Chylous ascites following robotic lymph node dissection on a patient with metastatic cervical carcinoma

Chylous ascites is an uncommon postoperative complication of gynecological surgery. We report a case of chylous ascites following a robotic lymph node dissection for a cervical carcinoma. A 38-year-old woman with IB2 cervical adenocarcinoma with a palpable 3 cm left external iliac lymph node was taken to the operating room for robotic-assisted laparoscopic pelvic and para-aortic lymph node dissection. Patient was discharged on postoperative day 2 after an apparent uncomplicated procedure. The patient was readmitted the hospital on postoperative day 9 with abdominal distention and a CT-scan revealed free fluid in the abdomen and pelvis. A paracentesis demonstrated milky-fluid with an elevated concentration of triglycerides, confirming the diagnosis of chylous ascites. She recovered well with conservative measures. The risk of postoperative chylous ascites following lymph node dissection is still present despite the utilization of new technologies such as the da Vinci robot

Pleuro-pulmonary tumours detected by clinical and chest X-ray analyses in rats transplanted with mesothelioma cells

New strategies for cancer therapy must be developed, especially in severe neoplasms such as malignant pleural mesothelioma. Animal models of cancer, as close as possible to the human situation, are needed to investigate novel therapeutical approaches. Orthotopic transplantation of cancer cells is then relevant and efforts should be made to follow up tumour evolution in animals. In the present study, we developed a method for the orthotopic growth of mesothelioma cells in the pleural cavity of Fischer 344 and nude rats, along with a procedure for clinical survey. Two mesothelioma cell lines, of rat and human origin, were inoculated by transthoracic puncture. Body weight determination and chest X-ray analyses permitted the follow-up of tumour evolution by identifying different stages. Autopsies showed that tumours localized on the whole pleural cavity (diaphragm, parietal pleura), mediastinum and pericardium. Tumour morphology and antigenic characteristics were consistent with those of the inoculated cells and were similar in both types of rats inoculated with the same cell type. These results demonstrate that mesothelioma formation in rats can be followed up by clinical and radiographic survey after gentle intrathoracic inoculation of mesothelioma cells, thus allowing the definition of stages of interest for further experimental trials. © 1999 Cancer Research Campaig

Detection of occult carcinomatous diffusion in lymph nodes from head and neck squamous cell carcinoma using real-time RT–PCR detection of cytokeratin 19 mRNA

The aim of the present study was to evaluate the occult lymph node carcinomatous diffusion in head and neck squamous cell carcinoma (HNSCC). A total of 1328 lymph nodes from 31 patients treated between 2004 and 2005 were prospectively evaluated by routine haematoxylin–eosin–safran (HES) staining, immunohistochemistry (IHC) and real-time Taqman reverse–transcriptase polymerase chain reaction (real-time RT–PCR) assay. Amplification of cytokeratin 19 (CK19) mRNA transcripts using real-time RT–PCR was used to quantify cervical micrometastatic burden. The cervical lymph node metastatic rates determined by routine HES staining and real-time RT–PCR assay were 16.3 and 36.0%, respectively (P<0.0001). A potential change in the nodal status was observed in 13 (42.0%) of the 31 patients and an atypical pattern of lymphatic spread was identified in four patients (12.9%). Moreover, CK19 mRNA expression values in histologically positive lymph nodes were significantly higher than those observed in histologically negative lymph nodes (P<0.0001). These results indicate that real-time RT–PCR assay for the detection of CK19 mRNA is a sensitive and reliable method for the detection of carcinomatous cells in lymph nodes. This type of method could be used to reassess lymph node status according to occult lymphatic spread in patients with HNSCC

Chirurgie des métastases pulmonaires des cancers colorectaux : facteurs prédictifs de survie

IF 0.576International audienceIntroductionColorectal cancer is the 3rd commonest cause of death from cancer: 5% of patients will develop lung metastases. The management of oligometastatic disease is based on the objective of optimal local control.State of the artTo date, no results from randomized control trials support the resection of pulmonary metastases in oligometastastic colorectal cancer patients. However, numerous series, mainly retrospective, report long-term survival for highly selected patients, with 5-year survival ranging from 45 to 65% in the most recent series. The consensual predictive factors of a good prognosis are: a disease free-interval > 36 months, a number of metastases ≤ 3, a normal level of carcino-embryonic antigen and the absence of hilar or mediastinal lymph node involvement.PerspectivesAround 20 to 40% of patients will develop recurrence, probably linked to the presence of undetectable micrometastases. Therefore, experimental work is being undertaken to develop new treatment techniques such as isolated lung perfusion, radiofrequency ablation and stereotactic radiation therapy.ConclusionHighly selected patients suffering from colorectal cancer lung metastases could benefit from resection with improved survival and disease-control.IntroductionLe cancer colorectal représente la 3e cause de mortalité par cancer : 5 % des patients vont développer des métastases pulmonaires. Le concept de chirurgie des cancers oligométastatiques est basé sur l’objectif d’un contrôle local optimal de la maladie.État des connaissancesÀ ce jour, aucun essai contrôlé randomisé ne valide la chirurgie de résection des métastases pulmonaires des patients oligométastatiques porteurs d’un cancer colorectal contrôlé localement. Cependant, de nombreuses séries, le plus souvent rétrospectives, rapportent des survies prolongées chez des patients très sélectionnés, allant de 45 à 65 % à 5 ans dans les séries les plus récentes. Les facteurs consensuels de bon pronostic établis sont : un intervalle libre supérieur à 36 mois, un nombre de métastases ≤ 3, un taux d’antigène carcino-embryonnaire normal et l’absence d’envahissement ganglionnaire médiastino-hilaire.PerspectivesEnviron 20 à 40 % des patients vont présenter des récidives pulmonaires probablement liées à l’existence de micro-métastases indétectables. Ainsi, des travaux expérimentaux sont actuellement menés pour développer de nouvelles techniques de traitement, telles que la perfusion pulmonaire isolée, la radiofréquence et la stéréotaxie.ConclusionLa résection des métastases pulmonaires de cancers colorectaux peut améliorer la survie et le contrôle de la maladie chez des patients bien sélectionnés