Lymph Node Tumor Volumes in Patients Undergoing Sentinel Lymph Node Biopsy for Cutaneous Melanoma

Background: Regional lymph node tumor volumes in patients undergoing sentinel lymph node (SN) biopsy (SNB) for treatment of cutaneous melanoma have not been described. The objectives of this study were to describe the lymph node tumor volumes typically seen in this population and to correlate tumor volumes with tumor thickness and positive SN characteristics.Methods: Review of a consecutive series of patients with clinically localized cutaneous melanoma who underwent SNB of nonpalpable regional lymph node basins followed by complete lymphadenectomy (LND) was performed. Multiple lymph node sections from positive SNs and nonsentinel nodes (NSNs) in LND specimens were examined microscopically. Individual tumor deposit diameters were measured using an ocular micrometer. Aggregate tumor volumes were calculated for SN and LND specimens. Tumor volumes and SN and LND positivity rates were correlated with tumor thickness, the number of positive SNs, and the presence of multiple SN tumor deposits.Results: SNB procedures were performed for 149 melanomas in 189 regional nodal basins. The mean tumor depth was 2.48 mm. The mean number of SNs/basin was 2.1. Thirty-two of 149 SNB procedures (21.5%) revealed a total of 34 nodal basins with at least one positive SN. The median tumor volume in positive SNs was 4.7 mm³ (range, 0.1-3618 mm³; mean, 209 mm³). The median aggregate tumor volume in positive LND specimens was 4.9 mm³ (range, 0.1-3618 mm³; mean, 224 mm³). Six basins (17.6%) contained at least one positive NSN. The regional node aggregate tumor volume correlated weakly with tumor thickness (Pearsons correlation coefficient = .302, P = .0934). NSN positivity was not predicted by tumor thickness, American Joint Committee on Cancer tumor stage, number of positive SNs, or number of metastatic deposits within SNs.Conclusions: Most melanoma-positive SNs contain minute tumor volumes. Tumor thickness and patterns of SN metastases may not be predictive of tumor burden or the presence of positive NSNs.     

胎儿房室结微血管构筑的扫描电镜观察

用血管铸型结合扫描电镜方法观察了7例胎儿房室结微血管构筑.微动脉反复分支呈树状,行走方式呈波浪形或螺旋形.毛细血管网可分为内外两层:外层纵行为主,以"H"或"Y"形吻合;内层弯曲行走为主,并互相交错吻合.以房室结动脉主干为界,其下方毛细血管密度较大,其上方及前方较小.房室结的上方、前下方和后下方均有微动脉连接毛细血管网.整个结的毛细血管大致可分为结后部上方、下方及前部三个区域.靠毛细血管网外层处可见管径较粗、呈袋状的微静脉.     

The role of radiography, computed tomography and bone scanning in prostatic cancer

This report reviews the roles of conventional radiography, computerized axial tomography, and nuclear bone scanning in the diagnosis, staging, follow-up, and management of prostatic cancer. Computed tomography (CT) offers great promise for the better definition of the extent of the primary tumor of prostatic cancer. It contributes positively to the planning of radiation therapy portals in the treatment of localized disease. By means of bipedal lymphangiography and CT scanning, pelvic and periaortic lymphadenopathy may be detected more often than was previously possible without staging pelvic lymphadenectomy, which can be reserved for the discovery of microscopic disease. Soft-tissue metastases that are located deep within the body cavities can now be measured accurately by CT scanning, as can their response to therapy. Skeletal metastases, the most common variety in prostatic cancer, can be detected with a high degree of sensitivity by nuclear bone imaging. Serial bone scans are remarkably useful in following the response of osseous deposits to treatment, as well as in detecting relapsing disease. The management of malignant obstruction of the ureters has been greatly facilitated by the application of angiographic techniques to percutaneous nephrostomy performed under fluoroscopic control.     

Relationship between body weight and the incidence of positive axillary nodes at mastectomy for breast cancer

The question, whether obesity is associated with an increased incidence of positive axillary nodes at mastectomy for breast cancer, was studied in two quite different hospital populations; one from a large urban teaching hospital (Montefiore) and one from a medium-sized Air Force medical center (Malcolm Grow). In the Montefiore population, the answer was "yes"; 67% of the node-positive patients, but only 31% of the node-negative patients were obese (20% or more above ideal weight) (p less than 0.05). In the Malcolm Grow population, the answer was "no"; 20% of the node-positive and 20% of the node-negative patients were obese. The different answers, we believe, are due to the biological differences between the populations; the Montefiore population was shorter (by an average of 1.7 inches), heavier (by an average of 20 lbs), and more obese. The incidence of obesity was about three times as high in the Montefiore population (52% versus 20%; p less than 0.02) and it contained a statistically distinct subpopulation of obese patients, while the few obese patients in the Malcolm Grow population constituted merely the upper tail of a unimodal log-normal distribution of weight in that population. We propose that it is possible to demonstrate a relationship of obesity to node-positivity in the Montefiore population but not in the Malcolm Grow population because obesity was highly prevalent in the former and almost nonexistent in the latter. It seems self-evident that it is not possible to demonstrate an effect of obesity in a population if that population manifests no significant obesity, statistically speaking, but disregarding this principle, we believe, may account for the controversy in the literature about whether obesity is a risk factor in breast cancer.     

食管癌淋巴结转移的临床病理因素

目的 探讨食管癌淋巴结转移的临床病理相关因素。方法 对204例食管癌根治标本进行统计,分析各主要临床病理改变与淋巴结转移关系。结果 204例食管癌中有淋巴结转移者89例,淋巴结转移率为43.6％。胸中段癌淋巴结转移率为48.0％,胸上段癌和胸下段癌的淋巴结转移率分别为32.0％和26.9％。髓质型和溃疡型淋巴结转移率分别为47.6％和56.0％,除缩窄型外其他类型转移率最高者为21.4％。男性患者淋巴结转移率为54.3％,女性淋巴结转移率为28.4％。浸润至黏膜层和黏膜下层者,未发现淋巴结转移,浸润至浅肌层、深肌层、纤维膜者淋巴结转移率分别为28.6％、45.6％和48.8％。以上四种因素中前后两者间比较差异均有显著性(P<0.05)。淋巴结转移率与年龄无关,也不随肿瘤大小的增加而增加。结论 男性食管胸中段癌患者淋巴结转移率较高,尤其当肿物为髓质型和溃疡型时最为显著。     

喉癌组织恶性度与颈淋巴结转移关系

采用五因素评点法对４０例喉鳞癌进行组织学和临床方面的研究。结果表明，组织恶性度与Ｔ分期无相关性，浸润方式弥散及恶性度高（评分≥１１）的肿瘤发生颈淋巴结转移率显著高于有完整肿瘤边界者及恶性度低（评分≤１０）者。提示喉癌组织恶性度在预测颈淋巴结转移上有实用价值，可临导临床治疗方案的选择。     

静脉注射免疫球蛋白对急性川崎病患儿淋巴细胞凋亡的影响

通过观察静脉注射免疫球蛋白（ＩＶＩＧ）对川崎病（ＫＤ）患儿淋巴细胞凋亡（ＡＰＯ）的影响，进一步探讨ＩＶＩＧ对免疫性疾病的作用机理。对２６例川崎病患儿和２０名健康儿童外周血单个核细胞（ＰＢＭＣ）经抗－ＣＤ３单克隆抗体刺激培养不同时间（０，１２，２４，４８，７２小时）ＡＰＯ百分率和ＤＮＡ片断化分析，２６例患儿随机分为两组，阿司匹林＋ＩＶＩＧ治疗组（ｎ＝１６）和阿司匹林治疗组（ｎ＝１０），并对ＰＢＭＣ经植物血凝素（ＰＨＡ）刺激淋巴细胞增殖反应进行了观察。结果：ＫＤ患儿ＡＰＯ百分率和ＤＮＡ片断化较正常儿童明显降低（Ｐ＜０．００１）和延迟；ＩＶＩＧ治疗后，降低的ＡＰＯ百分率和延迟的ＤＮＡ片断化被逆转，同时与单用阿司匹林组比较，临床症状明显改善。淋巴细胞增殖反应下调（Ｐ＜０．００１）。外周血淋巴细胞ＡＰＯ下调可能参与了ＫＤ的发病。ＩＶＩＧ治疗ＫＤ的机理可能部分归于对被抑制的淋巴细胞ＡＰＯ的逆转。ＩＶＩＧ对其它淋巴细胞凋亡不足的自身免疫性疾病治疗可能存在同样机理。     

Hospital-related differences in breast cancer management

A retrospective review is presented of 1353 consecutivepatients with histopathologically confirmed invasive breast carcinoma treatedradically with curative intent during the decade 1980–89.None had received adjuvant systemic therapy with hormonesor prolonged chemotherapy. The distribution of lymph-node negative(N–) and lymph-node positive (N+) patients was 75%and 25%, respectively.The treatment and outcome were analysed as regardsconventional prognostic parameters, in particular considering the axillarylymph-node status and the responsible hospital category (GeneralMunicipal Hospitals (MH)) versus Comprehensive Cancer Center (CC)).The most striking difference was detected as regardsthe number of examined lymph nodes. The mediannumber of nodes described at the MH was7, as compared to 14 at the CC(p < 0.001). In patients with pT1 tumoursthe highest rate of lymph-node positivity was observedwhen 10 or more axillary nodes were removed.Adjuvant radiotherapy reduced the loco-regional recurrence rate inthe N– patients, whereas only the regional recurrenceswere reduced among the N+ patients. The five-and 10-year tumor-related survival rates were 86% and76%, respectively, with no difference between the MHand the CC.As life-prolonging adjuvant hormone therapy and chemotherapy isnow available for patients with axillary lymph nodemetastases, it is important that patients with breastcancer are operated adequately with the aim toremove at least 10 axillary lymph nodes. Athorough examination of the axillary content should beperformed by the pathologist, and the number ofresected lymph nodes and metastases should be reported.The establishment of nation-wide standard criteria for themanagement of breast cancer is recommended.     

Early ovarian cancer: Is there a role for systematic pelvic and para-aortic lymphadenectomy?

Baiocchi G, Raspagliesi F, Grosso G, Fontanelli R, Cobellis L, di Re E, di Re F. Early ovarian cancer: Is there a role for systematic pelvis and para-aortic lymphadenectomy? Int J Gynecol Cancer 1998; 8 : 103–108.
In order to focus on the incidence and the clinical significance of lymphatic spread in patients with cancer apparently confined to the ovaries, we present our 20 year experience in a large series of patients with early ovarian cancer who had systematic pelvic and para-aortic lymphadenectomy. A retrospective study of 280 consecutive patients is presented. Systematic pelvic and para-aortic lymphadenectomy was performed in 205 cases (73.2%). Selective sampling and node biopsy were performed in 30 (10.7%) and 7 (2.5%), respectively. Node metastases were found in 32/242 patients (13.2%). The incidence of metastatic nodes was significantly higher in patients with serous adenocarcinomas and/or poorly-differentiated tumors. When few nodes were involved (1–3) lymphatic spread was most ipsilateral to the tumor. Even though the retrospective nature of the study has to be considered, univariate analysis revealed statistically significant differences in 5-year survival based on FIGO stage, histology, grade of differentiation, and node status. By contrast, using multivariate analysis, none of these risk factors was an independent variable for predicting long-term survival. However, node status closely approached the statistically significant level ( P = 0.06). Only prospective and randomized studies can clarify the role of lymphadenectomy in early ovarian cancer. However, while awaiting these results, this surgical procedure should be a part of a research protocol.     

伽玛刀治疗后的肿瘤内出血

目的：探讨颅内肿瘤患者伽玛刀治疗后肿瘤内出血的原因。方法：在伽玛刀治疗的３４５例颅内肿瘤病变患者中，发现３例有肿瘤内出血，分析了他们的临床特点及ＣＴ，ＭＲＩ表现，结果：２例经保守治疗基本痊愈，１例恶化。结论：对于那些曾有过肿瘤卒中史、高血压病史或肿瘤血运丰富的病人行伽玛刀治疗后应警惕发生肿瘤内出血的危险