. Except for T(1) squamous cancer, radical surgery can be achieved only by extensive dissection of ipsilateral intrapulmonary and mediastinal lymph nodes.

Adenocarcinoma↗

PubMed2006

Intraoperative, radio-guided sentinel lymph node mapping in 110 nonsmall cell lung cancer patients.

BACKGROUND: Sentinel lymph node identification has been tested in lung cancer patients with conflicting results. The present study was designed to assess the sensitivity, negative predictive value, and accuracy of intraoperative sentinel lymph node mapping by means of a radio-guided method in patients with nonsmall cell lung cancer to find the most appropriate definition of sentinel lymph node and to evaluate the usefulness of different particle sizes of radiocolloid. METHODS: One hundred ten patients with clinically N0 nonsmall cell lung cancer were enrolled in the pilot study of intraoperative sentinel node identification. Four quadrants of the peritumoral tissue were injected with 2 mL of 0.5 mCi technetium-99m suspension. Four radiocolloids of different particle size were used. After complete lymphadenectomy, all resected lymph nodes were examined with hematoxylin-eosin staining. All sentinel nodes negative for metastases by routine staining were searched further for metastatic deposits with both serial sections and immunohistochemistry for cytokeratins. RESULTS: The radio-guided method had a high identification rate, a high sensitivity, and a high negative predictive value (100%, 87%, and 93%, respectively) when immunohistochemistry was considered. When standard hematoxylin and eosin staining was applied, sensitivity and negative predictive value of sentinel lymph node labeling was lower (74% and 89%, respectively). No significant differences were found in either the sensitivity or negative predictive value among the colloid solutions of different particle size used in radio labeling, although smaller particles have shown a tendency to produce better results. CONCLUSIONS: The radio-guided technique provides efficient sentinel lymph node identification in lung cancer. Further studies are warranted to confirm the clinical utility of this strategy.

Adult↗

PubMed1997

Pathologic examination of the sentinel lymph node.

One of the most important prognostic indicators in patients with malignant melanoma is lymph node status. While the five-year survival of stage I and II patients (without clinical adenopathy) is approximately 80 percent, this drops to 36-50 percent in patients with clinical or microscopic lymph node involvement. Other factors within lymph node specimens which affect disease-free and overall survival are the number of positive nodes (1 vs. 1-3 vs. 4 or greater) and the presence of extracapsular extension. Recently, the technique of sentinel lymphadenectomy has been developed to facilitate detection of metastatic disease in regional lymph nodes. Successful completion of this procedure requires a specialized but multidisciplinary approach, utilizing the surgeon, oncologist, nuclear radiologist, and pathologist. The pathologist's role is pivotal in this process, because identification of melanoma metastasis in the sentinel lymph node(s) is not only an important prognostic indicator but also dictates whether the patient will receive further surgery and adjuvant chemotherapy. Therefore, the goal of the pathologist in examining the sentinel lymph node is to maximize identification of nodal metastases of malignant melanoma. This is accomplished by following a standard protocol which fully utilizes all tissue submitted in concert with commonly available immunohistochemical techniques.

3,3'-Diaminobenzidine↗

PubMedDate not supplied

[Ratio of lymph node metastasis in gastric carcinoma after D2 gastrectomy].

The classification of lymph node metastasis in patients with gastric carcinoma is controversial. In the past, all systems used for this disease defined N classification by the location of lymph node metastases relatively to the primary tumor. In the 1997, the UICC and AJCC redefined the pathologic nodal status on the basis of the number of involved nodes rather than their location. More recently, the ratio between the number of metastatic and the total examined lymph nodes has been proposed as a new quantitative staging system. Aim of our study was to clarify the outcome of the ratio of the metastatic lymph nodes (RML) in a monoinstitutional series of 164 patient with primary gastric cancer who underwent gastrectomy with D2 lymph node dissection. Our data showed that ratio of metastatic lymph nodes is a simple, convenient, and reproducible staging system with an ability to predict surgical results and it is an independent prognostic factor after D2-gastrectomy.

Gastrectomy↗

PubMedDate not supplied

Sentinel lymph node micrometastasis as a predictor of axillary tumor burden.

The sentinel lymph node biopsy (SLNB) procedure is an alternative method for assessing the axillary lymph node (ALN) status in patients with breast cancer. The SLNB carries the risk of a false-negative result, with patients harboring positive ALNs in the face of a negative SLNB examination. In addition, the significance of a SLNB with cells identified only with keratin or with deposits less than 0.2 mm remains unresolved. We analyzed our SLNB data over the past 5 years in order to determine the relationship between SLN tumor burden and ALN tumor burden. Pathology files for the past 5 years at Magee-Womens Hospital were searched for all SLNB cases that had an axillary lymph node dissection (ALND). Each SLNB case was reviewed and tabulated for breast tumor size, SLN tumor size, and largest tumor size in the ALND. Correlation and frequency distribution were performed for the status of all SLNs and ALNDs. Patterns of lymph node metastasis were recorded and the sizes of the SLN metastases were reported according to the recent Philadelphia Consensus Conference on Sentinel Lymph Nodes and the revised American Joint Committee on Cancer (AJCC) staging. SLN metastases were classified as immunohistochemistry (IHC) positive if only single keratin-positive cells or clusters were present and were not observed with standard tissue stains, as submicrometastatic (SMM) if tumors were less than 0.2 mm (excluding IHC positive), as micrometastatic if tumors were larger than 0.2 mm but </=2 mm, or as macrometastatic if tumors were larger than 2 mm. A total of 445 patients had both SLNB and ALND. Fifty percent (224/445) of cases were SLN positive, including 58 SLN positive/ALN positive cases and 166 SLN positive/ALN negative cases. Of the 221 patients in the SLN-negative group, 4 were ALN positive (false-negative SLN). The incidence of SLN metastases increased with tumor stage, with the percentage of SLN positives as follows: T1a, 2.1%; T1b, 10.9%; T1c, 51.7%; and T2, 35.3%. There were 4 of 41 patients (10%) with SLNs that were IHC positive that had macrometastases in a solitary ALN. Three of 22 patients (13.6%) that were SMM positive had ALN macrometastasis in a solitary ALN. Four of 49 patients (8.1%) with micrometastatic SLNs had a solitary positive ALN, 3 of which were macrometastases (6.1%). Overall a total of 10 of 112 patients (9.0%) with traditionally defined SLN micrometastases of 2.0 mm or less had a solitary ALN macrometastasis. The vast majority (90%) of these macrometastases were found with T1c and T2 breast tumors. There was a significant difference in the means of SLN tumor sizes for the SLN-positive/ALND-negative (4.5 mm) versus SLN-positive/ALND-positive (10.1 mm) patients, although the range of SLN tumor sizes within each group were similar. There is an increasing incidence of SLN-positive and ALN-positive cases with increasing T stage. Overall in this series, 9% of patients with SLN metastases </=2 mm had a solitary axillary macrometastasis. Ninety percent of these metastases occurred with T1c/T2 breast tumors, indicating the important codependence of T stage. Overall there is a subset of patients who are IHC positive, SMM positive, or micrometastatic positive with ALNs that are macrometastatic who are at risk of harboring axillary macrometastases. Keratin IHC of breast SLNs is useful for defining these subsets.

Axilla↗

PubMed1989

Involution of lymph node histiocytes in AIDS.

Lymph nodes of human immunodeficiency virus (HIV)-infected patients were studied histologically and immunohistochemically to elucidate the pattern of involution of various histiocytes in AIDS. Specimens consisted of one node with hyperplasia, five with atrophy, and three with severe atrophy. Antibodies such as L25, ID1, My4, 12, anti-Leu 3a, KiM4, OKT6 and anti-S100 protein were used for identification of the histocytes. Another antibody, VAK5, was used to demonstrate HIV antigen. T-zone histiocytes were mildly decreased in the hyperplastic node, but considerably decreased in the atrophic nodes. My4+ sinus histiocytes were unchanged in number and enlarged in the hyperplastic node, but not decreased in the atrophic nodes. Follicular dendritic cells (FDCs), defined by KiM4, were mostly depleted in the atrophic nodes. The T4 antigen was detected in some of the sinus histiocytes of the atrophic nodes. T6-positive cells were not found in any of the nodes. HIV antigen was detected only in FDCs. It is therefore suggested that various histiocytes respond differently to HIV, and that T-zone histiocytes and sinus histiocytes persist up to the late stage of AIDS.

Acquired Immunodeficiency Syndrome↗

PubMed2000

Color-coded duplex sonography of the cervical lymph nodes: improved differential diagnostic assessment after administration of the signal enhancer SH U 508A (Levovist).

The vascularity of cervical lymph nodes can be documented by means of color-coded duplex sonography and malignant and benign lymph nodes distinguished on the basis of typical patterns of vascularity. However, not all intranodal vessels can be visualized by color-coded duplex sonography, and minute vessels are detectable only after the administration of a signal enhancer. This also makes it possible to assess the morphology of cervical lymph nodes that are inaccessible on plain sonography. In the present study we examined acute and chronic inflammatory and metastatic lymph nodes as well as malignant lymphomas to determine the extent to which a specific pattern of vascularity can be detected with color-coded duplex sonography after the injection of Levovist as a signal enhancer. In addition, digital image processing was used to quantify the vascularity detected in relation to the cross-sectional area of the lymph nodes as seen at sonography and to determine whether there are any differences in lymph node types as regards an increase in the detection of vascularity. After injection of the marker a typical pattern of vascularity could be assigned to all lymph nodes examined and differences shown in quantifying vascularity: This increase was greatest in the acutely inflamed lymph nodes (36.0 +/- 5.0%) and smallest in lymph nodes with chronic inflammation (2.3 +/- 1.3%). These findings show that cervical lymph nodes of varying origin differ by virtue of their pattern of vascularity, with increased vascularity detectable after administration of a signal enhancer.

Carcinoma, Squamous Cell↗

PubMed2000

[Protocol for lymph node dissection in stomach carcinoma. Possibility for quality assurance].

Since 1984 we have been using the opportunity to registrate the dissected lymph nodes at different locations of the lymph nodes and the carcinoma in case of D-2 dissection by means of a lymph node dissection protocol. The total rate of lymph nodes by the several patients is an indirect sign for the quality of the lymph node dissection and the preparation work of the pathologist. In about 17% of all cases the number of all found lymph nodes by the pathologist was lower than 15 and so an exactly classification in the N-category was not possible. In case of an exactly lymph node dissection on one hand side the prognosis for the patients life can be improved and on the other hand side an exactly pathological classification is an opportunity to estimate the prognosis better than.

Gastrectomy↗

PubMed2004

Laparoscopic retroperitoneal lymph node dissection for nonseminomatous testicular carcinoma.

Retroperitoneal lymph node dissection (RPLND) is still the most sensitive and specific method for the detection of lymph node metastases in stage I nonseminomatous testicular carcinoma. In stage II disease, residual malignant tumor and mature teratoma can be removed. Acceptance of this operation, however, has decreased due to the morbidity caused by the open approach. To reduce this morbidity, and to improve the acceptance of RPLND, laparoscopy has been introduced. Clinical data with long-term follow-up are now available which demonstrate the technical feasibility of laparoscopic RPLND. Studies comparing laparoscopy and open surgery show advantages for the laparoscopic approach in terms of reduced blood loss, intraoperative complications and operative time. Mainly minor complications, such as chylous ascites or lymphocele formation, are observed. The conversion rate to open surgery, mainly due to intraoperative bleeding, is acceptable at less than 10%. As in open surgery, antegrade ejaculation can be preserved successfully. RPLND has also been shown to provide adequate oncological results. In stage I disease, lymph node metastasis is found in 25-41% of cases. Patients with histologically proven retroperitoneal tumor receive adjuvant chemotherapy whereas individuals without evidence of retroperitoneal disease do not require additional treatment. Follow-up controls in both groups, without local recurrence, demonstrate the excellent diagnostic accuracy of this procedure. Meanwhile laparoscopic RPLND has also been introduced successfully in the management of stage II disease. Small volume residual tumors can be removed with an acceptable complication rate. However, this operation is technically demanding and should be performed only at institutions with considerable laparoscopic experience. In conclusion, laparoscopic RPLND is a safe method for low-stage germ cell tumors with minimal invasiveness and excellent clinical results. Thus laparoscopy might contribute to a better acceptance of RPLND.

Carcinoma↗

PubMed1997

[Four cases of subpleural intrapulmonary lymph node].

We presented four cases of subpleural intrapulmonary lymph node showing the indeterminate pulmonary nodule. Case 1 was a 54-year-old male who had a subpleural nodule, 7 mm in diameter in the right S8 segment on chest CT. This nodule showed difficulty to differentiate from small peripheral lung carcinoma. Case 2 was a 72-year-old male who was diagnosed adenocarcinoma of lung. Chest CT showed multiple pulmonary nodules, about 5 mm in diameter except main tumor in the right middle and lower lobes. These nodules showed difficulty to differentiate from intrapulmonary metastasis. Case 3 was a 70-year-old female who was diagnosed lung metastasis of sigmoid colon cancer. Chest CT showed a subpleural nodule, 3 mm in diameter except main tumor in the right S9 segment. This nodule also showed difficulty to differentiate from lung metastasis. Case 4 was a 40-year-old female who had a subpleural nodule, 10 mm in diameter in the right S9 segment. This nodule also showed difficulty to differentiate from small peripheral lung carcinoma. We diagnosed subpleural intrapulmonary lymph nodes, in case 1, 2 and 3, by open thoracotomy and in case 4, thoracoscopic surgery. It should be always kept in mind that subpleural pulmonary nodules in especially middle and lower lobes of lung might be intrapulmonary lymph nodes. Thoracoscopic surgery would be a very useful procedure for diagnosis and therapy of subpleural intrapulmonary lymph nodes.

Adult↗