Inguinal lymph node metastases from testicular tumor

The Northern Israel Cancer Center serves 1 million inhabitants. Between 1968 and 1982, 33 patients with a diagnosis of nonseminomatous tumors of the testis were referred to this center. Of these patients inguinal lymph node metastasis developed in 4, each of whom had had risk factors for such metastasis. Two patients had undergone previous orchiopexy, and 2 had extension of the tumor to the epididymis and the tunica vaginalis testis. The inguinal region should be examined and watched carefully in patients with testicular tumor, especially those at high risk for inguinal metastases. Today, disease in patients with inguinal metastasis is curable by lymph node dissection and/or combination chemotherapy.     

Bilateral cervical lymph node metastases in well-differentiated thyroid cancer

We analyzed the regional lymph node metastases of 98 patients with thyroid cancer who underwent bilateral modified neck dissection. Bilateral jugular lymph node metastases were frequent in patients with papillary carcinoma of the thyroid, especially in those patients with obvious carcinoma in both lobes of the gland, cancer arising in the isthmus, clinically detectable bilateral lymphadenopathy, and recurrent thyroid cancer. In patients whose cancer was clinically confined to one lobe, and where there were no obviously enlarged contralateral lymph nodes, the occurrence of contralateral jugular lymph node metastasis was significantly correlated with the contralateral paratracheal lymph node metastasis. The bilateral lymphadenectomy appears to be appropriate in these instances.     

Pattern of cervical lymph node metastases from papillary carcinoma of the thyroid

INTRODUCTION: The management of cervical metastases from papillary thyroid carcinoma ranges from selective removal (berry picking) to a formal comprehensive neck dissection. Without a clear understanding of the distribution of nodes at risk, the formulation of strategies on how best to manage the clinically positive neck is difficult. This study reports on observations made in patients who underwent a therapeutic comprehensive neck dissection for metastatic papillary thyroid carcinoma by defining lymph node involvement with respect to neck level. METHODS: The clinical records and pathological reports of 75 consecutive patients who underwent a neck dissection for cervical metastases from papillary thyroid carcinoma over a 10-year period were reviewed. All dissections were therapeutic in nature, being performed in patients with clinically positive neck nodes. Eighty neck dissection specimens were obtained and analyses were divided into three groups by virtue of the type of dissection performed: a bilateral comprehensive neck dissection, unilateral radical neck dissection and unilateral comprehensive neck dissection. The relative involvement of cervical nodes was analysed with reference to node levels I-V. RESULTS: Patients in the anterolateral group (levels II, III and IV) were at greatest risk of metastatic disease, with level III nodes consistently the most frequently involved, across all treatment groups. Only three patients exhibited level I involvement, all of whom had extensive neck disease involving all or almost all neck levels. CONCLUSION: The majority of patients present with multiple level node disease, with the anterolateral group at greatest risk. A comprehensive neck dissection is recommended for all patients with palpable cervical lymphadenopathy.     

甲状腺乳头状癌淋巴结转移规律的研究

目的探讨甲状腺乳头状癌淋巴结转移的规律,为临床行选择性颈淋巴结清扫术提供依据。方法回顾性分析华中科技大学附属协和医院乳腺、甲状腺外科中心2003年6月至2006年6月间行甲状腺癌根治＋颈淋巴结清扫术,且颈清扫的淋巴结数目大于8枚的83例甲状腺乳头状癌临床资料。结果甲状腺乳头状癌最容易转移至Ⅵ区（单侧甲癌72.3%,双侧甲癌88.9%）,其次是Ⅲ、Ⅳ区（单侧甲癌57.9%,双侧甲癌50%～66.7%）,Ⅴ区和Ⅰ区较少发生淋巴结转移（单侧甲癌0%～20.1%,双侧甲癌25%～33.3%）。侵犯甲状腺包膜（88%）和滤泡亚型（85.7%）的甲状腺癌容易发生颈淋巴结转移。良性病变局部恶变（27.3%）和包膜型（25%）甲状腺癌,较少发生颈淋巴结转移。甲状腺上极的肿瘤可以先出现颈外侧区淋巴结转移。结论甲状腺乳头状癌的淋巴结转移的研究有助于确定选择性颈淋巴结清扫术范围,建议甲状腺乳头状癌常规清扫Ⅵ区淋巴结,肿瘤位于甲状腺下极者需清扫对侧下极淋巴结;对于肿瘤位于甲状腺上极的患者,应增加清扫Ⅱ、Ⅲ区的淋巴结。对风险较高的滤泡亚型及侵犯包膜的甲状腺乳头状癌清扫范围要更大,应清扫Ⅱ～Ⅵ区淋巴结。     

Inguinal lymph node metastases from germ cell testicular tumors

Between 1948 and 1982, 22 patients were seen with metastasis to the inguinal nodes from testicular germ cell tumors: 8 had a history of unilateral or bilateral orchiopexy with or without herniorrhaphy, 4 had nonsurgically corrected or uncorrected cryptorchidism, 9 had a history of herniorrhaphy, hydrocelectomy or transscrotal orchiectomy and 1 had no history of scrotal, iliac or inguinal surgery, or of tunica vaginalis or scrotal wall involvement by tumor. The histological type was pure seminoma in 5 patients, embryonal carcinoma in 7 and mixed tumor in 10. Treatment was individualized for tumor type and mode of presentation, and varied during the years according to the modalities available. At the time of this report 8 of 22 patients (36 per cent) are alive without evidence of disease from 2 to 29.5 years, 3 (16 per cent) have died without evidence of disease 10 to 17 years after treatment, 10 (45 per cent) have died of metastases 10 months to 6 years after treatment and 1 has been lost to followup. The over-all incidence of groin metastases from testicular carcinoma is low, even with a history of scrotal or inguinal surgery.     

甲状腺乳头状癌淋巴结转移相关因素分析

目的 探讨甲状腺乳头状癌颈淋巴结转移的相关因素.方法 收集2005年1月-2008年3月接受手术并进行淋巴结切除的38例(44侧)甲状腺乳头状癌患者的临床资料(不包含因复发手术的病例),回顾分析甲状腺乳头状癌淋巴结转移的相关因素.结果 在38例(44侧)患者中,颈淋巴结的转移率为57.89%,颈部中央区淋巴结转移(47.37%)为最常见的转移部位,出现颈侧区淋巴结转移的患者(31.58%)中66.67%同时伴有中央区淋巴结转移.颈部淋巴结转移的相关冈素为年龄＜45岁和肿瘤侵犯被膜,多因素分析显示,年龄为淋巴结转移的独立相关因素.结论 颈淋巴结转移是甲状腺乳头状癌的常见情况,尤其是中央区淋巴结;建议有甲状腺被膜侵犯的甲状腺乳头状癌患者应常规清扫中央区淋巴结.     

A case of multiple occult thyroid cancers with tracheal stenosis by invasion from metastatic lymph node

A 59-old woman visited to our hospital with complaint of uttering stenotic sound at expiratory stage. Her chest X-ray film showed a suspicious intratracheal tumor, which was arising from the left side of the tracheal wall and confirmed 4 cm from the vocal cord by bronchofiber scope. The biopsy specimens showed well differentiated papillary adenocarcinoma. The lesion was judged to be a intrathoracic thyroid carcinoma and to infiltrate the trachea. Her air way failed to be ensured with YAG-LASER. Therefore, a subemergency operation was done. The intrathoracic lesion had no sequence of the thyroid gland. Two occult thyroid carcinomas were intraoperatively discovered. She underwent total thyroidectomy and sleeve trachectomy whose anastomosis was wrapped up in an omental flap. The intraluminal part of the tumor histologically showed poorly differentiated carcinoma, in contrast to the extratracheal part of the tumor showing well differentiated carcinoma. She was treated with radioactive iodine due to her positive 131I scintigraphy. Nine months later, a very similar lesion newly developed at the left side of trachea and made same symptoms.     

Minimal thyroid carcinoma: A report of nine cases discovered by cervical lymph node metastases

From 1962 to 1983, nine patients with minimal carcinoma of the thyroid were referred to Aichi Cancer Center Hospital and to Aichi Medical University Hospital for evaluation of enlarged lymph nodes in the neck. The radiographic study and scintigraphy of the thyroid were useful in detection of small thyroid lesions. In two cases, a lymph node biopsy was required for confirmation of the diagnosis. The thyroid lesions were histologically papillary carcinoma, in all the cases. A modified neck dissection with total thyroidectomy was carried out in five patients and modified neck dissection with thyroid lobectomy was done in four cases. Nine patients were followed for 6 months to 20 years and all the patients except one are alive.     

The detection and localisation of abdominal lymph node metastases from testicular teratomas

Review of the results of treatment of 275 patients with testicular teratomas indicates that the size of para-aortic node metastases as defined by lymphography is closely related to prognosis, and that accurate definition of these metastases is essential in planning treatment. Although para-aortic lymphadenectomy does not appear to be necessary therapeutically or as a staging procedure, excision of residual bulk disease may be required after chemotherapy and radiotherapy. In these cases the residual para-aortic tumour mass should be accurately localised by ultrasonography so the best surgical approach can be used.     

Advanced synchronous rectal and prostate cancers diagnosed by lateral lymph node dissection: A case report

IntroductionRectal and prostate cancers are common cancers occurring globally, and both can metastasize to the pelvic lateral lymph nodes (LLNs).Presentation of caseA 69-year-old man, presenting with blood in stool, was diagnosed with rectal cancer. Computed tomography revealed a 7-mm LLN in the right internal iliac artery region, leading to the suspicion of metastasis. The patient underwent laparoscopic low anterior resection and LLN dissection. Histopathological findings of the metastatic tissue in the LLN were different than that of rectal cancer, and endocrine tumor was suspected. Immunostaining performed based on high serum prostate-specific antigen (PSA) level revealed positivity for PSA and α-methylacyl-CoA racemase in the dissected LLN. Thus, he was diagnosed with synchronous rectal and prostate cancers and received hormonal therapy for stage IV prostate cancer, which led to a dramatic reduction in PSA level after three months. He was followed regularly and did not relapse or experienced disease progression for either cancer for approximately four years after the initial diagnosis.DiscussionFew studies reported synchronous rectal and prostate cancers, both of which can metastasize to pelvic LLNs. However, preoperative diagnosis of the primary cancer metastasizing to the LLNs is challenging. Treatment of synchronous rectal and prostate cancers requires a strategy to diagnose each tumor stage and corresponding degree of progression because lymph node metastases affect staging in both cancers.ConclusionLymph node dissection may be useful in determining progression and treatment plan in cases of concurrent rectal and prostate cancers with suspected LLN metastasis.     

多排螺旋CT对甲状腺乳头状癌颈淋巴结转移的诊断价值

目的评估多排螺旋CT(MSCT)诊断甲状腺乳头状癌(PTC)伴颈淋巴结转移的临床价值。方法回顾性分析38例PTC行功能性颈清扫的术前MSCT结果,并与手术后病理诊断结果对比。结果 38例患者MSCT检查阳性率为84.2%(32/38),且绝大多数淋巴结转移灶有特征性影像学改变。颈中央区淋巴结转移率最高,达52.6%(20/38),但该区小的转移淋巴结MSCT难以检出,而致6例假阴性。结论 MSCT诊断PTC颈淋巴结转移具有较高的准确率。PTC初次手术建议常规行颈中央区淋巴结清扫。     

甲状腺微小乳头状癌颈部淋巴结转移的危险因素分析

目的:探讨甲状腺微小乳头状癌(PTMC)颈部淋巴结转移的危险因素。方法:回顾性分析贵州医科大学附属医院甲状腺外科2014年1月—2016年3月收治的169例PTMC患者临床病理资料。结果:169例患者均行预防性中央区淋巴结清扫,其中54例(32.0%)发生中央区淋巴结转移,单因素分析发现中央区淋巴结转移与年龄45岁、多灶性肿瘤、侵出包膜有关(均P0.05),多因素分析显示,年龄、多灶性肿瘤、侵出包膜都是中央区淋巴结转移的独立危险因素(均P0.05)。30例行中央区淋巴结加侧颈区淋巴结清扫,其中18例(10.7%)发生侧颈区淋巴结转移,单因素分析显示,肿瘤最大径、侵出包膜、多灶性肿瘤、中央区淋巴结转移与侧颈区淋巴结转移有关(均P0.05),多因素分析显示,肿瘤侵出包膜为侧颈区淋巴结转移的高危因素(P0.05);11例(6.5%)发生中央区并侧颈区淋巴结转移,侵出包膜、多灶性肿瘤为中央区并侧颈区淋巴结共同发生转移的高危因素(均P0.05)。高分辨率颈部淋巴结B超对中央区淋巴结转移的灵敏度、特异度分别为14.8%、96.5%,其对侧颈区淋巴结转移的灵敏度、特异度分别为94.4%、83.3%。结论:年龄45岁、多灶性肿瘤、侵出包膜是PTMC颈部淋巴结转移的危险因素。高分辨率颈部淋巴结B超可以作为甲状腺癌颈部淋巴结转移术前评估的重要手段。     

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。     

C MET蛋白在有颈部淋巴结转移的甲状腺癌中的表达和意义

目的探讨C-MET蛋白在有或无颈部淋巴结转移的甲状腺乳头状癌、甲状腺滤泡状癌及良性甲状腺组织中的表达及其临床意义。方法采用免疫组织化学方法检测有颈部淋巴结转移的甲状腺乳头状腺癌（PTC1组）62例，无颈部淋巴结转移的甲状腺乳头状腺癌（PTC2组）50例，甲状腺滤泡状腺癌（FTC组）l0例及良性甲状腺组织（良性组）30例中的C—MET蛋白的表达。结果PTCI组的C—MET表达明显高于其它3组（P〈0．001）。两两比较C—MET表达结果：PTC1组与PTC2组比较，P〈0．001；PTC1组与FTC组比较，P〈0．001；PTC1组与良性组比较，P〈0．001；PTC2组与FTC组比较，P=0．002；PTC2组与良性组比较，P〈0．001；皆有显著性差异。结论C—MET的表达是甲状腺乳头状癌是否有淋巴结转移的预测因子，是肿瘤的囊外扩展和直接侵犯的标记。该指标对甲状腺乳头状癌淋巴结转移的术前评估，决定手术方式均有一定指导意义。     

隐匿性甲状腺癌并颈部多发淋巴结转移1例报告

患者46岁女性,以颈部多发肿物为首要症状,外院穿刺病理为甲状腺癌转移,但甲状腺彩超及甲状腺ECT均未能发现病灶。完善相关检查,排除手术禁忌征后行右侧甲状腺+峡部+左侧甲状腺次全切除+双侧颈部淋巴结清扫术。术中探查肿瘤体积小,0.3*0.3cm,属甲状腺微小癌,又称隐匿性甲状腺癌。分化型的甲状腺癌生长缓慢,预后良好,但仍属于致命性疾病,甲状腺微小癌出现如此转移实属少见。     

Importance of lymph node metastases in follicular thyroid cancer

There are many concepts of risk and prognostic factor analysis for differentiated thyroid cancer. The prognostic role of lymph node metastases in follicular thyroid cancer (FTC), however, is still controversial. We performed a retrospective trial in 186 patients with FTC (124 women, 62 men; mean follow-up 5.5 years) questioning whether lymph node metastases and radical thyroid surgery with neck dissection contribute to the prognosis of FTC. Univariate analysis demonstrated that lymph node metastasesp <0.005), tumor size (p <0.005), tumor stage (p <0.005), distant metastases p = 0.0063), and gender (p = 0.003) are significant prognostic factors for recurrence (Kaplan-Meier). Tumor size (p = 0.004), lymph node metastases p = 0.0478), and distant metastases p = 0.0064) influenced mortality. Age and extent of surgery were not significant for recurrence nor was gender for mortality. Multivariate analysis (Cox regression test) characterized tumor size (p <0.005) and lymph node metastases p = 0.004) as prognostic factors for recurrence of FTC. No significant difference was detected between patients being treated by thyroidectomy when compared to patients treated by thyroidectomy plus neck dissection in relation to recurrence. Our data demonstrate lymph node metastases to be a significant prognostic factor for recurrence of FTC and the patient’s survival. We advocate thyroidectomy plus central lymph node dissection as the basic surgical strategy. For T3 and T4 tumors, unilateral modified neck dissection is an all but optional procedure. Whether radical surgery with thyroidectomy plus neck dissection has an impact on survival remains questionable.