Retroperitoneal lymph node dissection in patients with low stage testicular cancer with embryonal carcinoma predominance and/or lymphovascular invasion

PURPOSE: The outcome after primary retroperitoneal lymph node dissection (RPLND) was analyzed in patients with clinical stage I-IIA nonseminomatous germ cell testicular cancer with embryonal carcinoma predominance (ECP) or lymphovascular invasion (LVI). MATERIALS AND METHODS: Between 1989 and 2002, 267 patients with clinical stage I-IIA nonseminomatous germ cell testicular cancer, and ECP and/or LVI underwent RPLND. Patient information was obtained from a prospective database. Median followup was 53 months. RESULTS: Overall 42% of patients had pathological stage (PS) II disease, of whom 54% had low volume (PN1) disease and 16% had retroperitoneal teratoma. The 5-year progression-free probability was 90% overall, 90% for PS I and 86% for PN1. All patients with relapse were continuously free of disease following standard chemotherapy with or without resection of residual masses and the 10-year actuarial overall survival was 100%. When adjuvant chemotherapy was restricted to patients with PN2 disease, the estimated 5-year relapse rate was 9% and an estimated 72% of patients avoided chemotherapy. CONCLUSIONS: The low risk of systemic relapse in patients with PS I and PN1 after RPLND alone combined with the 16% incidence of retroperitoneal teratoma and the favorable morbidity profile supports RPLND over primary chemotherapy for the treatment of patients with low stage disease with ECP and/or LVI who are not candidates for surveillance. An estimated 72% of patients are spared the potential toxicity of chemotherapy if adjuvant therapy is restricted to patients with PN2. After primary RPLND and selective adjuvant chemotherapy late recurrence is distinctly uncommon and long-term cancer control is anticipated in essentially all patients.     

Results of resection in non-oat cell carcinoma of the lung with mediastinal lymph node metastases.

From 1974 to 1981, 1598 patients with non-oat cell carcinoma of the lung were seen and treated. All were staged according to the AJC staging system. Of these, 706 patients had evidence of mediastinal lymph node metastases (N2). There were 151 patients (21%) who had complete, potentially curative resection of their primary tumor and all accessible mediastinal lymph nodes. The histologic type of tumor was adenocarcinoma in 94 patients, epidermoid carcinoma in 46 patients, and large-cell carcinoma in 11 patients. The extent of pulmonary resection consisted of a lobectomy in 119 patients, pneumonectomy in 26 patients, and wedge resection or segmentectomy in six patients. Almost all patients also received radiation therapy to the mediastinum. Clinical staging of the primary tumor and the mediastinum was based on the radiographic presentation of the chest and on bronchoscopy. Before treatment, 104 of 151 patients (69%) were believed to have had stage I (90 patients) or II (14 patients) disease, and 47 patients had stage III disease, of whom only 33 had evidence of mediastinal lymph node involvement. Excluding deaths from unrelated causes, the overall survival rate was 74% at 1 year, 43% at 3 years and 29% at 5 years. Survival in patients with clinical stage I or II disease treated by resection was favorable despite the presence of N2 nodes (50% at 3 years). Survival in obvious clinical N2 disease was poor (8% at 3 years). There was no difference in survival between patients with adenocarcinoma and those with epidermoid carcinoma. However, survival was poorer in patients with N2 nodes in the inferior mediastinum compared to those without lymph node involvement at that level.     

Regional lymph nodes in infants with embryonal carcinoma of testis

Clinical and pathologic material from 16 infants with embryonal carcinoma of the testis was reviewed specifically as to the route of metastatic spread and the findings obtained from retroperitoneal lymphadenectomy. Hematogenous metastases were noted in 3 patients (19 per cent) and lymphatic metastases were observed in 2 patients (13 per cent). In 12 patients in whom disease was clinically limited to the testis retroperitoneal lymphadenectomy was negative, although a review of the literature suggests that unsuspected metastases might be expected in 6 per cent of such patients. The 2 patients who had lymph node metastases had large, clinically evident but unresectable retroperitoneal lymph node masses. The low yield of retroperitoneal metastases in early disease makes lymphadenectomy suspect as a primary staging or treatment procedure, but the occasional patient presenting with retroperitoneal disease requires that the procedure not be abandoned at this time.     

Results of resection for bronchogenic carcinoma with mediastinal lymph node metastases in selected patients.

Between 1982 and 1988, 254 consecutive patients underwent resection for bronchogenic carcinoma with mediastinal lymph node metastases at Marie Lannelongue Hospital. Selection of cases for surgery was carried out using CT and mediastinoscopy. The surgical procedure performed were pneumonectomy (169), lobectomy (65), or bilobectomy (20) associated with resection of ipsilateral mediastinal lymph nodes. Almost all diseased nodes appeared grossly enlarged at surgery and only a few were of normal size. Postoperative mortality was 5.6%. Resection was potentially curative in 191 cases (75%) and palliative in 63 cases (25%). Almost all patients received adjuvant treatment (mainly radiotherapy). Actuarial 5-year survival was 18% for the entire group, and 23% for those who underwent curative resection. No patient with palliative resection survived 5 years. The following factors proved to be significantly associated with a better prognosis: complete resection, independent lymph node metastases, involvement of only one level, lower paratracheal involvement. On the other hand, there was no difference between pathological types (squamous cell carcinomas, adenocarcinomas, oat cell carcinomas) with regard to prognosis. We advocate an aggressive approach in selected cases of N2 bronchogenic carcinoma. Neoadjuvant chemotherapy should be tested in these specific patients with a view to the possibility of improving results.     

M-VAC chemotherapy for patients with lymph node metastases and/or locally advanced bladder carcinoma

Sixteen patients with lymph nodes metastases and/or locally advanced bladder carcinoma were treated with a combination chemotherapy regimen consisting of methotrexate, vinblastine, adriamycin, and cisplatin (M-VAC) from November 1986 through September 1988. There were 14 men and 2 women. The median age was 61.9 years, with a range from 43 to 81 years. Complete response (CR) was observed in 6 of 16 patients (38%), partial response (PR) was confirmed in 5 of 16 patients (31%), and overall response rate was 69%. Median duration of response was 10.3 and 5.2 months in CR and PR patients, respectively. The myelosuppression with this regimen was tolerable. This study demonstrates that the M-VAC regimen is effective in the invasive bladder carcinoma with or without lymph nodes metastases. However, the duration of response is relatively short, and the true long-term benefits of this regimen remain to be determined.     

Cervical lymph node metastases and squamous cell carcinoma of the lip.

BACKGROUND: Squamous cell carcinoma of the lip generally has a favorable outcome. The chance of long-term survival is significantly reduced if lymph node metastases develop. Any features that could identify patients having increased risks of occult lymph node metastases would allow more aggressive treatment and, possibly, a better outcome. METHODS: A chart review of lip cancer from this institution identified 1001 patients with squamous cell carcinoma of the lip. This database was used to identify the characteristics that are associated with occult lymph node metastases. RESULTS: Delayed cervical lymph node metastases developed in 40 patients. No significant differences were noted in the frequency of delayed lymph node metastases according to gender, lip subsite, or age less than 40 years. Significant differences were noted in association with the tumor size, tumor differentiation, and local recurrence. CONCLUSIONS: Elective cervical lymphadenectomy is justifiable for higher grade tumors and for locally recurrent tumors. An increase in delayed metastases was observed in patients with tumors greater than 3 cm, but the proportion is not great enough to justify elective neck dissections.     

Detection of lymph node invasion in prostatic carcinoma with iliopelvic lymphoscintigraphy.

Eleven patients, ranging in age from 58 to 79 years and referred for 125I implantation because of localised prostatic carcinoma, were subjected to iliopelvic lymphoscintigraphy (IPL) prior to lymph node dissection. Scintigraphy was performed by perianal injection into the ischiorectal fossa of 0.2 ml 99mTc radio-labelled antimony sulphide colloid. The sensitivity of IPL was 100% and the specificity 13%, with a prevalence of positive nodes of 27%. It was concluded that IPL is not useful as a non-surgical method of detecting lymph node invasion in localised prostatic carcinoma because of the low specificity.     

Giant cell tumor of bone with pulmonary and lymph node metastases. A case report

A giant cell tumor of bone appeared in a lymph node of a 21-year-old man at the time of local recurrence in its original location in the distal femur, prior to metastasizing the lung. Following a wide resection, the lesion did not recur, but asymptomatic pulmonary metastases were discovered. DNA analysis by flow cytometry demonstrated identical patterns in the primary and initial recurring lesions, as well as in the pulmonary metastases, which suggests that this technique may be a valuable diagnostic tool for assessing the potential aggressiveness of giant cell tumor of bone. Giant cell tumor of bone is rarely associated with metastases of any kind. Rare instances of pulmonary spread have been reported in the literature. Lymph node involvement is even more unusual. Only two such cases have been previously reported.     

Retroperitoneal lymph node dissection in patients with interaortocaval lymph node metastases of transitional cell carcinoma of the urinary tract

Three patients suffered from renal pelvic, ureteral and bladder cancers that were treated with both standard surgical treatments and two adjuvant cycles of cisplatin-based combination chemotherapy. Metastases of interaortocaval lymph nodes were detected in all patients between 9 and 33 months from the surgery for primary lesions. All patients received three cycles of cisplatin-based combination chemotherapy and retroperitoneal lymph node dissection (RPLND). The chemotherapy achieved partial response (62-98%). Two patients with viable cancer cells died with hepatic metastases; the first 15 months and the second 25 months from the date of diagnosis of distant lymph node metastasis. The third patient, who had no viable cancer cells, remains alive and disease-free 36 months later. Therefore, RPLND after chemotherapy provides prognostic information that helps to define patients who might benefit from additional systemic chemotherapy.     

甲状腺乳头状癌Ⅵ区淋巴结的归属

目的 评价临床颈侧区淋巴结阴性(cN0)的甲状腺乳头状癌(PTC)患者行选择性颈侧淋巴结清扫的价值。方法 通过分析139例PTC患者(初治时为cN0)的复发和(或)转移部位(甲状腺,Ⅵ区,颈侧区,远处),把Ⅵ区淋巴结转移归入原发灶复发,明确与颈侧区淋巴结转移的区分,逆向分析评价cN0 PTC患者选择性颈侧清扫的临床价值。结果 PTC患者甲状腺复发83％(73／88),Ⅵ区转移76％(67／88),17例为已作选择性颈侧淋巴结清扫,占65％(17／26)。颈侧区淋巴结转移为17％(17／98),其中5例发生于已作选择性颈侧淋巴结清扫,占19％(5／26)。结论 支持对cN0 PTC患者行患侧腺叶切除加Ⅵ区清扫,不支持颈侧区(Ⅱ-V)的选择性颈侧淋巴结清扫。而对初治时为cN0,但术前超声和CT为N 的患者,则支持行颈侧区淋巴结的选择性清扫。在甲状腺癌诊治中,CT检查是必要的。     

322例食管、贲门癌淋巴结转移资料分析

目的探讨不同期别、不同部位食管、贲门癌淋巴结转移规律。方法回顾2002年1月至2006年12月间单纯手术治疗、资料完整的322例食管、贲门癌病人资料。根据UICC(1997)食管癌分期标准,对术中所见、术后病理切取检验的淋巴结数目统计,计算出不同期别、不同部位食管、贲门癌淋巴结转移率、转移度。结果T1、T2N1M0(IIB期)食管、贲门癌淋巴结转移率为30%。其中食管癌淋巴结转移率为31.82%,贲门癌为16.67%;T3N1M0、T4任何NM0(III期)食管、贲门癌淋巴结转移率为87.5%。其中食管癌淋巴结转移率为92.3%,贲门癌为81.82%。同一肿瘤浸润深度、不同长度的淋巴结转移率无差别。病变在3cm以内,各浸润度的淋巴结转移率差别不大。但大于3cm以上淋巴结转移率明显升高(P<0.05)。高分化食管癌淋巴结转移率为33.33%,低分化食管癌淋巴结转移率为71.43%(P<0.01);高分化贲门癌淋巴结转移率为20%,低分化贲门癌淋巴结转移率为85.37%(P<0.001)。结论食管癌和贲门癌淋巴结转移有各自的规律,贲门癌应当作为一个独立的疾病进行研究。肿瘤的长度不是影响淋巴结转移的重要因素,肿瘤的分化程度和浸润深度与淋巴结转移密切相关。     

Thymosin beta 10 correlates with lymph node metastases of papillary thyroid carcinoma

Background

Thymosin beta 10 (TMSB10) has recently been recognized as being an important player in the metastatic cascade including tumor angiogenesis, invasion, and metastasis. However, a role for this protein in papillary thyroid carcinoma (PTC) has not yet been established.

Methods

Real-time polymerase chain reaction was used to examine the expression of TMSB10 messenger RNA in 36 cases of thyroid tissue samples: normal thyroid, PTC without lymph node metastases (LNM) and PTC with LNM (n = 12 cases in each subgroup). For immunohistochemistry, 130 patients with PTC were selected during the period of 2004–2005, 91 with and 39 without LNM. Statistical analysis was applied to evaluate the correlation between TMSB10 expression and LNM of PTC.

Results

By real-time polymerase chain reaction analysis, the expression of TMSB10 messenger RNA in normal thyroid tissue, PTC without LNM, and PTC with LNM tissue were significantly different (P < 0.0001). On immunohistochemistry analysis of 130 patients with PTC, in which 91 cases had cervical LNM and 69 cases had central neck LNM, high expression levels for TMSB10 were more common in patients with cervical LNM compared with patients without (81% versus 33%, P < 0.001). Similarly, high expression levels of TMSB10 were more common in patients with central neck LNM compared with those without (87.0% versus 44.3%, P < 0.001).

Conclusions

High expression levels of TMSB10 correlated with LNM in PTC, especially in the central neck region. Patients with PTC with low levels of TMSB10 expression may be unlikely to have central neck LNM and could therefore avoid prophylactic central neck dissection.     

Prognostic impact of lymph node involvement in pulmonary metastases from colorectal cancer.

OBJECTIVE: The purpose of this study was to identify the prognostic impact of unexpected lymph node metastases in patients undergoing resection of pulmonary metastases from colorectal cancer and specify the influence of pulmonary and mediastinal nodal involvement according to the modified Narukes lymph node mapping [Mountain CF, Dresler CM. Regional lymph node classification for lung cancer. Chest 1997;111(6):1718-23.]. METHODS: From January 1993 to December 2003, 175 patients were diagnosed and resected for pulmonary metastases of colorectal cancer. Follow up informations were collected for 169 patients and an analysis of prognostic factors was performed. Ninety-six men (56.8%) and 73 women (43.2%) with a median age of 62 (range 34-81) were identified, 28 (16.7%) patients were found to have lymph node metastases, five of them were identified during a recurrent procedure. Probability of survival was calculated according to the method of Kaplan-Meier. The prognostic influence of lymph node metastases on survival was analyzed with the log-rank test. RESULTS: Median survival was 47.2 months after first metastasectomy. Ten patients with intrapulmonary nodal involvement had a median survival of 86 months whereas 12 patients with hilar and six patients with mediastinal lymph node metastases had a median survival of 24.5 and 34.7 months. The survival difference between pulmonary and hilar/mediastinal metastases was statistically significant (p=0.008/p=0.07). Five year survival with pulmonary, hilar, and mediastinal metastases was 78.5, 0, and 0%, respectively. Perioperative mortality was 0%. CONCLUSIONS: Resection of pulmonary metastases secondary to colorectal cancer is safe and indicated in highly selected patients. Because tumor involvement of lymph nodes has a strong impact on survival; depending on their location, at least a lymph node sampling should always be performed. Adjuvant chemotherapy in case of proven lymph node metastases might be a good option to improve prognosis.     

Resectional surgery in the treatment of primary carcinoma of the lung with mediastinal lymph node metastases.

Between 1966 and 1970 we reviewed 46 consecutive patients undergoing resection for primary carcinoma of the lung, in whom mediastinal lymph node metastases were found at operation. There was one operative death. Five of the remaining 45 patients survived five years--one of 10 cases of large cell carcinoma, one of 19 cases of adenocarcinoma, and three of 12 cases of epidermoid carcinoma. We believe that mediastinal lymph node metastases are not per se a contraindication to resection of epidermoid carcinoma of the lung.     

Breast carcinoma presenting with axillary lymph node metastases. An analysis of specific histopathologic features

Forty-three patients with metastatic carcinoma in axillary lymph nodes from an unknown primary site were studied. Thirty-one women (72%) were subsequently identified as having primary carcinoma in the ipsilateral breast. Based on the histologic patterns of the metastasis, patients were divided into three groups. Type I axillary lymph node metastases were composed of sheets of large, apocrine-like pleomorphic cells with pale to granular pink cytoplasm, large nuclei, and prominent nucleoli. This type was found in two-thirds of the cases. Type II metastases were readily recognizable as characteristic of breast carcinoma and included glandular, cribriform, and papillary patterns and comedonecrosis. Type III metastases demonstrated a mixture of the two previous patterns. Patients proven to have breast carcinoma ranged in age from 33 to 83 (average 58). Among the 31 cases with proven breast carcinoma, mammography was abnormal in 11 (35%). In the 12 other cases (18%), no primary in the breast or other site was demonstrated. Patients not proven to have breast carcinoma had a similar age distribution, comparable proportions of histologic patterns of metastases, and similar survival results to those with a demonstrated breast carcinoma, and none of the 12 patients were later shown to have another primary. The findings described here indicate that when mammary carcinoma presents initially with axillary metastases, it often has a distinctive histological pattern. In most cases this consists of relatively large, apocrine-like cells growing diffusely without forming glands or papillary structures. A minority of metastases have patterns (comedonecrosis; trabecular, glandular, or trabecular growth) more characteristic of the usual spectrum of breast carcinoma. Awareness of this morphological diversity should assist the pathologist in suggesting the breast as a primary site when the initial manifestation is an axillary lymph node metastasis.     

食管癌淋巴结转移特点及其危险因素

目的 探讨食管癌淋巴结转移情况及其危险因素,为外科手术行淋巴结清扫提供参考。方法回顾总结2006年1月至2010年12月在复旦大学附属肿瘤医院胸外科行三野淋巴结清扫食管癌根治术308例患者的临床资料．分析淋巴结的转移规律及特点。结果308例患者平均清扫淋巴结（35．6±14．5）枚,197例（64％）患者出现淋巴结转移。Logistic单因素分析结果显示,脉管（淋巴管及血管）侵犯（P=0．019）及肿瘤浸润深度（P〈0．001）是发生淋巴结转移的危险因素。各站淋巴结中,胸部气管旁淋巴结转移率最高（25．0％）。上段食管癌腹部淋巴结转移率显著低于中段或下段食管癌（P=0．001）,而各段食管癌颈胸部淋巴结转移率比较,差异无统计学意义（P〉0．05）。颈胸部和颈胸腹部淋巴结转移率分别为14．6％和11．0％,而颈腹部和胸腹部则分别为3．6％和4．9％。脉管侵犯（P〈0．001）和胸部气管旁淋巴结转移（P=0．014）是食管癌发生颈部淋巴结转移的危险因素。结论食管癌淋巴结转移具有上、下双向和跳跃性的特点．胸部气管旁淋巴结转移可作为行颈部淋巴结清扫的指征。     

The prognosis of melanoma patients with metastases to two or more lymph node areas.

The prognosis of melanoma patients who present with metastatic involvement of two or more noncontiguous lymph node regions before the detection of extranodal metastases has not been previously reported. We identified 21 patients with metastatic melanoma in at least two nodal basins in a review of 175 patients with melanoma undergoing lymphadenectomy at the National Cancer Institute. The median survival time of these patients was 46 months, with 55%, 27%, and 17% of the patients alive 2, 5, and 10 years, respectively, after the second lymphadenectomy. Because the prognosis of melanoma patients with metastases to two or more regional nodal areas appears equivalent to that of patients with metastatic involvement of only one regional node site, lymphadenectomy of the involved groups should be performed with therapeutically curative intent.     

Axillary lymph node metastases in patients with a final diagnosis of ductal carcinoma in situ

BACKGROUND: Recent studies report the incidence of axillary metastases in patients with ductal carcinoma in-situ (DCIS) approaches 13%. The purpose of this study was to define the incidence of axillary micrometastases in patients with pure DCIS before and after the introduction of sentinel lymph node biopsy. METHODS: Patients with a final diagnosis of DCIS form the basis of this study. Data were entered prospectively into an Institutional Review Board approved Oracle database from January 1997 through July 2002. RESULTS: One hundred and thirty-four patients had lymph nodes evaluated. Ninety-eight percent of patients had no evidence of metastatic disease and 2% were found to have micrometastases. This was consistent in those who had level I or II lymph node sampling or both and those who had lymphatic mapping and a sentinel lymph node biopsy procedure. CONCLUSIONS: These data do not support axillary lymph node removal of any type in patients with pure DCIS.