Cholangiocarcinoma with Regional Lymph Node Metastasis Masquerading as Sclerosing Mesenteritis / 대한췌담도학회지

Sclerosing mesenteritis is a rare disease presenting as chronic inflammation and fibrosis of mesentery around the small and large intestine. And in most cases, it shows indolent and benign clinical course resulting in favorable prognosis. It is often diagnosed through characterized radiologic finding in abdominal examinations including computed tomography scan. However, it is important to rule out other conditions involving mesentery when diagnosing sclerosing mesenteritis. In the case of malignancy, the method of treatment and prognosis can be completely different therefore thorough examinations are essential. We herein report a 75-year-old male who suffered from frequent diarrhea and weight loss. Initially, he was diagnosed with sclerosing mesenteritis through abdominal computed tomography scan showing "misty" soft-tissue attenuation around the mesenteric vessel. However, follow up positron emission tomography scan and biopsy finding confirmed the common bile duct cancer with lymph node metastasis.

Cholangiocarcinoma with Regional Lymph Node Metastasis Masquerading as Sclerosing Mesenteritis / 대한췌담도학회지

Sclerosing mesenteritis is a rare disease presenting as chronic inflammation and fibrosis of mesentery around the small and large intestine. And in most cases, it shows indolent and benign clinical course resulting in favorable prognosis. It is often diagnosed through characterized radiologic finding in abdominal examinations including computed tomography scan. However, it is important to rule out other conditions involving mesentery when diagnosing sclerosing mesenteritis. In the case of malignancy, the method of treatment and prognosis can be completely different therefore thorough examinations are essential. We herein report a 75-year-old male who suffered from frequent diarrhea and weight loss. Initially, he was diagnosed with sclerosing mesenteritis through abdominal computed tomography scan showing "misty" soft-tissue attenuation around the mesenteric vessel. However, follow up positron emission tomography scan and biopsy finding confirmed the common bile duct cancer with lymph node metastasis.

Role of FNAC In Diagnosis of Non-Thyroidal Head and Neck Lesions.

Fine needle aspiration cytology (FNAC) is of particular relevance in head and neck lesions because of easy assessibility, excellent patient compliance, miminally invasive nature of procedure and helping to avoid surgery in non-neoplastic lesions, inflammatory conditions and also some tumors. The study was conducted on 160 patients presenting with non-thyroidal head and neck swellings. Swellings arising from lymphnodes formed largest group 110 (68.75%) cases, salivary gland origin leisions comprised of 15(9.3%) cases and miscellaneous lesions 35 (21.8%) patients. Aspiration was satisfactory in 153 (95.63%) and unsatisfactory in 7 (4.40%) patients. The cytodiagnostic yield was 147 (91.87%) cases in the study. In 46 patients surgical intervention and histopathological examination (HPE) of the specimen was undertaken. The sensitivity of FNAC compared with HPE where available in diagnosing lymphnode lesions was 83.33%, salivary gland lesions was 100% and miscellaneous swellings was 95.83%. The overall sensitivity in the study in diagnosing non-thyroidal head and neck lesion was 93.47%. No major complication was recorded.

Total de linfonodos identificados após a ressecção do câncer colorretal / Lymph nodes identification after colorectal cancer resection

RACIONAL: A base cirúrgica principal no tratamento do câncer colorretal é a remoção em bloco do tumor com adequadas margens proximal e distal, associada à remoção dos linfonodos mesentéricos. OBJETIVO: Avaliar fatores associados à quantidade de linfonodos encontrados em peças cirúrgicas de pacientes com câncer colorretal. MÉTODOS: Estudo retrospectivo, de pacientes consecutivos, operados com diagnóstico de adenocarcinoma colorretal. Foram excluídos aqueles submetidos ao tratamento cirúrgico paliativo. Os dados demográficos, operatórios e histopatológicos foram analisados utilizando os testes exato de Fisher, Qui-quadrado, Wilcoxon rank-sum e um modelo de regressão logística. RESULTADOS: No período de 2000 a 2008, foram operados 298 pacientes com câncer colorretal. Os dados incluídos na análise estavam disponíveis para 173 pacientes. Destes, 85 (49 por cento) eram do sexo feminino e a idade mediana era de 65 (26-94) anos. A ressecção mais comum foi a colectomia esquerda (45 por cento), seguida pela colectomia direita (23 por cento). O número mediano de linfonodos isolados foi oito (0-67) e 33 por cento dos pacientes tiveram 12 ou mais linfonodos identificados na peça cirúrgica. Os pacientes com idade menor que 50 anos e aqueles submetidos à coletomia direita obtiveram maior número de linfonodos isolados. CONCLUSÕES: A idade do paciente menor que 50 anos e o tipo de ressecção cirúrgica estão associados ao maior número de linfonodos encontrados nas peças cirúrgicas.

BACKGROUND: The main base in surgical treatment of colorectal cancer is en-bloc removal of the tumor with adequate proximal and distal margins, combined with the removal of lymph nodes. AIM: To evaluate factors associated with the number of lymph nodes found in surgical specimens from patients with colorectal cancer. METHODS: Analysis of a retrospective data of consecutive patients operated with a diagnosis of colorectal adenocarcinoma. Were excluded those undergoing palliative surgery. Demographic data, operative and histopathological findings were analyzed using the Fisher exact test, chi-square, Wilcoxon rank-sum and a logistic regression model. RESULTS: From 2000 to 2008, were operated 298 patients with colorectal cancer. The data included in the analysis were available for 173 patients. Of these, 85 (49 percent) were female and median age was 65 (26-94) years. The resection was the most common left colectomy (45 percent), followed by right colectomy (23 percent). The median number of lymph nodes were isolated from eight (0-67) and 33 percent of patients had 12 or more lymph nodes identified in surgical specimens. Patients younger than 50 years and those who underwent right colectomy had a greater number of lymph nodes isolated. CONCLUSIONS: Patient age less than 50 years and the type of surgical resection are associated with higher number of lymph nodes found in surgical specimens.

Pharyngeal lymphatic ring: anatomical review

The tonsils form part of a circular band of adenoid tissue which guards the opening into the digestive andrespiratory tubes, known as Waldeyer’s ring. The anterior part of the ring is formed by the submucouslymphoid clusters (lingual tonsil) on the posterior part of the tongue; the lateral portions consist of thepalatine tonsils and the lymphoid tissue in the vicinity of the auditory tubes, while the ring is completedbehind by the pharyngeal tonsil on the posterior wall of the pharynx. In the intervals between these mainsmaller collections of lymphoid tissue are found. This paper intends to give to the clinician an anatomicalreview about the subject.

Distribution of involved regional lymph nodes in recurrent and locally advanced breast cancer and its impact on target definition / 中华放射肿瘤学杂志

Objective The frequency and the anatomic distribution of involved regional nodes in recurrent and locally advanced breast cancer were analyzed, in order to evaluate the rational of conventional regional node radiation technique and provide evidence for target definition of breast cancer . Methods Patients with recurrent or locally advanced breast cancer who were treated in our hospital from August 2003 to December 2009 were included in this study. 111 patients had contrast enhanced chest CT images of the whole regional nodes before treatment. The regional nodes were categorized into 8 anatomical substructures including medial and lateral supraclavicular nodes ( SC-M, SC-L), axilla nodes ( ALN )- Ⅰ , Ⅱ , Ⅲ,infraclavicular nodes (IFN), Rotter's nodes (RN) and internal mammary nodes (IMN). The frequency of involvement and anatomical distribution of the involved nodes on CT images were analyzed. Results A total of 111 patients were enrolled this study and 199 anatomical substructures with involved nodes were identified. The frequency of involvement were :SC-M 33, SC-L 21, ALN- Ⅰ 30, ALN-Ⅱ 25, ALN-Ⅲ + IFN 35, RN 27, IMN 28. Supraclavicular region and axilla were the most frequently involved area (72. 3% ).The average depth of the SC-M and SC-L nodes was 33.48 mm ± 10. 57 mm and 45.62 mm ±20. 45 mm,and 51.5% and 71.4% of the SC-M and SC-L nodes were located more than 3 cm deep from the skin. The axilla nodes were located cranial and caudal to the axillary vein in 5 and 20 locally advanced breast cancer patients and in 64 and 28 patients who received prior axillary dissection. The majority of involved IMN was located within the first 3 intercostal spaces (26/28). The average distance between the center of involved IMN and chest skin was 24. 23 mm ± 10. 28 mm. The average distance between the center of involved IMN and midline of the body was 29. 38 mm ±6. 7 mm. The center of involved IMN was 6.19 mm ±5.73 mm lateral and 5.73 mm ± 4. 56 mm posterior to the internal mammary vessels. Conclusions Conventional field design is unlikely to provide sufficient dose to the entire risk region because of individual differences.Individualized treatment planning based on CT would become feasible with increasing knowledge of natural risk of nodal involvement.

Evaluation of the 7th UICC TNM Staging System of Gastric Cancer

Since January of 2010, the seventh edition of UICC tumor node metastasis (TNM) Classification, which has recently been revised, has been applied to almost all cases of malignant tumors. Compared to previous editions, the merits and demerits of the current revisions were analyzed. Many revisions have been made for criteria for the classification of lymph nodes. In particular, all the cases in whom the number of lymph nodes is more than 7 were classified as N3 without being differentiated. Therefore, the coverage of the N3 was broad. Owing to this, there was no consistency in predicting the prognosis of the N3 group. By determining the positive cases to a distant metastasis as TNM stage IV, the discrepancy in the TNM stage IV compared to the sixth edition was resolved. In regard to the classification system for an esophagogastric (EG) junction carcinoma, it was declared that cases of an invasion to the EG junction should follow the classification system for esophageal cancer. A review of clinical cases reported from Asian patients suggests that it would be more appropriate to follow the previous editions of the classification system for gastric cancer. In addition, in the classification of the TNM stages in the overall cases, the discrepancy in the prognosis between the different stages and the consistency in the prognosis between the same TNM stages were achieved to a lesser extent as compared to that previously. Accordingly, further revisions are needed to develop a purposive classification method where the prognosis can be predicted specifically to each variable and the mode of the overall classification can be simplified.

Study of Fine Needle Aspiration Cytology in Lymphadenopathy with Special Reference to Acid-fast Staining in Cases of Tuberculosis

The present study was conducted to evaluate the usefulness of FNAC as a diagnostic tool in 1000 patients of lymphadenopathy. Fine needle aspiration was performed in all the patients following through clinical examination and slides were stained with H & E, PAP and Ziehl Neelsen stains. The results of FNAC were further correlated with paraffin embedded sections of tissue blocks. Eight hundred and sixty-four cases (86.4%) were of benign lymphadenopathy; out of which 536 (53.6%) cases were of reactive nature and 328 cases (32.8%) were tubercular. The remaining 136 (13.6%) cases were of malignant lymphadenopathy, consisting 45 (4.5%) cases of primary malignancies i.e. lymphomas and 91 (9.1%) cases of metastasis to lymph nodes. Out of 328 cases, Z-N positivity for AFB was found in 152 cases (46.4%) and Mantoux test was positive in 180 cases (54.9%). On correlation of FNAC findings with histopathology; sensitivity and specificity was found out to be 91.6% and 99%, respectively, with diagnostic accuracy of 97.3% in cases of benign lesions. The same being 97%, 97.5% and 97.4%, respectively in tubercular lesions. The sensitivity, specificity and diagnostic accuracy was 100% each in malignant lesions. FNAC of lymphnodes is an excellent first line method, for investigating the nature of the lesions, as it is economical and convenient alternative to open biopsy.

The influence of lymph node metastasis on prognosis of early gastric carcinoma / 中国现代普通外科进展

Objective:To explore the general pattern of lymph node metastasis and its effect on prognosis in early gastric cancer.Methods:The clinicopathological and follow-up data of early gastric cancer cases from 1990.6~2000.6 were retrospectively analyzed.Results:The tumor size and depth of invasion were related to lymph node metastasis in early gastric cancer.The 5-year survival rate of patients with node-positive early gastric cancer was significantly lower than those of patients with node-negative,72.4% and 92.5% respectively.The 5-year survival rate of patients with ≥4 metastatic lymph nodes was significantly lower than those of patients with 1~3 metastatic lymph nodes,50.0% and 84.2% respectively.Conclusion:Lymph node metastasis is the independent prognostic factor.Postoperative therapy should be recommended for the patients with ≥4 metastatic lymph nodes.

Values of resecting the lymph nodes adjacent to the recurrent laryngeal nerve in the operation on cNo thyroid papillary carcinoma / 中国癌症杂志

Purpose:To study the significance of resecting the lymph nodes adjacent to the recurrent laryngeal nerve in the operation on cNo thyroid papillary carcinoma,and its value inselecting the fashion of operation .Methods:Reviewing the clinical-pathological material of 186 cases of cNo thyroid papillarycary cinoma,and analyzing the relationship between lymph nodes adjacent to the recurrent laryngeal nerve and lateral cervical nodes metastasis. Results:Of 186 cases of cNo thyroid papillary cacinoma,there were 42.5% (79/186) with metastatic lymph nodes adjacent to the recurrent laryngeal nerve,63.2% of which had lateral cervical nodes or distant metastasis,while only 8 cases had metastasis in the negative group. Conclusions:The thyroid papillary carcinoma with metastatic nodes adjacent to the recurrent laryngeal nerve means there is a higher chance of metastasis in regions of the neck. Resecting the lymph nodes adjacent to the recurrent laryngeal nerve and frozed pathological examination can be a basis to determine whether redical neck dissection should be performed.

The relationship between the p53 expression and MRI manifestion of the T-staging and the lymph nodes metastasis of the nasopharyngeal carcinoma / 中华放射学杂志

0.05).The expression rate of p53 protein in patients with cervical lymph nodes metastasis(≥4cm)was 81.8%(9/11),in cervical lymph nodes metastasis (