Renal Cell Carcinoma with Gallbladder Metastasis

The nature of polypoid masses within the gallbladder is difficult to define preoperatively. Tumors larger than 1 cm in size are strongly related to malignancy, but they are not always primary tumors of the gallbladder. We present a patient who underwent radical surgery for renal cell carcinoma and the preoperative finding of a polypoid mass within the gallbladder turned out to be a metastatic lesion.     

Solitary Lymph Node Metastasis in Gastric Cancer

The feasibility and diagnostic reliability of sentinel node (SN) biopsy for gastric cancer are still controversial. We studied the clinicopathological features and localization of solitary lymph node metastasis (SLM) in gastric cancer to provide useful information for use of the SN concept in gastric cancer. From 2000 to 2004, 3,267 patients with gastric cancer underwent D2 radical gastrectomy. The clinicopathological features of 195 patients with histologically proven SLM and the distribution of metastasized nodes were assessed. The incidence of SLM was 6.0% in all cases. Compared with the node-negative patients, significant differences were observed in age, tumor size, depth of invasion, and surgical type. The cumulative 5-year survival rate of patients with SLM was 80.5%, which was significantly lower than 90.2% for node-negative patients (P < 0.001). Of patients with SLM, 82.6% had it in the perigastric node area (N1), and the other 17.4% patients had skip metastasis in the N2-N3 nodes. Perigastric nodes were the most common first sites of drainage from the tumor, making them the main targets of the operative SN mapping procedure. Due to the higher than expected incidence of skip metastasis in gastric cancer, D2 lymphadenectomy should be performed until the reliability of SN navigation surgery is validated in multicenter prospective clinical trials.     

Predictors to Assess Non‐Sentinel Lymph Node Status in Breast Cancer Patients with Sentinel Lymph Node Metastasis

Abstract: The next step of sentinel lymph node biopsy (SLNB) in breast cancer is to determine which patients need axillary lymph node dissection (ALND) following a positive SLNB. A prospective database of 239 patients who underwent SLNB followed by complete ALND at Keio University Hospital from January 2001 to June 2005 was reviewed. A total of 131 patients with one or more positive sentinel lymph nodes (SLNs) were further analyzed. A univariate analysis showed a significant correlation between non‐SLN involvement and lymphatic invasion, vascular invasion, number of tumor‐involved SLNs, radioactivity of SLNs, and size of SLN metastasis (p = 0.0002, p = 0.004, p = 0.006, p = 0.04, p = 0.03, respectively). By multivariate analysis, lymphatic invasion and the number of tumor‐involved SLNs remained significant predictors of non‐SLN involvement. In breast cancer patients with a positive SLN, lymphatic invasion and the number of tumor‐involved SLNs were both independent predictors of non‐SLN involvement.     

胃黏膜下层癌淋巴结转移临床病理因素分析

【摘要】 目的 研究胃黏膜下层癌淋巴结转移率及其影响因素。 方法 回顾性分析南京医科大学第一附属医院1998年1月至2007年12月手术证实的181例胃黏膜下层癌的临床病理资料,对病人年龄、性别、肿瘤组织学类型、形态学类型、大小、部位、浸润深度、脉管内癌栓等与淋巴结转移的关系进行单因素与多因素分析。 结果 胃黏膜下层癌淋巴结转移率为20.44%。影响胃黏膜下层癌淋巴结转移的因素主要有肿瘤组织学类型（分化型 vs 分化不良型,P =0.0352）、直径大小（＜2cm vs ≥2cm,P =0.0143）、部位（近端胃vs胃体vs远端胃,P =0.0254）及脉管内癌栓（无vs有,P =0.0323）。Logistic回归分析显示肿瘤组织学类型与大小为胃黏膜下层癌淋巴结转移的独立性危险因素。结论 胃黏膜下层癌淋巴结转移与肿瘤组织学类型、大小、部位及脉管内癌栓等因素有关。临床上应参考上述临床病理因素判断淋巴结转移风险,制定合适的治疗方案。     

Maxillary Verrucous Carcinoma Coincident With Cervical Lymph Node Metastasis of Colon Adenocarcinoma

Cervical lymph node metastasis is an extremely rare event in oral verrucous carcinoma. Isolated cervical lymph node metastasis of colon cancer is also rare. This article describes a case of maxillary verrucous carcinoma accompanied by colon adenocarcinoma that metastasized to a cervical lymph node in a 69-year-old Japanese woman. During preoperative evaluation for maxillary verrucous carcinoma, enlarged cervical lymph nodes and colon cancer were suspected by positron emission tomography. Colonoscopy with biopsies confirmed primary colon adenocarcinoma. Left radical neck dissection, partial maxillectomy, and full-thickness skin graft to the mucosa of the upper lip were performed before treatment of colon adenocarcinoma. Cervical lymph nodes showed metastasis from colon adenocarcinoma, and right hemicolectomy was performed. This is the first case report of synchronous oral verrucous carcinoma and colon adenocarcinoma with cervical lymph node metastasis.     

Occult Lymph Node Metastasis in Gastric Cancer with Submucosal Invasion

To evaluate more precisely the incidence of lymph node metastasis in patients with submucosally invaded (sm) gastric cancer, three additional sections were made from the remaining half of 1,794 lymph nodes taken from 57 patients, for a detailed reexamination. Lymph node metastasis was demonstrated in 19 nodes from 11 patients by the initial routine examination; however, the detailed reexamination showed cancer involvement in a further nine lymph nodes from eight patients. Of these eight patients, metastasis had not been detected in any lymph nodes by routine examination in six. Macroscopically, the lesion was of the depressed or mixed type in six of the eight patients. From the intranodal location and growth pattern of the cancer foci, lymph nodes with occult metastasis were divided into the marginal sinus type, the medullary sinus type, and the mixed type, with the marginal type being found most frequently. The overall incidence of lymph node metastasis in patients with sm gastric cancer was as high as 29.8% (17/57) in this series. Moreover, a follow-up study revealed that two patients with occult metastasis died of cancer recurrence postoperatively. Accordingly, systematic regional lymph node dissection should be carried out at the time of surgery for sm gastric cancer.     

Axillary Lymph Node Metastasis from Papillary Thyroid Carcinoma: Report of a Case

We report a case of axillary lymph node metastasis (LNM) from papillary thyroid carcinoma (PTC) in a 21-year-old man. The patient presented with bilateral cervical and right axillary lymphadenopathy, and computed tomography (CT) showed a primary tumor of the thyroid and gross lymphadenopathy from the neck to the right axilla. We performed a total thyroidectomy with therapeutic nodal dissection. The resection of the primary thyroid tumor and all the node metastases was curative. Pathological examination confirmed that the resected lesions were PTC and nodal metastases from the primary tumor. Six years after the operation, cervical, upper mediastinal, and axillary lymph node recurrence developed and multiple lung metastases were found on a CT scan. He was treated with radioactive iodine therapy. Axillary LNM from PTC is unusual and seems to be associated with a poor prognosis. Thus, comprehensive treatment strategies are needed to improve the outcome of patients with PTC who present with axillary LNM.     

胸段食管癌淋巴结转移度与临床病理因素相关性分析

目的探讨胸段食管癌淋巴结转移度与主要临床病理因素的相关性及临床意义。方法分析2004年7月至2005年6月409例食管癌患者的病例资料,其中胸上段癌58例,中段癌267例,下段癌84例。临床分期0~Ⅰ期23例,Ⅱa期199例,Ⅱb期31例,Ⅲ期139例,Ⅳ期17例,均行手术切除肿瘤及淋巴结清扫。术后分析淋巴结转移情况,对主要病理因素进行统计学处理。结果全组术后病理示淋巴结转移率45.72%,总淋巴结转移度15.32%。统计分析显示随着肿瘤长径增加、浸润深度加深、分化程度降低,淋巴结转移度呈增高趋势,髓质型较其他大体类型、中下段食管癌较胸上段癌,淋巴结转移度增高。结论肿瘤长度>5cm、浸润深肌层以外、中低分化程度、髓质型病变以及中下段食管癌者,淋巴结转移度显著增高,于术前分期、手术方式选择、淋巴结清扫以及手术前后综合治疗中应予重视。     

胸段食管癌颈部及上纵隔淋巴结转移

探讨胸段食管癌颈部及上纵隔淋结转移规律。方法采用颈,胸,腹三切口施行胸段食管癌手术６１６例,同时施行三区域淋巴洁清扫。结果：中及上纵隔淋巴结转移率和转移度分别为５７．１％和２１．５％。结论胸段食管癌必须重颈部及上纵隔淋巴结清扫。     

高、低年龄组乳腺癌淋巴转移规律及对手术的指导意义

目的 探讨高、低年龄组乳腺癌在淋巴结转移方面存在的差异。指导手术治疗。方法 分别研究高、低年龄组乳腺癌临床分期、淋巴结分组,肿瘤大小、组织学分级与淋巴结转移率及转移度的关系。结果 低龄组乳腺癌淋巴结转移率及转移度高于高龄组。结论 低龄组乳腺癌应重视根治性,淋巴结清扫范围不宜缩小,术后应积极给予辅助治疗。高龄组乳癌合并症多,淋巴转移程度低,可适当缩小手术清扫范围。     

腔镜下阴茎癌双侧腹股沟淋巴结清扫术14例报告

目的探讨腔镜下阴茎癌双侧腹股沟淋巴结清扫术的效果。方法2009年9月～2011年11月对14例阴茎癌行腔镜下双侧腹股沟淋巴结清扫术。术前对腹股沟淋巴结和隐静脉进行多普勒超声扫描和盆腔淋巴CT检查,术中建立人工手术腔隙,置人腔镜以及操作器械,先用超声刀扩大皮下腔隙,向上至腹股沟韧带上方的腹外斜肌腱膜,外侧至缝匠肌外缘,内侧为长收肌内侧,下界为股三角顶端,解剖出股动静脉、大隐静脉及其分支,并切除该范围内的淋巴结和脂肪组织,从穿刺孔取出清扫的淋巴结和脂肪组织,术后置引流管引流。结果14例均顺利完成腔镜下腹股沟淋巴清扫术,术中未发生并发症。手术时间平均103min（95～112min）,术中出血量平均85ml（20～130m1）。双侧切除淋巴结共5—14枚,平均9枚,淋巴结均阴性。术后留置引流管平均5d（3～7d）。术后住院5～8d,平均6d。1例出现淋巴囊肿,2个月后消退,其余患者未发生股血管损伤、皮缘坏死、愈合延迟、皮下积液和淋巴漏等切口相关的并发症。14例术后随访6—20个月,平均9个月,患者无明显双下肢肿胀及活动障碍。结论腔镜下阴茎癌双侧腹股沟淋巴结清扫术可以保证清扫范围并减少标准开放手术带来的切口相关并发症。     

原发性肝癌门静脉癌栓患者合并肝门淋巴结转移手术疗效的比较研究

目的探讨原发性肝癌门静脉癌栓合并肝门淋巴结转移的手术疗效。方法 2001年1月～2003年12月28例肝癌伴门静脉癌栓术中发现肝门淋巴结肿大行肝门淋巴结清扫术,将有肝门淋巴结转移的15例设为淋巴结转移组,无肝门淋巴结转移的13例设为非淋巴结转移组,对2组患者的无瘤生存期和总生存期情况进行比较。结果淋巴结转移组生存2～13个月,中位生存期4个月,无瘤生存1～8个月,无瘤中位生存期3个月;非淋巴结转移组患者生存3～69个月,中位生存期11个月,无瘤生存2～32个月,无瘤中位生存期7个月。2组患者的无瘤生存期和总生存期有显著性差异（χ2=5.786,P=0.038;χ2=3.963,P=0.045）。结论伴有肝门淋巴结转移的原发性肝癌门静脉癌栓患者的手术疗效较差,即使行肝门淋巴结清扫也不能达到根治效果,并不能显著提高该病人的生存期。     

Parasternal Lymph Node Metastasis of Malignant Peritoneal Mesothelioma: Report of a Case

We report a case of malignant peritoneal mesothelioma with parasternal lymph node metastasis. The patient was a 34-year-old man who presented with a history of several years of abdominal pain and ascites of unknown origin. Exploratory laparoscopic biopsies yielded histological findings of malignancy, but a final diagnosis was not able to be made. A chest computed tomographic scan done the following year showed a parasternal nodule, and thoracoscopically obtained biopsied material was positive for calretinin. These findings led to a pathological diagnosis of metastasis to the parasternal lymph node from peritoneal mesothelioma.     

Hybrid Renal Cell Carcinomas Containing Histopathologic Features of Chromophobe Renal Cell Carcinomas and Oncocytomas Have Excellent Oncologic Outcomes

Background

Modern histopathology is able to differentiate chromophobe renal cell carcinomas (cRCCs), oncocytomas, and chromophobe–oncocytic hybrid RCCs; however, the true frequency and clinical courses of these tumors remain unclear.

Objective

To determine the clinical course of hybrid RCC.

Design, setting, and participants

Ninety-one surgically treated tumors, originally classified as oncocytoma or cRCC, were slide reviewed and reclassified by an experienced uropathologist. Immunohistochemical cytokeratin-7 (CK7) staining was used to distinguish oncocytoma (CK7 positive in <10% of the cells) and hybrid RCCs (CK7 positive in >10% of the cells).

Interventions

Radical tumor nephrectomy or nephron-sparing surgery.

Measurements

Recurrence-free and tumor-specific survival.

Results and limitations

Overall, 16 tumors (17.6%) were hybrid RCCs, 32 tumors were cRCCs, and 43 tumors were pure oncocytomas. Perinephric tissue invasion (pT3a) was found in one pure oncocytoma and in two hybrid RCCs. The pathologic stage for cRCC was pT1 in 50% of tumors (n = 17), pT2 in 23.5% of tumors (n = 8), and pT3a in 26.5% of tumors (n = 9). Low-grade RCC was found in 76.5% of tumors (n = 26), and vascular invasion was found in 11.8% of tumors (n = 4). After a mean follow-up of 50 mo, no oncocytomas or hybrid RCCs were found, but two cRCCs had recurred. The 3-yr tumor-specific survival rates for patients with oncocytoma, hybrid RCCs, and cRCC were 100%, 100%, and 97%, respectively.

Conclusions

Hybrid RCCs are more common than expected. The survival rate is 100% for both hybrid RCCs and oncocytomas. Hybrid RCCs may be candidates for active surveillance, and surgery may be unnecessary. CRCCs should be treated because a small proportion of these tumors exhibit aggressive clinical courses.     

计算机分析影响胃癌淋巴结转移的因素

目的:回顾性分析影响胃癌淋巴结转移的诸因素,为合理制定根治术式提供理论依据.方法:分析554例胃癌切除术患者的病史、手术记录和病理检测结果资料.应用BMDP软件包计算不同部位淋巴结转移者术后逐年生存率,采用单因素和Logistic回归多因素分析方法探讨胃癌临床病理特点与淋巴结转移的关系.结果:淋巴结转移者和无转移者5年生存率分别为31.04%和90.9%.单因素分析发现,大体类型、分化程度、浸润深度、原发部位及肿瘤大小均与淋巴结转移有关;多因素分析则发现肿瘤浸润深度及肿瘤大小为影响淋巴结转移的独立因素.结论:淋巴结转移是影响胃癌患者预后的重要因素,而胃癌的临床病理特点与淋巴结转移密切相关.     

P选择素在胃癌、肾癌中表达及其意义

目的:P选择素可介导血小板、内皮细胞与肿瘤细胞相互粘附和作用,本研究探讨了P选择素与肿瘤转移的关系。方法:用P选择素单抗和免疫组化技术,检测60例胃癌和20例肾癌组织P选择素表达,并对55例胃癌作5年以上随访。结果:60例胃癌组织中P选择素阳性表达为32例,阳性率为53.3％;20例肾癌的阳性表达11例,阳性率为55.0％。P选择素不仅在肿瘤血管内皮上表达,也可在肿瘤细胞膜上表达。胃癌淋巴结转移者P选择素阳性表达率为70.3％,显著高于无淋巴结转移的26.1％,P<0.01。P选择素在Ⅲ、Ⅳ期肿瘤的阳性表达率明显高于Ⅰ、Ⅱ期肿瘤(胃癌,分别为80.0％和26.7％,P<0.01;肾癌,分别为87.5％和33.3％,P<0.05)。此外55例胃癌中P选择素阳性表达者的平均生存期25.5±21.8月和5年生存率为10.7％,显著低于阴性表达者(P<0.01)。结论:P选择素与胃癌、肾癌的浸润转移有关,并可能是一种观察肿瘤预后的新指标。