Current evidence on transcervical mediastinal lymph nodes dissection

In the last decade, we witnessed the development of two new, fascinating techniques of mediastinal exploration: the video-assisted mediastinoscopic lymphadenectomy (VAMLA) and the transcervical extended mediastinal lymphadenectomy (TEMLA). During this time, several articles were published, providing a substantial body of evidence regarding different aspects of these techniques. Based on this evidence, we discuss the operative technique, its applications and results as well as questions to be answered and possible future development. The aim of this review is to provide the readers who have no personal experience with these techniques, with the key information regarding the usefulness, advantages and drawbacks of VAMLA and TEMLA.     

Benign mesothelial cells in mediastinal lymph nodes.

Inclusions of benign tissues in lymph nodes are most often aberrant glandular tissue, including endosalpingiosis, the thyroid, parotid, breast, and pancreas. Nonglandular inclusions are rare and include nevus cells and decidua. Mesothelial cells in lymph nodes are exceedingly rare; only eight cases have been reported in mediastinal lymph nodes and three cases in abdominal lymph nodes. The incidence of benign mesothelial cells in mediastinal lymph nodes in patients with a history of pericarditis or pleuritis is reported in this study. A retrospective search showed eight cases with removal of mediastinal lymph nodes in the absence of neoplasm. Hematoxylin and eosin-stained sections were examined in all cases. Immunohistochemical stains for CAM 5.2 were performed in all cases, and stains for AE1/AE3, Ber-EP4, carcinoembryonic antigen, Leu-M1, B72.3, and S-100 were performed in one case. CAM 5.2-positive cells with features of mesothelial cells were present in five of eight cases. In all cases, the cells were present in nodal sinuses and appeared as single cells or small clusters. The cells were missed on routine hematoxylin and eosin sections in all cases but one, in which they were numerous and mimicked metastatic carcinoma. Malignancy was not found in any of the cases preoperatively, at the time of surgery, or during the follow-up period. Benign mesothelial cells may embolize to regional lymph nodes in pleuritis or pericarditis. In most cases, these cells are few and undetectable on routine sections. Rarely, hyperplastic mesothelial cells may be present and must be distinguished from metastatic carcinoma, mesothelioma, and melanoma.     

Endoscopic evaluation of the tracheobronchial tree and mediastinal lymph nodes

Assessment of the airways and surrounding structures, including the mediastinum and pulmonary parenchyma, has been greatly facilitated by advancements in bronchoscopic techniques, both rigid and flexible. Recent years have seen an explosion in technologies that have revolutionized the ability to visualize, biopsy, or otherwise assess regions of potential pathology within the upper aerodigestive tract and adjacent structures. This article concisely and comprehensively reviews the endoscopic evaluation of the tracheobronchial tree and mediastinum with a focus on emerging technologies and their role in treatment of thoracic disease.     

PET staging of mediastinal lymph nodes in thoracic oncology

There is an extensive and growing body of literature about the role of positron emission tomography (PET) in the management of non-small cell lung cancer and esophageal cancer. This article focuses on the use of PET in mediastinal staging of these common thoracic malignancies. PET is the most accurate noninvasive approach to staging mediastinal lymph nodes in non-small cell lung cancer. The role of PET in mediastinal lymph node staging in esophageal cancer is less clear, since it has been largely supplanted by endoscopic ultrasonography. A review of the evidence for and against the use of PET in mediastinal staging is provided and the use of PET in practice is discussed.     

Surgical treatment for lung cancer with metastasis to mediastinal lymph nodes.

A series of cases of lung cancer were analyzed, with particular attention to the relationship between the presence of lymph node metastases and the prognosis for surgical intervention. The cases are classified into four clinical stages and a detailed classification of histologically proved lymph node metastasis and pleural involvement is presented. Results indicate that the presence of mediastinal lymph node metastasis, especially in cases with squamous-cell carcinoma and negative subcarinal lymph node, does not contraindicate surgical treatment.     

Invasive staging of mediastinal lymph nodes: mediastinoscopy and remediastinoscopy

Nodal status in lung cancer is essential for planning therapy and assessing prognosis. The involvement of ipsilateral and contralateral mediastinal lymph nodes is associated with poor prognosis and usually excludes patients from upfront surgical treatment. Mediastinoscopy is a time-honored procedure that allows the surgeon to access the upper mediastinal lymph nodes for either biopsy or removal. Remediastinoscopy is mainly indicated to assess objective tumor response in mediastinal lymph nodes after induction therapy for locally advanced lung cancer and to indicate further therapy.     

肺鳞癌、腺癌纵隔淋巴结转移的特点

目的 研究原发肺鳞癌及腺癌纵隔淋巴结转移特点,探讨临床意义.方法 对353例原发肺癌施行同侧纵隔淋巴结廓清术,病理检测淋巴结转移频度.结果 清除淋巴结2380组,平均每例6.74组.N2 淋巴结转移率16.2%.T1、T2、T3间淋巴结转移率差异有统计学意义(P<0.01).N2转移率在鳞癌、腺癌分别为30.1%、44.1%.64.2% 鳞癌N2转移为某一组淋巴结,腺癌3组以上转移者46.2%.上叶肺癌跨区域N2转移占15.1%,下叶(包括中叶)肺癌跨区域转移占53.1%.跳跃式转移占N2转移的53.7%.结论 肺鳞癌及腺癌纵隔淋巴结转移具有多发性、跳跃性及跨区域性特点.     

A case of an anaplastic meningioma metastasizing to the mediastinal lymph nodes

Context: Grade II and III (World Health Organization classification) meningiomas rarely develop in the spinal cord. However, we experienced a case with an anaplastic meningioma that developed in the spinal cord at the cervicothoracic junction and metastasized to the mediastinal lymph nodes. No such cases have previously been reported.

Findings: The patient was a 68-year-old man who developed back pain that did not affect his daily living. He developed left lower limb paralysis, and was admitted after magnetic resonance imaging (MRI) revealed an intramedullary tumor at the level of cervical vertebra 7 and thoracic vertebra 1. Positron emission tomography revealed tracer uptake in the intramedullary tumor and the mediastinal lymph nodes, suggesting a metastatic spinal cord tumor or malignant lymphoma. A lymph node biopsy was then performed. Although the tumor was highly malignant, its primary site was not identified. Detailed examinations by several other departments revealed no abnormalities. On hospital day 30, his left lower limb paralysis deteriorated, and MRI revealed that the tumor had grown. Thus, laminaplasty, laminectomy, and tumor resection were performed. The tumor was an anaplastic meningioma that resembled mediastinal lymph node tissue, and other tumor lesions were not found. These findings suggested that an anaplastic meningioma had metastasized to the mediastinal lymph nodes. The patient did not respond to radiotherapy, and he was transferred to another hospital.

Conclusion: In cases of intramedullary spinal tumors with metastasis without other potential primary tumor lesions, early diagnosis and treatment should be performed while considering anaplastic meningioma.