ОСОБЕННОСТИ ПОРАЖЕНИЯ СИГНАЛЬНЫХ ЛИМФАТИЧЕСКИХ УЗЛОВ ПРИ ПЕРВИЧНОЙ МЕЛАНОМЕ КОЖИ

Introduction. Each tenth tumor of skin is melanoma. Presence of tumor cells in sentinel lymph node influenced the medical tactics.The objective of the research was to study the metastasis of skin melanoma into the clinically negative regional lymph nodes.Material and methods. Histological, immunohistochemical, cytological and immunocytochemical methods were used to study biopsies of regional lymph nodes in 60 patients with skin melanoma.Results. 5 % of patients were diagnosed with melanoma in situ, 15 % – Т1, 28.3 % – Т2, 23.3 % – Т3, 28.3 % – Т4. At outflow of the lymph through 1 collector, the metastases in sentinel lymph node (SLN) was defined in 51 %, through 2 collectors – in 81.8 % of cases. Tumor cells damaged single lymph node in 35.3 % of cases, two and more lymph nodes in 64.7 % of cases. Metastases in SLN with formation of secondary tumor at the T1 melanoma were observed at 11.1 %, T2 – 5.9 %, T3 – 21.4 %, T4 – 47.1 % of studies. Clusters of cells or isolated cells of melanoma in SLN at Т1 were noted in 22.2 %, at Т2 – in 41.2 %, at Т3 – in 42.9 %, at Т4 – in 35.3 % of cases. At outflow of lymph through 1 collector, metastasises of melanoma in non-sentinel lymph nodes (NSLN) were revealed in 24 %, through 2 collectors – in 44.4 % of cases. Secondary changes of NSLN were noted in 16.7 % of cases of defeat of single SLN, in 31.8 % of cases of defeat of two and more SLN. Metastases of melanoma were revealed in 69.2 % of cases of formation of secondary tumor and in 4.8 % of cases of presence of clusters in SLN in removed NSLN.Conclusion. At increase of Тmelanoma of the skin, the quantity of sentinel lymph nodes with reactive changes decreased, and their number with metastases increased. Metastatic defeat of sentinel lymph nodes at outflow of lymph through 2 lymph collectors in two and more SLN and NSLN exceeded the defeat of SLN at outflow of lymph through 1 lymph collector in single lymph nodes. The use of immunocytochemical method of research allowed to expand pathomorphological verification of metastatic defeat of sentinel lymph nodes by 66.7%.Введение. Каждая 10-я опухоль кожи – меланома, на план лечения которой влияет наличие опухолевых клеток в сигнальном лимфоузле.Цель исследования – изучение метастазирования меланомы кожи в клинически негативные региональные лимфатические узлы.Материал и методы. Гистологическим, иммуногистохимическим, цитологическим и иммуноцитохимическим методами исследованы биоптаты региональных лимфатических узлов 60 пациентов с меланомой кожи.Результаты. У 5 % пациентов диагностирована меланома в стадии in situ, у 15 % – Т1, у 28,3 % – Т2, у 23,3 % – Т3, у 28,3 % – Т4. При оттоке лимфы через 1 лимфоколлектор метастазы в сигнальном лимфоузле (СЛУ) определили в 51 %, через 2 лимфоколлектора – в 81,8 % случаев. В 35,3 % случаев опухолевые клетки поражали единичный лимфоузел, в 64,7 % – 2 и более лимфоузла. Метастазы в СЛУ с формированием вторичной опухоли при меланоме Т1 наблюдали в 11,1 %, Т2 – в 5,9 %, Т3 – в 21,4 %, Т4 – в 47,1 % исследований. Скопления клеток по типу кластера или разрозненные клетки меланомы в СЛУ при Т1 отмечены в 22,2 %, при Т2 – в 41,2 %, при Т3 – в 42,9 %, при Т4 – в 35,3 % случаев. При оттоке лимфы через 1 коллектор метастазы меланомы в несигнальных лимфоузлах (НСЛУ) выявлены в 24 %, через 2 коллектора – в 44,4 % случаев. Вторичные изменения НСЛУ отметили в 16,7 % случаев поражения единичного СЛУ, в 31,8 % наблюдений – поражения 2 и более СЛУ. В 69,2 % случаев формирования вторичной опухоли и в 4,8 % наличия кластеров в СЛУ в удаленных НСЛУ обнаружены метастазы меланомы.Выводы. При нарастании Т меланомы кожи уменьшалось число сигнальных лимфатических узлов с реактивными изменениями, и возрастала их численность с метастазами. Метастатическое поражение сигнальных лимфатических узлов при оттоке лимфы через 2 лимфоколлектора в 2 и более СЛУ и НСЛУ превышало поражение СЛУ при оттоке лимфы через 1 лимфоколлектор в единичные лимфоузлы. Использование иммуноцитохимического метода исследования позволило на 66,7 % расширить патоморфологическую верификацию метастатического поражения сигнальных лимфатических узлов

FEATURES OF DEFEATS OF SENTINEL LYMPH NODES AT PRIMARY MELANOMA OF SKIN

Introduction. Each tenth tumor of skin is melanoma. Presence of tumor cells in sentinel lymph node influenced the medical tactics.The objective of the research was to study the metastasis of skin melanoma into the clinically negative regional lymph nodes.Material and methods. Histological, immunohistochemical, cytological and immunocytochemical methods were used to study biopsies of regional lymph nodes in 60 patients with skin melanoma.Results. 5 % of patients were diagnosed with melanoma in situ, 15 % – Т1, 28.3 % – Т2, 23.3 % – Т3, 28.3 % – Т4. At outflow of the lymph through 1 collector, the metastases in sentinel lymph node (SLN) was defined in 51 %, through 2 collectors – in 81.8 % of cases. Tumor cells damaged single lymph node in 35.3 % of cases, two and more lymph nodes in 64.7 % of cases. Metastases in SLN with formation of secondary tumor at the T1 melanoma were observed at 11.1 %, T2 – 5.9 %, T3 – 21.4 %, T4 – 47.1 % of studies. Clusters of cells or isolated cells of melanoma in SLN at Т1 were noted in 22.2 %, at Т2 – in 41.2 %, at Т3 – in 42.9 %, at Т4 – in 35.3 % of cases. At outflow of lymph through 1 collector, metastasises of melanoma in non-sentinel lymph nodes (NSLN) were revealed in 24 %, through 2 collectors – in 44.4 % of cases. Secondary changes of NSLN were noted in 16.7 % of cases of defeat of single SLN, in 31.8 % of cases of defeat of two and more SLN. Metastases of melanoma were revealed in 69.2 % of cases of formation of secondary tumor and in 4.8 % of cases of presence of clusters in SLN in removed NSLN.Conclusion. At increase of Тmelanoma of the skin, the quantity of sentinel lymph nodes with reactive changes decreased, and their number with metastases increased. Metastatic defeat of sentinel lymph nodes at outflow of lymph through 2 lymph collectors in two and more SLN and NSLN exceeded the defeat of SLN at outflow of lymph through 1 lymph collector in single lymph nodes. The use of immunocytochemical method of research allowed to expand pathomorphological verification of metastatic defeat of sentinel lymph nodes by 66.7%