Mediastinal lymph node distribution, size and number: definitions based on an anatomical study.

OBJECTIVE: To create a reference map of mediastinal lymph nodes through the analysis of their size, number and distribution in various lymph node stations. METHOD: A total of 50 cadavers, 38 males and 12 females, were studied. Of those 50, 39 were Caucasian. The mean age was 59.9 +/= 14.1 years, the mean height was 173.1 +/= 7.6 cm, and the mean weight was 71.0 +/= 12.0 kg. A bilateral mediastinal dissection was performed in order to resect and isolate all lymph nodes. The area, as well as the major and minor transverse diameters, of each lymph node was determined by radiographic imaging analysis. RESULTS: In a sample of 485 chains, 1742 lymph nodes were dissected (2.58 +/= 1.89 lymph nodes/station), revealing a mean number of 21.2 +/= 8.5 lymph nodes on the right and 13.6 +/= 6.3 on the left. The lymph node stations 1, 2R, 4R, 5, and 7 were present in more than 90% of the sample. Only the 4R and 7 lymph node stations were always present. The lymph node stations 2L, 3p, and 8 were present in 32, 36, and 54% of the sample, respectively. Mediastinal lymph nodes were present in greater numbers in the 2R, 4R and 7 lymph node stations. In addition, these stations presented the largest mediastinal lymph nodes. CONCLUSION: Composing a reference map for lymph node sizes was feasible. No alterations were observed in the distribution, number, or size of lymph nodes in the age brackets studied, regardless of gender, race, weight, or height.

Distribuição, tamanho e número dos linfonodos mediastinais: definições por meio de estudo anatômico / Mediastinal lymph node distribution, size and number: definitions based on an anatomical study

OBJETIVO: Criar um mapa de referência dos linfonodos mediastinais através da análise de seu tamanho, número e distribuição nas diversas cadeias. MÉTODO: Um total de 50 cadáveres foram estudados, 38 do sexo masculino e 12 do feminino, sendo 39 brancos, com média de idade de 59,9 ± 14,1 anos, altura de 173,1 ± 7,6 cm e peso de 71,0 ± 12,0 kg. A dissecção do mediastino foi realizada bilateralmente, sendo todos os linfonodos ressecados e isolados. A área e os diâmetros transversos maior e menor de cada linfonodo foram determinados por análise de imagem. RESULTADOS: Em 485 cadeias, foram dissecados 1742 linfonodos (2,58 ± 1,89 linfonodos/cadeia). Observou-se uma média de 21,2 ± 8,5 linfonodos à direita e 13,6 ± 6,3 à esquerda. As cadeias 1, 2R, 4R, 5, e 7 estão presentes em mais de 90 por cento da amostra. Apenas as cadeias 4R e 7 estiveram sempre presentes. As cadeias 2L, 3p e 8 estiveram presentes em 32, 36 e 54 por cento, respectivamente. Os linfonodos mediastinais estão presentes em maior número nas cadeias 2R, 4R e 7. Estas mesmas cadeias também congregam os maiores linfonodos mediastinais. CONCLUSÃO: A composição de um mapa referencial para os tamanhos linfonodais foi factível. A distribuição, número e tamanho dos linfonodos não se alteraram no intervalo de idades estudado e não sofreram influência do sexo, raça, peso ou altura.

OBJECTIVE: To create a reference map of mediastinal lymph nodes through the analysis of their size, number and distribution in various lymph node stations. METHOD: A total of 50 cadavers, 38 males and 12 females, were studied. Of those 50, 39 were Caucasian. The mean age was 59.9 ± 14.1 years, the mean height was 173.1 ± 7.6 cm, and the mean weight was 71.0 ± 12.0 kg. A bilateral mediastinal dissection was performed in order to resect and isolate all lymph nodes. The area, as well as the major and minor transverse diameters, of each lymph node was determined by radiographic imaging analysis. RESULTS: In a sample of 485 chains, 1742 lymph nodes were dissected (2.58 ± 1.89 lymph nodes/station), revealing a mean number of 21.2 ± 8.5 lymph nodes on the right and 13.6 ± 6.3 on the left. The lymph node stations 1, 2R, 4R, 5, and 7 were present in more than 90 percent of the sample. Only the 4R and 7 lymph node stations were always present. The lymph node stations 2L, 3p, and 8 were present in 32, 36, and 54 percent of the sample, respectively. Mediastinal lymph nodes were present in greater numbers in the 2R, 4R and 7 lymph node stations. In addition, these stations presented the largest mediastinal lymph nodes. CONCLUSION: Composing a reference map for lymph node sizes was feasible. No alterations were observed in the distribution, number, or size of lymph nodes in the age brackets studied, regardless of gender, race, weight, or height.

Nuclear markers (star volume, mitotic index, AgNOR and Ki-67) of the primary tumor and its metastasis in non-small cell lung carcinomas.

Although tumor growth is controlled by growth rate and cell cycle, it is also likely that the proliferative activity of tumor cells can influence the growth rate of the primary cancer and account for their aggressiveness. Variations in growth rate, cell cycle control and proliferative activity could, in part, explain differences in invasive and metastatic properties among non-small cell lung carcinomas (NSLC). The purpose of this report is to: (1) evaluate growth rate by using growth- and cell cycle-regulating markers (mitotic count, nuclear star volume, AgNOR, and Ki-67) as reflections of growth rate and (2) compare the indices of primary NSLC with the indices of their metastasis in a series of patients with advanced disease. Thirty-three patients with non-small cell lung cancer and hematogenous metastases were retrospectively studied by histochemical, immunohistochemical, and morphometrical investigations. Clinical variables were examined for differences in the frequency of histological subtypes, nuclear star volume, mitotic index, AgNOR area, and Ki-67 immunohistochemistry indices of expression in subgroups of patients stratified by primary tumor and hematogenic metastasis. The impact of these factors on overall follow-up was analyzed. In the samples available in this study, consisting of primary-met paired tumors, which are unique and rarely available for studies of lung cancer, we found that nuclear star volume and mitotic index in metastatic tumors were significantly higher than in the primary tumors. Although there was no significant difference between the Ki-67 index of metastatic and primary tumors, the Ki-67 index in metastatic brain tumors was significantly higher than in the corresponding primary tumors. Examination of Kaplan-Meier survival curves demonstrated that patients with metastatic tumors showing AgNOR area higher than 10.82 microm2 and nuclear star volume lower than 559.50 microm3 had approximately the same odds ratio (log rank of 4.16 and 3.25, p = 0.04 and 0.01, respectively) for survival with a median survival time equal to 17 months for both groups. Analysis of the remaining marker correlation had no impact on survival. We conclude that these results offer future possibilities for more complex studies, including the results of additional immunohistochemical analysis using molecular markers that are known to be important in regulating cell proliferation, e.g., cyclin D1, p27, and cyclin E. These would influence clinical decisions or different therapeutic approaches in advanced stage disease of non-small cell lung cancer.

Fístula bílio-brônquica: relato de caso e revisäo de literatura / Bronchobiliary fistula: case report and literature review

No presente trabalho é relatado um caso de paciente protadora de fístula bílio-brônquica (FBB) secundária e coledocolitíase tratada no Hospital da Universidade de Mogi das Cruzes e é feita uma revisao da literatura pertinente ao assunto. Tratava-se de uma paciente, 35 anos, feminino, parda, cujo quadro clínico inicial era dor em hipocôndrio direito, de caráter contínuo, acompanhada de icterícia do tipo obstrutivo e bilioptise que atingia até um litro em 24 horas. O diagnóstico foi confirmado por radiografia simples de abdome e ultra-sonografia abdominal. O tratamento consistiu em laparotomia, colecistectomia, coledocotomia com retirada de dois cálculos, drenagem de vias biliares, colangiografia intra-operatória e liberaçao da cápsula hepática da cúpula frênica direita. A evoluçao pós-operatória foi satisfatória, com regressao da bilioptise no pós-operatório imediato. Houve regressao progressiva da icterícia em torno do sétimo dia do pós-operatório. A paciente foi estudada com broncografia após 24 meses que mostrou nao haver alteraçoes anatômicas dos brônquios basilares direitos pela inundaçao biliar. A paciente encontra-se no sétimo ano de seguimento sem evidência da doença.