Acinic cell carcinoma of the lung with metastasis to lymph nodes

A 64-year-old man presented with an asymptomatic left lower lobe mass. At bronchoscopy there was a tumor in the superior segment. Biopsy revealed an acinic cell carcinoma. There was no evidence of salivary gland or other site of origin. Lobectomy and lymph node staging showed involvement of interlobar (N1) nodes, while higher stations were benign. The patient remains well 20 months postoperatively. This is the only instance of primary pulmonary acinic cell carcinoma with lymph node metastasis among 15 cases in the literature. We review the clinical features, histology, and treatment of the reported cases.     

Establishment and characteristics of human hepatocellular carcinoma cells with metastasis to lymph nodes

BACKGROUND/AIMS: Although the mechanism of cancer metastasis has been gradually elucidated, less is known concerning the characteristics of human hepatocellular carcinomas (HCCs) with metastatic potential. We examined the expression of molecules that mediate cell-cell or cell-substrate interaction, nm23-H1 expression, and ultrastructural features of several human HCC cell lines. METHODOLOGY: Expression of E-cadherin, integrin (alpha3beta1), intracellular adhesion molecule-1 (ICAM-1), and nm23-H1 protein was analyzed by immunocytochemistry or Western blotting, and ultrastructural features were further studied by electron microscopy in 4 human HCC cell lines, PLC/PRF/5, HuH-7, OCUH-16, and Nuk-1 which were originally established from metastatic cells in lymph nodes at our institute. RESULTS: Neither E-cadherin, integrin, nor ICAM-1 was immunocytochemically detected in any of the 4 cell lines. Expression of nm23-H1 protein was weakly detected in OCUH-16, Nuk-1, and Huh-7 cells by Western blotting, but was clearly detected in PLC/PRF/5 cells by Western blotting. Ultrastructurally, metastatic Nuk-1 cells exhibited the intracytoplasmic canaliculus-like structures found in fibrolamellar carcinoma and the intracytoplasmic glandular lumina found in bile-duct carcinoma, while the other 3 cell lines did not. In addition, Nuk-1 cells expressed neither cytokeratin 8 nor cytokeratin 19. CONCLUSIONS: Nuk-1 cells, which are human HCC cells with metastasis to lymph nodes, alone exhibited intracytoplasmic canaliculus-like structures and glandular lumina, as well as a marked reduction of nm23-H1 protein, but did not express E-cadherin, integrin, or ICAM-1. Formation of both intracytoplasmic canaliculus-like structures and intracytoplasmic glandular lumina is one of the characteristics that may be involved in metastasis of HCC cells to lymph nodes, as is reduction of nm23-H1 protein.     

Impact of the number of examined lymph nodes on outcomes in patients with lymph node-negative gallbladder carcinoma

AIM To determine whether the number of examined lymph nodes(LNs) is correlated with the overall survival of gallbladder carcinoma(GBC) patients. METHODS Patients were collected from the Surveillance Epidemiology and End Results database(2004-2013) and categorized by the number of LNs into six groups: 1 LN, 2 LNs, 3 LNs, 4 LNs, 5 LNs, and ≥ 6 LNs. Survival curves for overall survival were plotted with a KaplanMeier analysis. The log-rank test was used for univariate comparisons.RESULTS In a cohort of 893 patients, the median number of examined LNs was two for the entire cohort. The survival for the 1 LN group was significantly poorer than those of the stage Ⅰ and Ⅱ disease groups and for the entire cohort. By dichotomizing the number of LNs from 1 to 6, we found that the minimum number of LNs that should be examined was four for stage Ⅰ, four or five for stage Ⅱ, and six for stage ⅢA disease. Therefore, for the entire cohort, the number of examined LNs should be at least six, which is exactly consistent with the American Joint Committee on Cancer criteria.CONCLUSION The examination of higher numbers of LNs is associated with improved survival after resection surgery for N0 GBC. The guidelines for GBC surgery, which recommend that six LNs be examined at least, are statistically valid and should be applied in clinical practice widely.     

Isolated metastasis to the gallbladder from hepatocellular carcinoma

Aim: Metastasis to gallbladder (GB) from hepatocellular carcinoma (HCC) is rare, and it is difficult to determine indications for surgery. We report eight cases of synchronous isolated GB metastasis, and analyze their features retrospectively. Methods: Among 439 HCC patients who underwent hepatectomy from 1998 to 2008 at our institution, 393 (89.5%) underwent concurrent cholecystectomy. Results: Among them, eight (1.8%) had GB metastasis without other distant metastases. None of these cases showed evidence of direct invasion. All cases had advanced portal vein thrombus (PVTT) and their main tumor located near the GB bed. Five cases had apparent tumor mass in the GB wall, and the other three cases had only tumor thrombus in the GB veins. Six cases were treated postoperatively with local infusion therapy with interferon, and three of them showed long‐term survival. Conclusion: Our eight cases of GB metastasis from HCC were closely related to PVTT. Surgical resection and multimodal treatment would be necessary for long‐term survival in cases with isolated GB metastasis.     

食管癌淋巴结转移的危险因素分析

目的探讨食管癌淋巴结转移的危险因素。 方法回顾性分析2015年7月至2017年9月,新疆自治区人民医院胸外科行手术治疗食管癌的224例患者的病例资料,比较淋巴结转移组(转移组)与非淋巴结转移组(非转移组)的关系,并进行多因素Logistic回归进行分析,探讨淋巴结转移的危险因素。 结果患者症状期较长、肿瘤长度、分化程度、肿瘤分期T与淋巴结转移有显著相关性(P<0.05)。 结论肿瘤低分化、肿瘤长度>5 cm、肿瘤侵润深度T₃～T₄、患者症状期>6个月是淋巴结转移的危险因素,应尽可能选择经右胸入路胸腹腔镜辅助下食管癌根治术,并清扫双侧喉返神经淋巴结。     

胆囊混合性腺神经内分泌肿瘤合并肝转移1例报告

1病例资料患者女性,49岁,因“上腹部伴腰背持续性隐痛2个月”于2018年10月25日入本院。既往高血压病史3年,未治疗。肝胆胰CT平扫+三期增强(图1)提示:平扫下可见肝实质密度减低,低于脾脏,胆囊不大,壁不均匀增厚,反折处显著;增强扫描可见不均匀延迟强化,胆囊管低位汇入胆总管,胆总管未见扩张,胆囊周围、肝门区见多发结节样软组织密度影,其余未见明显异常。检查结论:脂肪肝,胆囊占位性病变考虑胆囊癌伴周围多发淋巴结肿大。     

Gastrointestinal stromal tumor of stomach with inguinal lymph nodes metastasis: A case report

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor in the alimentary tract. To the best of our knowledge, few cases have been reported in the literature about the peripheral lymph node metastasis of GIST. Here we report an unusual case of gastric GIST with inguinal lymph nodes metastasis. After the metastatic lymph nodes were resected, the. patient started to take imatinib 400 mg/d for 12 mo. There were no signs of tumor recurrence at follow-up after 29 mo. This case suggests that th...     

Metastasis of primary gallbladder carcinoma in lymph node and liver

AIM: To evaluate the patterns with metastasis of gallbladder carcinoma in lymph nodes and liver. METHODS: A total of 45 patients who had radical surgery were selected. The patterns with metastasis of primary gallbladder carcinoma in lymph nodes and liver were examined histopathologically and classified as TNM staging of the American Joint Committee on Cancer. RESULTS: Of the 45 patients, 29 (64.4%) had a lymph node positive disease and 20 (44.4%) had a direct invasion of the liver. The frequency of involvement of lymph nodes was strongly influenced by the depth of the primary tumor (P= 0.0001). The postoperative survival rate of patients with negative lymph node metastasis was significantly higher than that of patients with positive lymph node metastasis (P= 0.004), but the postoperative survival rate of patients with Nl lymph node metastasis was not significantly different from that of patients with N2 lymph node metastasis (P= 0.3874). The postoperative survival rate of patients without hepatic invasion was significantly better than that of patients with hepatic invasion (P= 0.0177). CONCLUSION: Complete resection of the regional lymph nodes is important in advanced primary gallbladder carcinoma (PGC). The initial sites of liver spread are located mostly in segments IV and V. It is necessary to achieve negative surgical margins 2 cm from the tumor. In patients with hepatic hilum invasion, extended right hepatectomy with or without bile duct resection or portal vein resection is necessary for curative resection.     

Renal cell carcinoma with unusual metastasis to the gallbladder

Gallbladder involvement in patients with renal cell carcinoma (RCC) is extremely rare. We present a report of a 61-year-old man with a synchronous RCC metastasis to the gallbladder presenting as an intraluminal polypoid mass simulating primary gallbladder carcinoma. Enhanced abdominal computed tomography demonstrated a well-enhanced polypoid lesion in the gallbladder. Intraoperative rapid pathological examination of the gallbladder tumor showed clear cell-type cancerous cells. Microscopically, tumor cells of both the resected kidney and gallbladder had round uniform nuclei, clear cytoplasm, and well-defined cytoplasmic borders, forming alveolar patterns. Immunohistochemically, the tumor cells were negative for cytokeratin 7 (CK7) and carcinoembryonic antigen (CEA), which is usually positive in primary clear cell carcinoma of the gallbladder. Therefore, the final diagnosis was RCC with a synchronous gallbladder metastasis.     

彩色多普勒超声评价鼻咽癌颈部转移淋巴结放射治疗的疗效

目的应用彩色多普勒超声分析放疗前后鼻咽癌颈部转移淋巴结长短径比、内部及周边的血流情况,以此作为制定放疗计划和分析疗效的依据。方法选取53例鼻咽癌颈部淋巴结转移患者于放疗前后分别进行超声检查,测量110个肿大淋巴结的长短径比(L/S)、收缩期峰值血流(PSV)以及阻力指数(RI),并结合血流分型与分级的特点,分析淋巴结消退程度和血流信号情况。结果放疗疗程结束后,淋巴结完全消退的占75.45%(83/110),血流强度为1级的占22.73%(25/110),2级的占1.82%(2/110),3级血流未见。残余淋巴结给予推量放疗10 Gy后,淋巴结内未见血流显示。结论彩色多普勒超声可用于观察鼻咽癌颈部转移淋巴结放疗前后的血供变化,对判断放疗疗效有较高的价值。     

蜂毒致亚急性肝衰竭1例

1.病例资料:患者,女,51岁,退休工人,因“乏力,纳差,尿黄、眼黄、身黄20 d”入院。入院前20d,由于全身疼痛较剧,用蜜蜂(30-40只)蜇刺右上腹皮肤,治疗后疼痛缓解。当日即出现畏寒、发热,3 d后发热停止。随后感乏力,纳差,厌油,伴尿黄、眼黄、身黄,无恶心呕吐,无腹胀、腹痛、腹泻等,无身痒,陶土样大便,无腰痛,酱油色小便。病前和     

Characteristics of variants of colorectal carcinoma that do not metastasize to lymph nodes

Summary The clinical and pathologic characteristics of colorectal carcinomas that did not metastasize to mesenteric lymph nodes have been compared with the same characteristics of carcinomas that did metastasize to lymph nodes by computer-programmed analysis of significant differences in 420 cancers in the first group and 344 cancers in the second group. Characteristics associated with an increased probability of metastasis to lymph nodes included the past or present association of skin cancers, the existence of metastases outside the field of resection, and the characteristics of the cancer margins (greater stromal and vascular infiltration by cancer and less inflammatory cell infiltration). Factors associated with a decreased likelihood of metastasis to lymph nodes included favorable characteristics of the cancer margins (“pushing” or circumscribed margin and denser infiltration of inflammatory cells), deep local extension through the bowel wall into mesenteric fat and adjacent organs, and absence of distant metastases. The nonmetastasizing variants were found among tumors of all sizes and histologic grades. Further studies of the individual characteristics of both cancers and hosts are necessary for development of an infallible method of identifying tumors that have not metastasized. Such a method could permit the use of localized ablation more frequently. Read at the meeting of the American Proctologic Society, Boston, Massachusetts, June 16 to 18, 1969. Supported in part by USPHS Grants CA-09741 and CA-08023.     

A resected case of metachronous liver metastasis from mixed adenoneuroendocrine carcinoma of the stomach

A 71-year-old woman was found in gastroendoscopic examination to have a type 2 tumor at the posterior wall of the stomach with two type 0-IIa early adenocarcinomas at the lesser curvature and anterior wall. She underwent distal gastrectomy. Pathological evaluation of the type 2 tumor was mixed adenoneuroendocrine carcinoma and that of two type 0-IIa tumors were well differentiated tubular adenocarcinomas. The solitary metastasis was found in liver S8 on 15th month though S-1 was taken after the operation. Partial resection of the liver was performed, and its histological findings were similar to the mixed adenoneuroendocrine carcinoma of the stomach. After adjuvant chemotherapy with S-1+CPT-11 during half a year, S-1 single therapy was done for 16 months, and there is no evidence of recurrence for 28 months after liver resection.