Coronary angiographic abnormalities in mucocutaneous lymph node syndrome: acute findings and long-term follow-up

Coronary arterial changes in mucocutaneous lymph node syndrome were evaluated by retrospectively analyzing 62 coronary angiograms of 42 patients with abnormal coronary arteries. A total of 108 aneurysms on the initial studies were classified as follows: eight diffuse, 18 saccular, and 50 fusiform aneurysms and 32 localized areas of dilatation. These were also classified as large, medium, or small aneurysms. Approximately one-third of the aneurysms were in the right coronary artery and two-thirds in the left. Seventy percent of the aneurysms were located in the proximal portion of the coronary artery, 16% in the middle portion, and 14% in the distal portion. Sixteen patients were followed up with angiography for periods ranging from 4 months to 8 years 11 months. At follow-up, 48% of the 62 aneurysms had regressed to normal, 37% were diminished in size, and 10% were unchanged. Small and medium-sized aneurysms frequently showed complete regression. In contrast, large aneurysms tended to persist, and stenotic lesions formed at or adjacent to the aneurysm in 41%. Aneurysms larger than 9 mm in diameter, especially those that were diffuse in shape, carried a high risk of subsequent total occlusion.     

Cavitating mesenteric lymph node syndrome

Cavitating mesenteric lymph node syndrome (CMLNS) is a complication of celiac disease (chronic enteropathy characterized by intolerance to gluten ingestion) that is documented but poorly understood. Patients with CMLNS often present with weight loss that is refractory to treatment, fatigue, and diarrhea associated to clinical signs and laboratory findings of hyposplenism. Computed tomography shows multiple cystic mesenteric masses with a central low attenuation area caused by the presence of fluid and/or adipose material in the central cavity of the mesenteric lymph node.     

甲状腺乳头状癌术前颈部淋巴结转移超声诊断价值

目的探讨影响甲状腺乳头状癌(PTC)颈部淋巴结转移及转移区域的相关因素。方法选取自2016年1月至2017年8月于北部战区总医院行甲状腺手术的223例PTC患者为研究对象。根据术后病理颈部淋巴结是否转移将其分为淋巴结转移阳性组(LN+组,n=99)与淋巴结转移阴性组(LN-组,n=124)。记录患者的临床资料,包括性别、年龄、实验室检查指标、是否合并桥本氏病、术后病理诊断资料,以及超声声像图特征。采用χ~2检验、Fisher精确概率法及二分类Logistic回归分析影响PTC颈部淋巴结转移及转移区域的危险因素。结果性别、是否合并桥本氏病、病灶大小及典型PTC的超声征象具有预测颈部淋巴结转移及转移区域的价值(P<0.05)。结论当患者为男性、不伴有桥本氏病,且病灶较大并具有典型PTC超声特征时,外科医师应警惕颈部淋巴结转移。PTC肿瘤位置影响淋巴结的转移区域。     

The pathologist's role in sentinel lymph node evaluation

Patients with high-risk (thick, deeply invasive) primary melanoma were, in the past, managed by wide local excision and elective node dissection or wide local excision alone, with subsequent lymphadenectomy if the regional nodes developed clinically detectable metastases. We recently developed a more logical approach called selective lymph node dissection. To be effective, this requires close collaboration of surgeons, pathologists, and nuclear medicine physicians. The draining lymph node basin is identified preoperatively by lymphoscintigraphy. During surgery, a marker dye (isosulfan blue) and radioactive technetium labeled albumin are injected intradermally around the primary melanoma and the afferent lymphatics are followed up to the first lymph nodes of the ipsilateral regional nodal basin. The surgeon excises the blue-colored and maximally radioactive sentinel nodes and the pathologist critically evaluates these for the presence of a metastatic tumor. If the sentinel nodes are tumor free, no further nodal dissection is undertaken; if a tumor is present, a complete dissection of the nodal basin is performed. We have examined 1,119 sentinel lymph nodes from 669 patients treated by selective lymph node dissection. We identified melanoma cells in sentinel nodes from 126 patients (17.8%). A single node contained tumors in 67% of patients, 2 nodes were positive in 25%, and the remaining 12% of patients had three tumor-containing nodes. Melanoma cells were dispersed singly or in variably sized groups, usually in the peripheral nodal sinus. In around 40% of patients, immunohistochemistry is required to identify minute numbers of tumor cells. With experience, pathologists identify tumors in hematoxylin and eosin (H&E) preparations in an increasing proportion of lymph nodes. Tumor cells are more frequent in the sentinel nodes of patients with primary tumors of deeper Clark level and greater Breslow thickness. Tumor cells must be discriminated from capsular nevus cells, interdigitating dendritic leukocytes, macrophages, and intranodal neural tissues.     

乳腺癌内乳淋巴结显像的影像学评价

乳腺癌是目前妇女最常见的恶性肿瘤之一,其远处转移及复发是影响患者预后的重要因素,而淋巴结转移是其最常见的转移方式。内乳淋巴结(internal mammary lymph node,IMLN)与腋窝淋巴结同属乳腺淋巴回流的区域淋巴结,引流约20%~25%的乳腺淋巴液。近年来随着对 IMLN 研究的深入,发现其对远处转移及远期复发的预测价值与腋窝淋巴结相当。本文就国内外关于IMLN显像的影像学研究进展作一综述。     

Intestinal pseudo-obstruction in mucocutaneous lymph-node syndrome.

Mucocutaneous lymph-node syndrome (MCLS) is an acute exanthem with specific clinical features, sometimes complicated by involvement of internal organs. Two patients with MCLS had clinical and radiographic evidence of mechanical small-bowel obstruction, probably on the basis of focal vascular insufficiency, as anatomic obstruction was not documented in either instance. The cases indicate that intestinal involvement in patients with MCLS can simulate intestinal obstruction, and conservative management of such patients is appropriate.     

MSCT对纵隔淋巴结结核和纵隔淋巴结转移瘤诊断价值

目的 探讨多层螺旋CT(MSCT)对纵隔淋巴结结核和纵隔淋巴结转移瘤的诊断价值.方法 选取50例纵隔淋巴结结核及26例纵隔淋巴结转移瘤的MSCT影像资料,记录病变分布、大小、密度、融合、强化方式、邻近组织受累情况,进行对比分析.结果 成人纵隔淋巴结结核比转移瘤更易累及4R、2R、7区淋巴结.前者病灶直径在1～4 cm之...     

Breast cancer, Poland's syndrome, and sentinel lymph node involvement

Poland's syndrome includes a wide range of abnormalities that affect the thorax and the upper extremities. We present a case of a woman of 39 years of age who attended our clinic because of a lump in the right breast. Our experience with the present case suggests that the sentinel lymph node biopsy is feasible in patients with Poland's syndrome and breast cancer.     

CT evaluation of lymph node status at presentation of prostatic carcinoma.

Computed tomographic (CT) studies performed within a general oncology service in 104 consecutive patients with prostatic carcinoma were reviewed retrospectively to assess the incidence and distribution of lymphadenopathy. All patients were staged with CT at initial presentation, had normal skeletal scintigrams and were candidates for radical radiotherapy. The likelihood of lymphadenopathy was associated with increasing T-stage. 57 of the 92 (62%) patients without lymph node enlargement had local disease confined to the prostate (T2 or less) compared with only two of the 12 (17%) patients with enlarged nodes. Lymph node enlargement was more likely with a primary tumour of poorly differentiated histology. 12 patients (11.5%) had lymphadenopathy by established CT criteria; six with pelvic nodal enlargement alone and six with enlargement of pelvic and retroperitoneal nodes. In all patients pelvic nodal enlargement predominated and no patient had isolated retroperitoneal lymphadenopathy. Our findings indicate that CT staging studies of prostatic cancer do not need to include the retroperitoneum if there is no lymphadenopathy at or below the aortic bifurcation.