Les micrométastases : entité biologique et réalité clinique ?

Micrometastases or sub-micrometastases can be detected by standard histopathological method sometimes associated with immunohistochemistry in lymph nodes, bone marrow and blood. The consequence of these small size involvement may be prognostic and therapeutic. Two factors are necessary to assess this kind of involvement: the rate of involvement of non-sentinel lymph node after axillary lymph node dissection and significative difference of survivals. The rate of involvement of non-sentinel lymph node in case of micrometastases or sub-micrometastases is different from the rate of involvement in case of no lymph node metastases (7 to 8%) or in case of macrometases (30 to 50%). Micrometastase is an important factor to determine the rate of involvement of non-sentinel lymph node, the overall or disease free survival and to assess the need of radiotherapy and chemotherapy. In conclusion, micrometastases and sub-micrometastases have a clinical impact even if complementary axillary lymph node dissection is still discussed.     

Adjuvant treatments in breast cancer: interest of completion of axillary dissection in case of micrometastases or isolated tumor cells in sentinel lymph node

Prognostic signification of micrometastases ou isolated tumor cells (ITC) has not yet been clearly precised. Management of the axilla in case of micrometastases or ITC depends on the local pratices: no surgical completion or axillary lymph node dissection (ALND). Axillary lymph node status is the most important prognostic factor in patients with breast cancer; morbidity of ALND is now well known whereas its therapeutic benefit has not been demonstrated. This study is based on a retrospective database of 1375 patients who underwent sentinel node (SN) biopsy for breast cancer. In case of micrometastase or ITC in SN with completion axillary dissection, we examined if non-sentinel lymph node status has changed the indications of adjuvant treatments (chimiotherapy or radiotherapy). The results of our study show that non-sentinel lymph node status modify systemic therapy for a very few patients (less than 4% concerning chimiotherapy and less than 15% concerning radiotherapy).     

Cancer du sein et creux axillaire: état de l'art et perspectives

A therapeutic surgical de-escalation has been observed since many years with an actual prolongation for axillary lymph node area treatment. Axillary lymph node dissection (ALND) omission has been studied before and after validation of sentinel node (SN) biopsy procedure. A non-inferiority of ALND omission has been reported in case of non-involved SN. ALND omission has been studied in case of SN involvement without consensus in relation with scientific level of proof and with selective indications. The purpose of this work is to make a synthesis of the experiences on this subject then to envisage the current and future perspectives.     

Paradigm shift in axilla surgery for breast cancer patients treated with sentinel node biopsy

Background  

Sentinel node biopsy (SNB) is a standard technique for the diagnosis of regional lymph node metastases in clinically node-negative breast cancer patients. In the case of pathologically negative sentinel lymph nodes (SLN), axillary lymph node dissection (ALND) can be avoided.     

Sentinel node biopsy in vulvar malignancies: a preliminary feasibility study.

Sentinel lymph node biopsies (SLNB) were investigated in 8 cases (6 squamous cell carcinomas, 2 melanomas) of vulvar malignancy. The sentinel node was detected by patent blue dye injection (1 case), pre operative lymphoscintigraphy with intra-operative gamma hand-held probe (2 cases), and combined techniques (5 cases). The procedure was successful in all cases but one (1 invasive squamous cell carcinoma) in which there was medial groin recurrence at 6 months. Nodal invasion was observed in only one case and was confined to the sentinel node. No specific morbidity related to the SLNB procedure occurred. SLNB appears to be a feasible and promising technique, however, requiring further evaluation before being considered as a reliable method to spare inguinofemoral lymphadenectomy in early-stage patients free of sentinel node metastasis, or to be substituted in screening elderly clinically node-negative females.     

Le carcinome épidermoïde du pénis: évaluation clinique et thérapeutique des aires ganglionnaires

The presence of lymph node metastasis in the case of penile cancer is a major prognosis indicator. A survival rate of 80% can be reached in the case of a nodal invasion limited to 2 unilateral groin nodes (without extension out of the node), whereas a larger invasion requires a multimodal treatment. It is then important to realize the most precise assessment of the tumor’s spread, thanks to the use of dynamic lymphoscintigraphy for biopsy of inguinal sentinel node in patients cN0, or the positron emission tomography (18F-FDG PET-scan) in patients cN+.     

Endobronchial ultrasound for diagnosis of synchronous primary lung cancers

Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) has recently been shown to be accurate in diagnosis and staging of mediastinal lymph node metastases. We report a case of squamous cell carcinoma diagnosed by endobronchial biopsy with concomitant contralateral hilar lymph node metastasis from small cell carcinoma being confirmed by EBUS-TBNA. The diagnosis of synchronous primary lung cancers in this case, which altered the treatment strategy, would not be made if pathological staging of intrathoracic lymph node was not pursued. The unique role of EBUS-TBNA in diagnosis of hilar lymphadenopathy was underscored. The potential pitfall of missing synchronous lung tumour if the diagnosis is based either on sampling from intrathoracic lymph node or from endobronchial lesion alone is discussed.     

What is the impact of sentinel node biopsy in the management of cancer?

Sentinel node biopsy (SNB) is a surgical/histopathological diagnostictool that is increasingly used but still being evaluated insurgical oncology. The concept of sentinel node biopsy (SNB) was first establishedin melanoma of the skin [1]. It is based on the observationthat from a given area of the skin, lymphatic spreading of melanomacells proceeds following sequential steps, in an orderly fashion.The first lymph node encountered by floating melanoma cellsis called the sentinel node (SN) and SN is specifically (95%)the site of micrometastases if they exist. In case of unpalpableregional lymph node (N0), the histological status of     

Occipital lymph node metastasis from nasopharyngeal carcinoma：a special case report and literature review

Cervical lymph node metastasis is common in patients with nasopharyngeal carcinoma (NPC), but occipital lymph node metastasis in NPC patients has not yet been reported. In this case report, we describe an NPC patient with occipital lymph node metastasis. The clinical presentation, diagnostic procedure, treatment, and outcome of this case were presented, with a review of the related literature.     

非霍奇金淋巴瘤组织p73 mRNA基因表达与病因关系

目的 :探讨非霍奇淋巴瘤p73mRNA基因表达与病因的关系。方法 :采用逆转录聚合酶链反应技术 (RT PCR) ,检测 10例非恶性淋巴组织与 40例非霍奇金淋巴瘤组织 p73mR NA基因表达状况。结果 :10例非恶性淋巴组织均有mRNA表达 ( 10 0 % )。 40例非霍奇金淋巴瘤 p73mRNA表达 3 2 5 % ( 13 / 40 ) ,两组表达率差异有统计学意义 ,P <0 0 1。p73mRNA表达与临床分期无关 ,P >0 0 5 ,与病理类型有关 ,P <0 0 5。结论 :p73基因可能与非霍奇金淋巴瘤的发生有关     

Primary non-Hodgkin's lymphoma arising in an intramammary lymph node

Non-Hodgkin's lymphoma (NHL) of the breast may be primary or secondary. Both are rare and there are no morphological criteria to make the differential diagnosis. Benign intramammary lymph nodes are often encountered, but the development of either primary or secondary lymphoma within an intramammary lymph node is extremely rare. We report the case of a 72-year-old woman who presented with a palpable mass in her right breast. A mammography showed a large intramammary lymph node from which a biopsy was taken. On morphological and immunohistochemical examination the tumor fulfilled the criteria of NHL originating in an intramammary lymph node. The patient received chemotherapy which led to the disappearance of the mass. A review of the literature revealed that this is the third reported case of primary NHL originating in an intramammary lymph node.     

Complete Response of Isolated Para-aortic Lymph Node Recurrence from Rectosigmoid Cancer Treated by Chemoradiation Therapy with Capecitabine/Oxaliplatin plus Bevacizumab: A Case Report

Para-aortic lymph node recurrence is a rare type of metastasis from colorectal cancer, and no treatment has yet been established. Here, we report on a case of isolated para-aortic lymph node metastasis from rectosigmoid cancer that showed complete response to chemoradiation therapy with capecitabine/oxaliplatin plus bevacizumab. A 58-year-old woman underwent high anterior resection for rectosigmoid cancer in 2009. Para-aortic lymph node recurrence occurred in 2011. She underwent radiation therapy (50 Gy) and 8 courses of capecitabine/oxaliplatin plus bevacizumab. Abdominal computed tomography and positron emission tomography with 18-fluorodeoxyglucose did not reveal any para-aortic lymph node recurrence after chemoradiation therapy. Hence, this case was interpreted as a complete response. No recurrence was noted 6 months after the complete response. Chemoradiation therapy with capecitabine/oxaliplatin plus bevacizumab is likely to be effective in treating patients with para-aortic lymph node recurrence.Key Words: Chemoradiation therapy, Para-aortic lymph node recurrence, Colorectal cancer, Capecitabine/oxaliplatin plus bevacizumab     

Added value of the presence of blue nodes or hot nodes in sentinel lymph node biopsy of breast cancer

BACKGROUND: Combined use of blue dye and radiocolloid is considered to be useful for sentinel lymph node (SLN) biopsy of breast cancer. Whether both techniques together is superior to either alone was analyzed. PATIENTS AND METHODS: A consecutive series of 308 cases of breast cancer who underwent SLN biopsy using the combination technique was used. The frequency of a blue node or hot node was analyzed in all cases and only node-positive cases. Furthermore, the frequency of a blue node and hot node together, or either alone, and the highest radiocount of the SLNs in each case were examined for correlation with 8 clinicopathologic features. Three types of SLN containing both blue dye and radioactivity (blue-hot node), blue dye alone (blue-only node) and radioactivity alone (hot-only node), and the SLN radiocounts were analyzed for correlation with metastatic tumor. RESULTS: Of 308 cases, a blue node was present in 298 (97%), a hot node in 295 (96%), and either a blue or hot node in 306 (99%). The presence of a blue node or hot node was similarly affected by previous surgical biopsy and body mass index (BMI), and the presence of a hot node was also affected by age and tumor location. However, the presence of either a blue node or hot node was not affected by any of these characteristics. Of 77 node-positive cases, 8 (10%), 15 (19%) and 6 (8%) were considered to be node-negative based on blue node, hot node and either blue node or hot node positivity, respectively. The frequency of positivity for SLN metastasis decreased in order from blue-hot, blue-only to hot-only nodes. Of 62 cases with metastatic hot nodes, six (10%) were negative when the hottest node was examined, but the second-hottest node was positive. CONCLUSIONS: The added value of the presence of blue node or hot node was confirmed in the SLN biopsy using the combination technique, which suggests that all blue nodes and hot nodes need to be harvested.     

Salvage combination chemotherapy with docetaxel, ifosfamide and cisplatin (DIP): successful treatment of a case with metastatic testicular immature teratoma

We present a case of metastatic testicular immature teratomathat was successfully treated despite resistance to standardchemotherapy and unsuccessful salvage surgery. At first, BEP(bleomycin, etoposide and cisplatin) treatment was performedbut failed. The patient underwent incomplete retroperitoneallymph node dissection. He was then referred to us. By the timeof the referral lung and mediastinal lymph node metastasis hadappeared and para-aortic lymph node metastasis had grown larger.We administered the DIP (docetaxel, ifosfamide and cisplatin)regimen as a second line chemotherapy, which was effective with82% reduction of para-aortic lymph nodes, 88% of mediastinallymph nodes and 85% of lung metastasis. We performed para-aorticlymph node dissection followed by resection of lung metastasisand mediastinal lymph node dissection. The patient is now followed-upat the outpatient clinic without evidence of recurrent disease3.5 years after the last surgery.     

巨淋巴结增生症及其合并副肿瘤天疱疮的临床、病理和CT征象分析

 目的　研究巨淋巴结增生症及其合并副肿瘤天疱疮（PNP）的临床、病理、CT表现及其特点。方法　总结分析经手术病理证实的19例巨淋巴结增生症患者的临床、病理、影像及术后随访资料。结果　不伴有PNP及肺部异常的14例巨淋巴结增生症患者,大部分无症状,极少数仅有下腹部不适或隐痛。伴发PNP及肺部异常的患者,其临床表现、CT及病理学特点等都较特殊。病理分型：透明血管型18例,混合型1例。CT扫描：18例表现为直径2.5～15 cm的单发结节或巨大软组织肿块,1例表现为左颈部多发肿大的淋巴结,直径1.5～5 cm;17例边缘光滑,10例密度均匀;7例钙化,均表现为中央区多发散在斑点状分支状钙化,其中5例伴周围散在多发斑点、条状钙化,1例同时伴有周边壳状及环状钙化;形态呈圆柱状或椭球形及球形;增强扫描动脉期及延迟期持续显著强化且与动脉几乎同步强化。结论　CT扫描是诊断巨淋巴结增生症的有效方法,特别是CT动态增强和延迟扫描,在明确诊断、指导手术及评价预后方面具有重要价值。对于伴发PNP及肺部异常的病例,早期诊断和手术切除体内巨淋巴结增生症瘤样病变为治疗和痊愈的关键。     

乳腺癌前哨淋巴结定位和活检

目的：难证乳腺癌前哨淋巴结定位和活检技术的可行性和前哨淋巴结的组织状况能否准确预告腋淋巴结的状况。方法：本研究使用专利蓝,对３３例乳腺癌患者进行了术中及术后前哨淋巴结定位和活检术。结果：３０例（９１％）找到前哨淋巴结,前哨淋巴结预告腋淋巴结的准确率为９６．７％,假阴性１例。结论：本研究结果证实,乳腺癌前哨淋巴结定位和活检技术是可行的,前哨淋巴结的组织学特征能够准确反映腑淋巴结的状况。我们相信在将来     

A long-term survival case of postoperative lymph node metastases from hepatocellular carcinoma treated with lymph node dissection and percutaneous isolated hepatic perfusion (PIHP)

We report a long-term survival case of hepatocellular carcinoma (HCC) with recurrence in the liver and multiple lymph nodes treated with lymph node dissection and percutaneous isolated hepatic perfusion (PIHP). The patient was a 70-year-old man with HCC. In 1999, transcatheter arterial chemoembolozation (TACE) was performed for HCCs. In 2000, partial hepatectomy was achieved for a recurrence in the liver. In 2002, CT scan disclosed multiple lymph node metastases around the hepatic artery and the recurrence in the liver. We performed a lymph node dissection and radio-frequency ablation for the hepatic tumor. After the operation, PIHP was performed for residual lymph node metastases. Then, a recurrence in the liver occurred 3 times, but was treated successfully with local therapy. The patient survives for 10 years after the initial therapy, and 8 years after a lymph node dissection.     

A case of breast cancer diagnosed by inguinal lymph node metastasis

We describe a case of a 58-year-old woman with right inguinal lymph node swelling and a T1 tumor in the right breast. She was referred with an 18-month history of the former complaint and a six-month history of the latter. Excisional biopsy of the inguinal lymph node revealed breast cancer metastasis. Radiographical examination showed no metastases to the lungs, liver or bone. Modified radical mastectomy was performed. Histological examination revealed solid tubular carcinoma, PT2, PM (axillary lymph node metastases 4/16), stage IV. Estrogen and progesterone receptors were negative. Three cycles of postoperative cyclophosphamide, adriamycin and 5-fluorouracil (CAF) chemotherapy were given, and the right inguinal area was irradiated with 40 Gy. The patient complained of swelling in both legs three years after surgery. Computed tomography revealed marked lymph node swellings in the pelvic cavity. She died six months later. Inguinal lymph node metastasis from breast cancer is very rare, although distant lymph node metastasis in the cervix occurs frequently. This case should help clarify how breast cancer metastasizes to distant lymph nodes.     

Pure tubular carcinoma of the breast and sentinel lymph node biopsy: A retrospective multi-institutional study of 234 cases

Background

Pure Tubular Carcinoma (PTC) of the breast is a rare histological subtype of invasive breast cancer characterized by a low rate of lymph node involvement. Currently there is no consensus on less surgical axillary node staging according to this histological subtype.

Methods

We performed a retrospective multi-institutional study. Inclusion criteria were PTC, sentinel lymph node detection (SLND) and conservative breast surgery.

Results

From January 1999 to December 2006, 234 patients were included in the study from 9 institutions. The median pathological tumor size was 9.59 (1–22) mm. SLN were successfully detected in 98% (229/234) of patients. Among the 234 patients, a macrometastasis was found in 6 cases (2.5%), micrometastasis in 15 cases (6.4%), and isolated cells in 2 cases (0.8%). In the case of patients with SLND macrometastasis, half of them had macrometastasis in the complementary axillary lymphadenectomy, and none in the case of SLN only micrometastasis or isolated cells. Of the 122 patients with a pathological tumor size <10 mm, none had sentinel node macrometastasis. According to a multivariate analysis, pathological tumor size (>10 mm) was the only parameter significatively linked to the risk of lymph node involvement (p = 0.007).

Conclusion

In a large multi-institutional series with SLND, we have shown that the risk of axillary lymph node involvement in PTC is very low. In the case of PTC <10 mm, we suggest that surgical axillary evaluation, even with SLND, may not be warranted.     

Accuracy of fine-needle aspiration cytology of axillary lymph nodes in breast cancer patients: a study of 115 cases with cytologic-histologic correlation

BACKGROUND: Fine-needle aspiration (FNA) cytology of axillary lymph nodes is a simple, minimally invasive technique that can be used to improve preoperative determination of the status of the axillary lymph nodes in patients with breast cancer, thereby serving as a tool with which to triage patients for sentinel versus full lymph node dissection procedures. The aim of the current study was to determine the sensitivity and specificity of FNA cytology to detect metastatic breast carcinoma in axillary lymph nodes. METHODS: A total of 115 FNAs of axillary lymph nodes of breast cancer patients with histologic follow-up (subsequent sentinel or full lymph node dissection) were included in the current study. The specificity and sensitivity, as well as the positive and negative predictive values, were calculated. RESULTS: The positive and negative predictive values of FNA cytology of axillary lymph nodes for metastatic breast carcinoma were 1.00 and 0.60, respectively. The overall sensitivity of axillary lymph node FNA in all the cases studied was 65% and the specificity was 100%. The sensitivity of FNA was lower in the sentinel lymph node group than in the full lymph node dissection group (16% vs 88%, respectively), which was believed to be attributable to the small size of the metastatic foci in the sentinel lymph node group (median, 0.25 cm). All false-negative FNAs, with the exception of 1 case, were believed to be the result of sampling error. There was no 'true' false-positive FNA case in the current study. CONCLUSIONS: FNA of axillary lymph nodes is a sensitive and very specific method with which to detect metastasis in breast cancer patients. Because of its excellent positive predictive value, full axillary lymph node dissection can be planned safely instead of a sentinel lymph node dissection when a preoperative positive FNA result is rendered. .