Lymph node staging

Cancers of the head and neck (HNC) include cancers of the larynx, nasal passages/nose, oral cavity, pharynx, salivary glands, buccal regions, and thyroid. In these cancers, lymph node staging and localization of pathological lymph nodes are necessary to decide on either (neo) adjuvant or surgical therapy and are a major factor for the prognosis in HNC patients. Cervical node metastases have different incidence, and their presence is associated with a decrease in global survival to roughly half and with higher recurrence rates. The node metastases can be categorized in the following 2 groups: overt (clinical) or nonovert (occult). The latter can be subcategorized as metastases detectable by traditional methods (eg, staining) or "submicroscopic" metastases, only evident with immunohistochemical or molecular analysis. Compared with clinical invasive and laboratory examinations, which may have complications and are expensive, radiology plays an important role in lymph node staging. Mainly, the overt node metastases are the field of radiological imaging, and second, the detection of nonovert metastases is important and holds promise for the future because many patients of those initially classified as cN0 have, in fact, occult metastatic disease (pN1). Vice versa, radiological imaging has to avoid false-positive results that can lead to an elective or radical neck dissection, which are associated with increased morbidity and mortality and thus overshadow the improvement in survival. Radiological imaging plays a role not only as an initial staging of N+ but also in the case of N0 due to the continuing controversy for the treatment of N0 patients. A close observation of the patient may reveal a positive node in the follow-up. The imaging modalities used for the node staging in HNC patients include ultrasound, contrast-enhanced computed tomography, contrast-enhanced magnetic resonance imaging (MRI), and positron emission tomography scans. None of the above-mentioned methods reaches a 100% sensitivity or specificity, and the accuracy of the exact number of metastases or levels involved has not been studied; thus, neck dissection with subsequent pathological examination remains the gold standard for node staging. Among the described cross-sectional imaging modalities, MRI presents a lot of advantages mainly due to the increased soft tissue contrast and the ability to obtain tissue characteristics in different sequences, including diffusion- and perfusion-weighted sequences and proton spectroscopy imaging. The lack of the radiation burden makes MRI suitable for a close follow-up of the patient, and the imaging with the use of new intravenous contrast material (such as ultrasmall iron oxide particles) seems superior to the conventional. In this article, we will focus on the lymph node MRI staging in HNC patients and the MR anatomy of the nodes, the necessary diagnostic workup, and the advantages of the method over computed tomography. The possibilities of the new imaging sequences and the treatment implications will be addressed as well.     

Treatment of brain metastases from melanoma

Brain metastases from malignant melanoma have a poor prognosis, and treatment can be difficult because of rapid progression of the disease. To help define the treatment of this disease, we reviewed the published literature on brain metastases from melanoma. If a solitary metastasis is present, surgery might be beneficial, especially if systemic disease is absent. Stereotactic radiosurgery is a less invasive, attractive option for solitary or oligometastatic (up to 6) lesions. External beam whole-brain radiation therapy can produce responses and frequently palliates symptoms, but as the sole therapy, it is unlikely to eradicate brain metastases. Chemotherapy may be gaining a role with newer agents that penetrate the blood-brain barrier. Combined modality therapy appears to be the future direction of treatment of multiple metastases.     

Bilateral uveal metastases from small-cell carcinoma of the lung.

Metastasis from small-cell carcinoma of the lung (SCCL) has most frequently been found in the lymph nodes, bones, brain, and liver. We have reported a case of metastatic SCCL located in the uveal layer of both eyes (choroidal in one and iridic in the other), an extremely rare occurrence.     

Human melanoma cells derived from lymphatic metastases use integrin alpha v beta 3 to adhere to lymph node vitronectin.

Human melanoma is a highly metastatic cancer and the regional lymph nodes are generally the first site of metastasis. Adhesion to cryostat sections of human lymph nodes was therefore studied using two human melanoma models established from lymph node metastases, namely, MeWo cell lines of diverse metastatic potentials and a highly metastatic cell line of recent origin designated MIM/8. We found a good correlation between the metastatic potentials of the melanoma cells as measured in nude mice and their ability to adhere to cryostat sections of human lymph nodes. When adhesion to immobilized extracellular matrix proteins was measured, a significant increase in adhesion, which correlated with increased metastasis, was seen mainly on vitronectin and to a lesser extent on fibronectin. The adhesion to vitronectin and to the frozen sections were specifically blocked by an RGD-containing peptide, mAb 661 to vitronectin and mAb LM609 to integrin alpha v beta 3. FACS analysis revealed a significant and specific increase in cell surface expression of alpha v beta 3 on the metastatic cells as compared to the parent line. Together these results suggest that the adhesion of melanoma cells to lymph node vitronectin via the alpha v beta 3 receptor plays a role in the process of lymphatic dissemination.     

Lymph node hyperplasia of the gastric antrum

Signs of hyperplasia of the lymph nodules of the antral part of the stomach (HLNAPS) were revealed in 352 adults and 213 children during esophagogastroduodenoscopy. Endoscopic, clinical and morphological signs of this disease were described. HLNAPS resistance to common antiulcerative therapy was noted. The necessity of biopsy to specify this disease was emphasized.     

Lymph node topology dictates T cell migration behavior

Adaptive immunity is initiated by T cell recognition of foreign peptides presented on dendritic cells (DCs) by major histocompatibility molecules. These interactions take place in secondary lymphoid tissues, such as lymph nodes (LNs) and spleen, and hence the anatomical structure of these tissues plays a crucial role in the development of immune responses. Two-photon microscopy (2PM) imaging in LNs suggests that T cells walk in a consistent direction for several minutes, pause briefly with a regular period, and then take off in a new, random direction. Here, we construct a spatially explicit model of T cell and DC migration in LNs and show that all dynamical properties of T cells could be a consequence of the densely packed LN environment. By means of 2PM experiments, we confirm that the large velocity fluctuations of T cells are indeed environmentally determined rather than resulting from an intrinsic motility program. Our simulations further predict that T cells self-organize into microscopically small, highly dynamic streams. We present experimental evidence for the presence of such turbulent streams in LNs. Finally, the model allows us to estimate the scanning rates of DCs (2,000 different T cells per hour) and T cells (100 different DCs per hour).     

Sentinel lymph node in malignant melanoma

The authors describe the technique called sentry ganglion, the ganglion which has the highest risk of receiving neoplastic cells and towards which a primary tumor directs its metastasis. The authors explain the procedure for carrying out a biopsy on this ganglion and its warnings regarding different neoplasias and specifically regarding melanoma.     

Metachronous pulmonary and pancreatic metastases arising from sigmoid colon cancer: A case report

BACKGROUNDMetachronous pulmonary and pancreatic metastases from colorectal cancer are rare. The diagnosis of pancreatic metastases is difficult and predominantly relies on computed tomography, pathology and immunohistochemistry. Here, we describe the use of next-generation sequencing (NGS) for determination of the origin of metastasis and prognostic prediction of colorectal cancer.CASE SUMMARYA 59-year-old man was diagnosed with sigmoid adenocarcinoma stage IIA (T3N0M0) and underwent surgery in April 2014, followed by XELOX adjuvant chemotherapy. The patient developed pulmonary metastasis in the right upper lung and underwent surgery in May 2016 without further adjuvant chemotherapy. In May 2018, pancreatic metastasis was found and he underwent pancreaticoduodenectomy. After surgery, he was treated with adjuvant S-1 chemotherapy from June 2018 to March 2019. Histopathological review of the specimens from all three lesions indicated consistent patterns characteristic of colon cancer. Concordant gene mutation profiles were observed across the three lesions that included oncogenic driver mutations most frequently seen in colon cancer (e.g., APC, TP53, KRAS and FBXW7). Blood circulating tumor (ct)DNA before adjuvant chemotherapy was undetectable with NGS, suggesting a favorable response to chemotherapy. The patient was alive and well at the latest follow-up visit, achieving a disease-free survival of 17 mo.CONCLUSIONThe genetic profiles of primary tumor, metastases and ctDNA may have clinical value in auxiliary diagnosis, prognosis and therapeutic decision-making.     

进展期胃窦癌淋巴结转移分析

目的探讨进展期胃癌根治术的淋巴结清扫范围.方法对1988～2002年243例施行根治术(D2、D2 或D3)的进展期胃窦癌患者的病理检查进行回顾性分析.结果本组淋巴结转移率72.8%.Borrmann Ⅰ、Ⅱ、Ⅲ、Ⅳ型淋巴结转移率分别是42.9%、47.6%、85.1%、100.0%.Ⅰ、Ⅱ型与Ⅲ、Ⅳ型淋巴结转移有显著性差异(p＜0.01);Ⅲ、Ⅳ型淋巴转移距离远,N3站淋巴结转移率26.4%.T2和T3、4患者淋巴结转移率分别为40%和80.3%,N3站淋巴结转移分别为2.2%和20.7%,亦有显著性差异(p＜0.01).转移淋巴结小结节型和一般型转移范围较广泛,N3站淋巴结转移率分别为35.5%和20.0%.在N3站转移的患者中以No(12、13)转移率最高(16.9%、11.9%).结论对进展期胃窦癌,BorrmannⅢ、Ⅳ型,T3、T4者,转移淋巴结小结节型或一般型患者,胃癌根治术应施行D3淋巴结清扫;No(12、13)清扫应纳入标准D2的手术常规.     

Lymph node trafficking and antigen presentation by endobronchial eosinophils

Because eosinophils recruited into the airways in allergic diseases are exposed to inhaled allergens, we evaluated whether eosinophils within the endobronchial lumen can function in vivo as antigen-presenting cells for inhaled antigens. We recovered eosinophils from the airways after aerosol antigen challenge in sensitized mice or from the peritoneal cavities of IL-5 transgenic mice and fluorescently labeled these cells ex vivo. These labeled cells, instilled intratracheally into normal mice, migrated into draining paratracheal lymph nodes and localized to T cell-rich paracortical areas. The homing of airway eosinophils to lymph nodes was not governed by eotaxin, because CCR3(-/-) and CCR3(+/+) eosinophils migrated identically. Airway eosinophils, recovered after inhalational antigen challenge in sensitized mice, expressed MHC class II and costimulatory CD80 and CD86 proteins and functioned in vitro as CD80- and CD86-dependent, antigen-specific, antigen-presenting cells. Moreover, when instilled into the airways of antigen-sensitized recipient mice, airway eosinophils recovered after inhalational antigen challenge stimulated antigen-specific CD4(+) T cell proliferation within paratracheal lymph nodes. Thus, eosinophils within the lumina of airways can process inhaled antigens, traffic to regional lymph nodes, and function in vivo as antigen-presenting cells to stimulate responses of CD4(+) T cells.     

Surgical treatment of liver metastasis with uveal melanoma: A case report

BACKGROUNDUveal melanoma is the most common primary intraocular malignant tumor affecting the eyes in adults. Nearly half of all primary uveal melanoma tumors metastasize; yet, there are currently no effective treatments for metastatic uveal melanoma. At the time of diagnosis, less than 4% of patients with uveal melanoma have detectable metastatic disease. Uveal melanoma disseminates hematogenously, with the most common site of metastasis being liver (93%), followed by lung (24%) and bone (16%).CASE SUMMARYA 57-year-old woman was diagnosed with a dysplastic nevus on her eyelid, which was histologically confirmed as malignant melanoma after resection. The patient had no evidence of metastasis to other organs and received both radiation therapy and chemotherapy. After systemic treatment, a metastatic left neck lymph node was found and another round of chemotherapy was performed after resection. Positron emission tomography-Computed Tomography tracking after completion of chemotherapy revealed two metastatic liver nodules. The patient underwent partial liver resection and showed no signs of recurrence at 1 year after surgery.CONCLUSIONSurgery is an effective treatment for metastatic uveal melanoma. In patients with liver metastatic lesions, hepatectomy improves outcome.