102,427 research outputs found

    Sentinel lymph node in early stage ovarian cancer; a literature review

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    Although sentinel lymph node mapping has been widely implemented in gynecological malignancies in order to minimize the number of unnecessary lymph node dissections and to diminish postoperative morbidity rate, little is known about ovarian cancer sentinel lymph node mapping. This article presents a literature review regarding the effectiveness, safety and benefits of this method. Sentinel lymph node detection in early stage ovarian cancer seems to be a safe and effective method, able to minimize the rate of patients submitted to unnecessary lymph node dissection. The second goal of the procedure, to minimize the risk of missing involved lymph nodes, seems also to have been achieved, most studies reporting a very small number of cases diagnosed with positive non-sentinel lymph nodes. Considering all these data we can note that this procedure is not yet included as part of the standard therapeutic protocol, so that further studies would be necessary to include it as a common therapeutic approach in the case of patients with early stage ovarian cancer

    Esophageal Cancer Initially Thought to be Accompanied by a Solitary Metastasis to an Intrathoracic Paraaortic Lymph Node

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    Esophageal cancers usually exhibit lymph-node metastases. Although a solitary lymph-node metastasis is occasionally found, the involvement of an intrathoracic paraaortic node is rare. We present here an intrathoracic mid-esophageal cancer case in which an accompanying solitary retroaortic mass was found within the posterior mediastinum by integrated positron emission tomography/computed tomography. For diagnosis, thoracoscopic resection of the mass was performed from a left thoracic approach, and histology revealed it to be a squamous cell carcinoma metastasized from the esophageal cancer. Upon radical esophagectomy after neoadjuvant therapy as a T3N1M0 Stage IIIa (AJCC/UICC) cancer, the esophageal cancer was found to have invaded unexpectedly deeply in the vicinity of the descending aorta. Another lymph node within the paraaortic region was also involved (T4N1M0 Stage IIIc). The present case and other cases we review here inform our understanding of metastasis to intrathoracic paraaortic nodes as follows:1) its existence may indicate extensive lymph-node metastasis or direct tumor invasion nearby, and 2) it may be accompanied by other lymph-node involvements in this region, even if it appears solitary upon preoperative investigation. Thus, for radical esophagectomy, sufficient lymph-node dissection is required, even at locations not reached by the usual right thoracic approach. Definitive chemoradiotherapy may be a better choice for preoperatively recognized T3 esophageal cancer when the cancer is accompanied by paraaortic lymph node metastasis

    Incidence of lymph node metastases in clinical early-stage mucinous and seromucinous ovarian carcinoma: a retrospective cohort study

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    Objective: The use of lymph node sampling during staging procedures in clinical early-stage mucinous ovarian carcinoma (MOC) is an ongoing matter of debate. Furthermore, the incidence of lymph node metastases (LNM) in MOC in relation to tumour grade (G) is unknown. We aimed to determine the incidence of LNM in clinical early-stage MOC per tumour grade. Design: Retrospective study with data from the Dutch Pathology Registry (PALGA). Setting: The Netherlands, 2002–2012. Population or sample: Patients with MOC. Methods: Histology reports on patients with MOC diagnosed in the Netherlands between 2002 and 2012 were obtained from PALGA. Reports were reviewed for diagnosis, tumour grade and presence of LNM. Clinical data, surgery reports and radiology reports of patients with LNM were retrieved from hospital files. Main outcome measures: Incidence of LNM, disease-free survival (DFS). Results: Of 915 patients with MOC, 426 underwent lymph node sampling. Cytoreductive surgery was performed in 267 patients. The other 222 patients received staging without lymph node sampling. In eight of 426 patients, LNM were discovered by sampling. In four of 190 (2.1%) patients with G1 MOC, LNM were present, compared with one of 115 (0.9%) patients with G2 MOC and three of 22 (13.6%) patients with G3 MOC. Tumour grade was not specified in 99 patients. Patients with clinical early-stage MOC had no DFS benefit from lymph node sampling. Conclusions: LNM are rare in early-stage G1 and G2 MOC without clinical suspicion of LNM. Therefore, lymph node sampling can be omitted in these patients

    Ultrasound mapping of lymph node and subcutaneous metastases in patients with cutaneous melanoma: Results of a prospective multicenter study

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    Background: Ultrasound (sonography, B-mode sonography, ultrasonography) examination improves the sensitivity in more than 25% compared to the clinical palpation, especially after surgery on the regional lymph node area. Objective: To evaluate the distribution of metastases during follow-up in the draining lymph node areas from the scar of primary to regional lymph nodes ( head and neck, supraclavicular, axilla, infraclavicular, groin) in patients with cutaneous melanoma with or without sentinel lymph node biopsy (SLNB) or former elective or consecutive complete lymph node dissection in case of positive sentinel lymph node (CLND). Methods: Prospective multicenter study of the Departments of Dermatology of the Universities of Homburg/Saar, Tubingen and Munich (Germany) in which the distribution of lymph node and subcutaneous metastases were mapped from the scar of primary to the lymphatic drainage region in 53 melanoma patients ( 23 women, 30 men; median age: 64 years; median tumor thickness: 1.99 mm) with known primary, visible lymph nodes or subcutaneous metastases proven by ultrasound and histopathology during the follow-up. Results: Especially in the axilla, infraclavicular region and groin the metastases were not limited to the anatomic lymph node regions. In 5 patients (9.4%) ( 4 of them were in stage IV) lymph node metastases were not located in the corresponding lymph node area. 32 patients without former SLNB had a time range between melanoma excision and lymph node metastases of 31 months ( median), 21 patients with SLNB had 18 months ( p < 0.005). In 11 patients with positive SLNB the time range was 17 months, in 10 patients with negative SLNB 21 months ( p < 0.005); in 32 patients with CLND the time range was 31 m< 0.005). In thinner melanomas lymph node metastases occurred later ( p < 0.05). Conclusions: After surgery of cutaneous melanoma, SLNB and CLND the lymphatic drainage can show significant changes which should be considered in clinical and ultrasound follow-up examinations. Especially for high-risk melanoma patients follow-up examinations should be performed at intervals of 3 months in the first years. Patients at stage IV should be examined in all regional lymph node areas clinically and by ultrasound. Copyright (c) 2006 S. Karger AG, Basel

    One-stage versus two-stage lymph node dissection after investigation of sentinel lymph node in cutaneous melanoma: a comparison of complications, costs, hospitalization times, and operation times

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    The aim of the study was to evaluate whether complication rate, costs, operation times, and hospitalization times differed in two different patient groups: in group 1, frozen section analysis of the sentinel lymph node and lymph node dissection were carried out in the same operation. In group 2, normal investigation of the sentinel lymph node and lymph node dissection were done in a second operation. One hundred thirty-five patients with cutaneous melanoma were included. Hospitalization times, costs, complication rates, and operation times of two-stage and one-stage lymph node dissection of the draining area after detection of metastases in the sentinel lymph node were retrospectively compared. Lymph node metastasis in the sentinel lymph node was found in 23 patients. In 11 patients, removal of the sentinel lymph node and dissection of the lymph node basin was performed in the same operation. In 12 patients, a two-stage procedure was the treatment of choice. Operation times were not different in the two groups (p=0.87) while two-stage operation patients were hospitalized significantly longer (14.2±9.7 vs 23.9±24days; p=0.01) and costs were significantly higher (7,836.90±2,397.95 Swiss francs vs 5,279.40±1,994.90 Swiss francs). In addition, more complications were found in the two-stage grou

    Prognostic Significance of Serum Vascular Endothelial Growth Factor-C (Serum Vegf-C) and Lymph-Vascular Space Invasion in Early Stage Cervical Cancer

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    Background: Management of early stage cervical cancer is still challenging. Several clinical-pathological prognostic factors that are currently used in clinical practice include stage, bulky tumor, stromal deep invasion, differentiation, histology, lymph vascular space invasion and status of lymph-node. Serum Vascular Endothelial Growth Factor-C (VEGF-C) has an important role in metastasis as an angiogenic and lymphangiogenic factor. This study aimed to determine prognostic significance of serum VEGF-Cand lymph-vascular space invasionin early stage cervical cancer. Subjects and Method: This was a case-control study conducted at January to October 2007. A sample of47 early-stage cervical cancer patients including 14 patients with lymph node metastasis (case) and 33 patients without lymph node metastasis (control) was selected for this study. The dependent variable was lymph node metastasis. The independent variables were serum VEGF-C and lymph vascular space invasion. Serum VEGF-C levels were examined by ELISA method. The data were analyzed by logistic regression. Results: A cut-off point of serum VEGF-C level of 10.07 pg/ mLresulted in 78.57% sensitivity and 96.97% specificity. The risk of lymph node metastasis increased with serum VEGF-C level > 10.07 pg/ mL (OR= 80.0; 95% CI=7.99 to 800.71; p< 0.001) and lymph vascular space invasion (OR= 20.00; 95% CI=2.32 to 171.7; p= 0.006). Conclusion: Serum VEGF-C and lymph vascular space invasion can be used as independent prognostic factor on the risk of lymph-node metastasis in early stage cervical cancer. Keywords: cervical cancer, prognostic factor, serum VEGF-C, lymph node metastasis

    Para-aortic node involvement is not an independent predictor of survival after resection for pancreatic cancer

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    AIM To analyze the importance of para-aortic node status in a series of patients who underwent pancreaticoduodenectomy (PD) in a single Institution. METHODS Between January 2000 and December 2012, 151 patients underwent PD with para-aortic node dissection for pancreatic adenocarcinoma in our Institution. Patients were divided into two groups: patients with negative PALNs (PALNs-), and patients with metastatic PALNs (PALNs+). Pathologic factors, including stage, nodal status, number of positive nodes and lymph node ratio, invasion of para-aortic nodes, tumor\u2019s grading, and radicality of resection were studied by univariate and multivariate analysis. Survival curves were constructed with Kaplan-Meier method and compared with Log-rank test: significance was considered as P < 0.05. RESULTS A total of 107 patients (74%) had nodal metastases. Median number of pathologically assessed lymph nodes was 26 (range 14-63). Twenty-five patients (16.5%) had para-aortic lymph node involvement. Thirty-three patients (23%) underwent R1 pancreatic resection. One-hundred forty-one patients recurred and died for tumor recurrence, one is alive with recurrence, and 9 are alive and free of disease. Overall survival was significantly influenced by grading (P = 0.0001), radicality of resection (P = 0.001), stage (P = 0.03), lymph node status (P = 0.04), para-aortic nodes metastases (P = 0.02). Multivariate analysis showed that grading was an independent prognostic factor for overall survival (P = 0.0001), while grading (P = 0.0001) and radicality of resection (P = 0.01) were prognostic parameters for disease-free survival. Number of metastatic nodes, node ratio, and para-aortic nodes involvement were not independent predictors of disease-free and overall survival. CONCLUSION In this experience, lymph node status and para-aortic node metastases were associated with poor survival at univariate analysis, but they were not independent prognostic factors

    Sentinel Lymph Node Detection in Early Stage Cervical Cancer

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    Worldwide, cervical cancer is the fourth most common malignancy among women. Radical hysterectomy and pelvic lymphadenectomy is the standard treatment for early stage cervical cancer. If lymph node metastasis is present at the time of diagnosis, 5-year survival rate drops from 90% to 57%. The risk of lymph node metastases in women with early stage cervical cancer is approximately 15%, and determines the use of adjuvant treatment. Over 80% of patients do not benefit from pelvic lymphadenectomy, but may suffer from adverse complications or sequelae such as lymphedema, lymphocyst formation, and neurovascular and ureteral injury. The sentinel lymph node is the first node to which metastatic disease will spread from a primary tumor. The clinical benefits of biopsy of only the sentinel lymph node includes a significant reduction in the adverse effects of complete lymphadenectomy. The specific benefits of sentinel lymph node detection in early stage cervical cancer includes improved identification of metastatic lymph nodes through ultrastaging and identification of alternate lymph node drainage sites, as well as the possibility of intraoperative frozen section analysis, which may be used to guide surgical management. Sentinel lymph node detection in early stage cervical cancer could become the standard of care in the near future

    Allogeneic inhibitory activity of regional lymph node cells in the mouse isografted with methylcholanthrene-induced tumor

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    In mouse bearing progressive cancer a decrease was present in the allogeneic inhibitory activity of T-lymphocytes, which constitutes the core of immunological surveillance system in mammalians. For tests, methylcholanthrene-induced tumor (MC-tumor) was isografted subcutaneously on the back between scapulae of C3H mice, and the lymphocytes were prepared from the regional axillary lymph nodes removed from these mice at 1, 2, 3, or 4 weeks after grafting. These lymph nodes cells were cultured together with 40-fold numbers of allogeneic JTC-11 cells derived from Ehrlich cancer cells in a culture medium containing 2.0% (v/v) PHA for 24 or 48 hours. The proliferation rate of JTC-11 cells (increased numbers) at weekly interval was considered the allogeneic inhibitory activity of lymph node cells. As a result it was demonstrated that in the early stage after tumor transplantation, i.e., in the first or second week, regional lymph node cells showed a strong allogeneic inhibitory activity, as in the case with lymph-node cells from normal mice, but at progressive stage of cancer, i.e., the third or fourth week when tumors were larger, such activity was completely lost. It seems that mice with progressive cancer showed a decrease of allogeneic inhibitory activity, i.e., a disruption of homeostasis was present.</p