Transitional cell carcinoma of urinary bladder with cervical lymph node metastasis: a case report and review of literature

Bladder cancer usually spreads via the lymphatic and hematogenous routes, the common sites of metastases of urinary bladder cancers being the regional lymph nodes, liver, lung, bone, peritoneum, pleura, kidney, adrenal gland and intestines. Metastasis to non-regional lymph nodes especially cervical lymph nodes is extremely rare presentation. Metastasis to head and neck region is associated with poor prognosis and low survival rate. Here-in we report a case of cervical lymph node metastasis in patient with muscle invasive bladder cancer.

Kikuchi-Fujimoto Disease in a Filipino Boy: A Case Report

@#<p><strong>OBJECTIVE:</strong> To report a case of a 12-year-old boy with Necrotizing Lymphadenitis (Kikuchi-Fujimoto disease) presenting as lymphadenitis secondary to multiple diagnosis.</p><p> </p><p><strong>METHODS:</strong></p><p><strong>Design :</strong> Case Report</p><p><strong>Setting:</strong> Tertiary Private Hospital</p><p><strong>Patient:</strong> One</p><p> </p><p><strong>RESULTS:</strong> A 12-year-old boy consulted for two-month history of cervical lymphadenopathy with the underlying cause remaining unclear despite multiple consults, diagnosis and medical treatment. Lymphoma was considered and excision biopsy with further investigations confirmed a diagnosis of Kikuchi-Fujimoto disease. Supportive management was given with no recurrence of symptoms noted on 18 months of follow up. </p><p> </p><p><strong>CONCLUSION:</strong>  Kikuchi-Fujimoto disease in this case was a diagnosis of exclusion. Even with a proper history and physical examination, experts in otolaryngology can be misled to manage this case as malignant. Awareness of the disease and appropriate examinations including immunohistochemistry are important for a timely diagnosis and proper intervention.</p><p> </p><p><strong>KEYWORDS: </strong>lympadenitis; Kikuchi-Fujimoto disease; lymphoma; cervical lymph nodes</p>

Relationship between contrast-enhanced ultrasonography and two-dimensional ultrasound features of thyroid carcinoma and cervical lymph node metastasis / 中华内分泌外科杂志

Objective To explore the relationship between the features of thyroid carcinoma and its metas tasis to cervical lymph nodes(MCLN) with conventional and contrast-enhanced ultrasound imaging.Methods Totally 89 thyroid carcinoma nodules were used in this study.The pathology of those samples was confirmed by surgical pathology at the First Affiliated Hospital of Shanxi Medical University from Sep 1,2014 to Oct 30,2015.The samples were divided into two groups based on the surgical pathology report:the group with MCLN (49) and the group without MCLN (40).Using the pathology report as gold standard,we analyzed the conventional ultra sound features,contrast-enhanced ultrasound enhancement pattern as well as the quantitative parameters.Results ① There was statistically significant difference in tumor size,contact of the tumor with capsule or not,microcalcification of the tumor,as well as echo texture of the thyroid carcinoma nodules between the groups (P＜0.05).②) There was statistically significant difference in peak intensity (PI) between the two groups (P＜0.05).Conclusion There is a positive correlation between cervical lymph nodes metastasis and tumor size,with or without contact with fibrous capsule,with or without microcalcification,the internal echo as well as PI.

Research progresses in occult lymph node metastasis of oral squamous cancer / 口腔疾病防治

@#Oral cancer is a common malignant tumor in head and neck cancers, and the metastasis of cervical lymph nodes directly affects the prognosis of patients with oral cancer. Exploration and study on the detection of occult lymph nodes in patients with negative cervical lymph nodes is of great importance to improve the prognosis of patients with early oral cancer. This article reviews some progresses of occult lymph node metastasis of oral cancer in ultrasound guided fine-needle aspiration cytology (US-FNAC)、 positron emission tomography and single-photon emission computed tomography/computed tomography (SPECT/CT) fusion technology, sentinel lymph node biopsy technique (SLNB) and molecular biological detection、 nanotechnology and quantum dot technology.

Research progress of ultrasonography and computed tomography in the preoperative assessment of cervical lymph nodes metastases of esophageal cancer / 中华消化外科杂志

Esophageal cancer is one of the most common malignant tumors in China.At present, the best treatment of esophageal cancer is surgery.For the patients with cervical lymph nodes metastases, three-field lymph nodes dissection is the main solution.Ultrasonography and computed tomography (CT) of the neck play a decisive role in the preoperative examinations for patients with esophageal cancer, and should be used as routine examinations before surgery at the qualified hospital in order to improve the accuracy of preoperative assessment of cervical lymph nodes metastases of esophageal cancer and screen potential patients with esophageal cancer undergoing three-field lymph nodes dissection.

Analysis of FNAC of cervical lymph nodes: Experience over a two years period.

Background: Cervical lymphadenopathy is a common clinical presentation across patients of all age group. The aetiology may range from a benign nonspecific inflammation to lymphoproliferative disorders and metastatic malignancy. Aims & Objective: The present study was undertaken to study non neoplastic and neoplastic lesions of enlarged lymph nodes by Fine needle aspiration cytology (FNAC) in patients presenting with cervical lymphadenopathy referred to cytopathology department from the OPD/IPD of Civil Hospital, Ahmedabad over a period of two years (November 2011 to November 2013). Materials and Methods: A total of 2018 patients were subjected to FNAC of cervical lymph nodes over two years period (November 2011 to November 2013). Since in 113 patients, either the aspirate was inadequate or the opinion equivocal, the remaining 1905 cases were analysed. Results: Overall tuberculous lymphadenitis was the most common finding (898/1905, 46%), followed by reactive hyperplasia (624/1905, 33%). Malignant pathology accounted for 16% (306/1905) of cervical lymph node enlargement, most of which was due to metastatic squamous cell carcinoma (179/306, 58%). Conclusion: FNAC is an excellent first line of investigation and when used with a proper combination of experience and diligence, it can efficiently help at arriving in exact diagnosis.

The performance of color doppler flow imaging of cervical lymph nodes metastasized from nasopharyngeal carcinoma after induction chemotherapy / 中国基层医药

Objective To observe the performance of two-dimensional echocardiography and CDFI of metastatic cervical lymph nodes in nasopharyngeal carcinoma before and after induction chemotherapy,and to predict the short-term effect of the lymph nodes after sequential chemoradiotherapy.Methods Forty patients with sixty-five metastatic cervical lymph nodes which were confirmed as nasopharyngeal carcinoma by biopsy and CT were studied.CDFI was used to observe its size,the peak systolic velocity (PSV),resistivity index (RI),and record its classification of blood flow before and after induction chemotherapy,after radiotherapy 1 to 2 months for ultrasound,respectively,and the measured values and short-term effect in cervical lymph node metastasized were compared.Results According to the changes of blood supply after induction chemotherapy,lymph nodes were divided into three groups,the group of improve blood supply was given priority (55 ％),blood supply to reduce and no change groups were 23 ％,22％,respectively.After induction chemotherapy and sequential radiotherapy,all lymph nodes were narrow,regression rate after induction chemotherapy in blood supply to reduce,improve and no change groups were 52％,36％,25％,respectively,the regression rates of sequential chemoradiotherapy were 90％,81％,70％,respectively,among three groups are in degressive tendency,differences were significant (P ＜ 0.05).The blood supply changes after induction chemotherapy related well with the regression rate of chemotherapy(r =0.572,P =0.000) and sequential radiotherapy(r =0.553,P =0.000).The regression rate of chemotherapy related well with the regression rate of sequential chemoradiotherapy(r =0.621,P =0.000).After chemotherapy three groups of lymph node RI decreased,the difference was significant compared with that before treatment (P ＜ 0.05).After chemotherapy the groups to reduce and improve of PSV had significant differences compare with that before treatment (P ＜ 0.05),the group of blood supply no change of PSV had no significant difference (P ＞ 0.05).Conclusion Application of CDFI can clearly and accurately observe changes of metastatic cervical lymph nodes from nasopharyngeal carcinoma before and after induction chemotherapy,and the changes of blood supply and size after induction chemotherapy can predict the short-term effect after chemoradiotherapy.

Use of diffusion-weighted magnetic resonance imaging in cervical lymph node metastasis from nasopharyngeal carcinoma patients receiving intensity modulated radiation therapy / 中华放射医学与防护杂志

Objective To investigate the value of diffusion-weighted magnetic resonance imaging (DWI) and apparent diffusion coefficients (ADC) in detecting metastatic lymph nodes from nasopharyngeal carcinoma (NPC),and predicting the response of these nodes to concurrent chemoradiation (CRT).Methods Eighteen patients with pathologically proven NPC received conventional magnetic resonance imaging (MRI) and DWI before treatment,weekly during treatment,and one month after treatment.DWI was performed using a single-shot echo-planar (SSEPI) MR imaging sequence with b values of 0 and 1500 s/mm2.ADC maps were reconstructed for all patients and ADC values were calculated for each lymph node and tongue muscle.Totally fifty-two morphologically abnormal lymph nodes were analyzed.The ADC values of the metastatic lymph nodes before treatment were compared between those with the short axis≥10 mm (n=32) and those with the short axis<10 mm (n=20),and the dynamic changes in ADC values of the lymph nodes before,during,and after therapy were observed and recorded.Results The average ADC of the 32 lymph nodes with the short axis ≥ 10 mm was (0.71±0.12) x 10-3mm/s,not significantly different from that of the 20 lymph nodes with the short axis < 10 mm [(0.73±0.16) x 10-3mm/s,t = 1.11 ,P =0.27].The average ADC values of these lymph nodes before treatment was significantly lower than that of the tongue muscle (t = 19.35,P < 0.0001).During CRT,the ADC values of the lymph nodes increased gradually,with the most evident change in the first two weeks before reaching a relatively flat plateau thereafter.The ADC value of the residual lymph nodes after CRT was significantly higher than that before treatment (t = 12.72,P < 0.0001),however,not statistically significant different from that of the normal tongue muscle (t = 0.34,P = 0.73).Conclusions DWI plays an important role in diagnosing the metastatic lymph nodes from NPC and is feasible for observation of the early response of the lymph nodes to IMRT,thus helping the clinicians make appropriate treatment planning and replanning in the course of radiotherapy.

Thyroglobulin measurements in washout of fine needle aspirates in cervical lymph nodes for detection of papillary thyroid cancer metastases / Determinação da tireoglobulina no lavado da agulha da punção aspirativa de linfonodos cervicais para detecção de metástases do câncer papilar de tireoide

OBJECTIVE: The aim of this study was to evaluate the accuracy of the measurement of thyroglobulin in washout needle aspiration biopsy (FNAB-Tg) to detect papillary thyroid cancer (PTC) metastases. SUBJECTS AND METHODS: Forty-three patients (51.4 ± 14.6 years) with PTC diagnosis and evidence of enlarged cervical lymph nodes (LN) were included. An ultrasound-guided fine-needle aspiration of suspicious LN was performed, for both cytological examination and measurement of FNAB-Tg. RESULTS: The median values of FNAB-Tg in patients with metastatic LN (n = 5) was 3,419 ng/mL (11.1-25,538), while patients without LN metastasis (n = 38) showed levels of 3.7 ng/mL (0.8-7.4). Considering a 10 ng/mL cutoff value for FNAB-Tg, the sensitivity and specificity was 100 percent. There were no differences on the median of FNAB-Tg measurements between those on (TSH 0.07 mUI/mL) or off levothyroxine (TSH 97.4 mUI/mL) therapy (3.3 vs. 3.8 ng/mL, respectively; P = 0.2). CONCLUSION: The results show that evaluation of FNAB-Tg in cervical LN is a valuable diagnostic tool for PTC metastases that can be used independent of the thyroid status.

OBJETIVO: O objetivo deste estudo foi avaliar a acurácia da dosagem de tireoglobulina no lavado da agulha da punção aspirativa (PAAF-Tg) de linfonodos (LN) cervicais para detecção de metástases do câncer papilar de tireoide (CPT). SUJEITOS E MÉTODOS: Foram incluídos 43 pacientes (51,4 ± 14,6 anos) com diagnóstico de CPT e evidência de LN cervicais aumentados. Os LN suspeitos foram submetidos à punção aspiração com agulha fina guiada por ecografia para análise citológica e dosagem de tireoglobulina (PAAF-Tg). RESULTADOS: A mediana dos valores de PAAF-Tg nos LN metastáticos (n = 5) foi 3.419,0 ng/mL (11,1-25.538), enquanto nos LN não metastáticos (n= 38) a mediana foi de 3,7 ng/mL (0,8-7,4). Utilizando-se o nível de 10 ng/mL como ponto de corte, observaram-se sensibilidade e especificidade de 100 por cento. Os níveis de TSH sérico não interferiram na dosagem de PAAF-Tg (3,3 e 3,8 ng/mL nos grupos com TSH supresso (TSH 0,07 mUI/mL) e hipotireoidismo (TSH 97,4 mUI/mL), respectivamente, P = 0,2). CONCLUSÃO: Os resultados demonstram que a dosagem de PAAF-Tg é uma ferramenta importante no diagnóstico de metástases do CPT, podendo ser utilizada independente do "status" tireoidiano.

Significance of ¹⁸F FDG PET-CT for Preoperative Diagnosis of Cervical Lymph Nodes Metastasis in Papillary Thyroid Carinoma / 대한내분비외과학회지

PURPOSE: To compare the diagnostic accuracy of US/CT with US/CT/¹⁸F-FDG PET-CT in the diagnosis of cervical lymph nodes metastasis in papillary thyroid carcinoma. METHODS: From July 2008 to May 2010, 36 patients with papillary thyroid carcinoma, confirmed by aspiration cytology analysis, underwent neck US, neck CT and ¹⁸F-FDG PET-CT preoperatively. The sensitivity, specificity and diagnostic accuracy of the US/CT, US/CT/PET-CT was analyzed according to lymph node level (all: levels I~VI, central: level VI, lateral: levels I~V). RESULTS: At all lymph nodes group (level I~VI), US/CT/ PET-CT showed a sensitivity of 66.6%, a specificity of 61.9% and a diagnostic accuracy of 63.8%. The corresponding values for US/CT were 60.0%, 85.7%, 75.0% respectively. Considering the central cervical nodes group (level VI), US/CT/PET-CT showed a sensitivity of 57.1%, a specificity of 68.1%, and a diagnostic accuracy of 63.8%. The corresponding values of US/CT were 57.1%, 90.9%, 77.7% respectively. Considering the lateral cervical nodes group (level I~V), US/CT/PET-CT showed a sensitivity of 100%, a specificity of 84.3%, and a diagnostic accuracy of 86.1%. The corresponding values of US/CT were 75.0%, 84.3%, 83.3% respectively. The diagnostic results of US/ CT, US/CT/PET-CT in initial evaluation of the cervical nodes metastasis did not differ significantly. CONCLUSION: Our preliminary results suggest that additional PET-CT evaluation in US/CT does not provide statistically significant benefit for initial diagnosis of cervical lymph nodes metastasis in papillary thyroid carcinoma.

An Outbreak of Oropharyngeal Tularemia with Cervical Adenopathy Predominantly in the Left Side

PURPOSE: We describe the epidemiological and clinical characteristics and the efficacy of a delayed initiation to therapy in an oropharyngeal tularemia outbreak in Duzce, Turkey. MATERIALS AND METHODS: Between March and June 2000, 22 patients with tularemia were diagnosed by microagglutination tests. RESULTS: Oropharyngeal and ulceroglandular forms of the disease were discovered. Most of the cases were oropharyngeal (19 cases). The most common symptoms were sore throat (95.4%) and fever (90.9%). Lymphadenopathy (95.4%) and pharyngeal hyperemia (81.8%) were usually observed signs. The lymphadenopathies were localized especially in the left cervical region (66.7%), a finding that has not been previously reported in the literature. The time between the onset of the symptoms and diagnosis was 40.7 +/- 22.8 (10 - 90) days. The patients were treated with streptomycin plus doxycycline and ciprofloxacin. The patients' recoveries took up to 120 days. CONCLUSION: This report describes the first outbreak of tularemia in northwest Turkey. Tularemia may occur in any region where appropriate epidemiological conditions are found and should be kept in mind for differential diagnosis in oropharyngeal symptoms. Late initiation of therapy may delay complete recovery. In this outbreak, cervical lymph nodes predominantly localized on the 1eft side were found, which had not been previously reported.

Usefulness of Preoperative Ultrasound-guided Localization of Cervical Lymph Nodes with Skin Marking in Papillary Thyroid Cancer Patients / 대한내분비외과학회지

PURPOSE: To assess the value of preoperative ultrasonography (US) - guided skin marking for the investigation of cervical lymph node (LNs) metastasis in papillary cancer patients who had not undergone evaluation of cervical LNs at the initial diagnosis. METHODS: We evaluated cervical lymph nodes in 40 patients with papillary thyroid cancer. Ultrasonography wasperformed just prior to surgery. The shape, echogenicity, size, and location of lymph nodes were noted and the location of lymph nodes was marked on the skin surface with a pen under ultrasound guidance. The retrieved lymph nodes underwent intraoperative frozen section analysis to plan the extent of surgery. RESULTS: One hundred thirty two LNs were detected on preoperative US, 1087 LNs were surgically removed. Of 40 patients, 28 patients had lymph node metastasis. The cystic appearance, the presence of calcifications, hyperechogenicity and the absence of an echogenic hilum were significantly greater in malignant LNs than in benign LNs (P< 0.001). Among these, the cystic appearance and the presence of calcifications showed a very high specificity and seemed to be the most reliable in indicating malignant LNs. CONCLUSION: In papillary thyroid cancer patients, preoperatively ultrasound-guided localization of cervical LNs with skin marking shows good potential to determine surgical extent. Ultrasound features of LNs help in the selection of the node to remove with intraoperative frozen section analysis.

The Clinical Significance of a Minimal Extra-thyroidal Extension of Papillary Thyroid Cancer for the Recurrence of Regional Cervical Lymph Nodes

PURPOSE: Extra-thyroidal extension has been recognized as a poor prognostic factor for increased regional recurrence risk in papillary thyroid carcinoma, and is known to require treatment that is more aggressive. In the recent UICC TNM 6th Classification, an extra-thyroidal extension was divided into a minimal extra-thyroidal extension (T3) and a massive extra-thyroidal extension (T4). The aim of this study was to investigate the clinical effect of a minimal extra-thyroidal extension of a papillary carcinoma for the recurrence of regional cervical lymph nodes. METHODS: We retrospectively studied 154 patients with papillary thyroid carcinoma where a thyroidectomy was performed from Feb. 2003 to May. 2006 at the Department of Surgery, with the exclusion of 6 patients with a massive extra-thyroidal extension. We divided the cases into a no extra-thyroidal extension group and a minimal extra-thyroidal extension group according to the grading of the extra-thyroidal extension. The grading of the extra-thyroidal extension was based on both pathological findings and intraoperative surgical findings. Clinicopathological factors associated with each group were analyzed by univariate and multivariate analysis. We divided the cases into two groups according to age ( or =45 yrs) and lymph node status (positive, negative), and compared each group with regards to disease free survival according to the grading of the extra-thyroidal extension. RESULTS: By univariate analysis, a minimal extra-thyroidal extension was related to lymph node metastasis, tumor size, mutifocality (P0.05). CONCLUSION: We need to downstage to less than T3 for a minimal extra-thyroidal extension because there is no significant difference in disease free survival according to the grading of an extra-thyroidal extension in patients with papillary thyroid carcinoma.

Ultrasonographic Segmentation of Cervical Lymph Nodes Based on the Graph Cut with Elliptical Shape Constraint / 航天医学与医学工程

Objective To propose a modified graph cut algorithm under the elliptical shape constraint to segment the ultrasonogram of cervical lymph nodes. Methods Since cervical lymph nodes were usually oval-shaped, the prior of the elliptical shape information, which was expressed as a distance function, was used to constrain the cut cost of the graph cut algorithm. The initially segmented contour was fitted with an ellipse to get the constraint. Then a certain segmentation was obtained by minimizing the cut cost function constrained with the elliptical prior. This procedure was iterated until it to be convergent. Results Under the same user input, this algorithm successfully segmented nodes on the low contrast ultrasonograms, while the traditional graph cut approach failed. For 20 ultrasonograms, with the average minimum Euclidean distance (AMINDIST) measure and the Hausdorff distance measure, these two distances between contours manually delineated by the radiologist and those segmented by this algorithm were far less than the distances resulted from the traditional graph cut algorithm. Conclusion It is indicated that utilizing the elliptical shape constraint prior can obviously improve the graph cut algorithm for segmenting cervical nodes on ultrasonograms.

Tuberculosis of the cervical lymph nodes.

Analysis of 188 patients with pathological diagnosis of tuberculosis or findings consistent with tuberculosis of the cervical lymph nodes during the period 1985-1988 disclosed the following pertinent findings: (1) The histo-pathological diagnoses, based on findings of chronic granuloma with or without the presence of acid-fast bacilli (AFB) on staining, were “probable tuberculosis” in 38.8 percent of the cases, and “consistent with tuberculosis” in 61.2 percent of them. It is worthy of note that proof for AFB in the 1973 report (from the same laboratory) was available only in 1.58 percent of the cases.1 (2) The supraclavicular group was the frequently diseased of the lymph nodes as found in a previous study;1 this finding also conforms to the high incidence of palpable supraclavicular lymph nodes in pulmonary tuberculosis patients.5 This persistent prevalence of the site of tuberculous involvement may be used as evidence in support of early post-primary haematogenous dissemination of the pathogenic organism, rather than the less occurring lymphogenous spread from the site of upper digestive tract infection, as recently suggested.4

Changes of bcl-2, bax expression and neuron apoptosis in lymphostatic encephalopathy of rats / 中国病理生理杂志

AIM: To investigate the changes of bcl-2, bax expression and neuron apoptosis of cerebral cortex in lymphostatic encephalopathy of rats. METHODS: The model of lymphostatic encephalopathy was established by occluding and removing both the shallow and deep cervical lymph nodes in rats. The animals were sacrificed at 1, 2, 3, 5, 7 and 14 days after operation. HE staining was used to observe the structure of brain tissues and TUNEL staining was used to detect in situ cell apoptosis. The expressions of bcl-2 and bax were examined by RT-PCR. RESULTS: Cerebroedema appeared at the second day and was the most serious at the 5th day after blockage of cervical lymphatics. The number of TUNEL positive cells and the expression of bax began to increase at the 2nd day, reached a peak at the 5th day and dropped to control level at the 14th day. The expression of bcl-2 began to increase at the 1st day, reached a peak at the 5th day and dropped to control level at the 7th day. The increasing extent of bax was higher than that of bcl-2. CONCLUSION: The blockage of cervical lymphatics can lead to lymp[JP2]hostatic encephalopathy. Apoptosis is the main form of neuron death in the cortex and has relation to the increasing expression of bcl-2 and bax. [JP]