Benign glandular elements and decidual reaction in retroperitoneal lymph nodes

Among 70 patients with gynecologic malignancies who underwent surgical staging and pelvic and periaortic lymphadenectomy, five were found to have benign glandular and/or stromal elements in the retroperitoneal lymph nodes. In three instances, these were originally diagnosed as metastatic cancer. The literature on this subject is reviewed and its significance is discussed.     

Distribution of platinum in human gynecologic tissues and pelvic lymph nodes after administration of cisplatin

OBJECTIVE: The purpose of this study was to develop a diverting colostomy technique for use in dogs. STUDY DESIGN: Clinical case series. ANIMALS: Five client-owned dogs presented for diseases requiring diverting colostomy during treatment. METHODS: Diverting colostomy was performed in five dogs. A ventral approach was used in the first dog and the colon was exteriorized adjacent to the linea alba. The technique used in the next four dogs involved creation of a left flank rod-supported loop colostomy in which the colon was exteriorized through a muscle-separating flank approach to the abdomen. RESULTS: Peritoneal leakage of fecal material resulted in the perioperative death of the first dog. The flank colostomies were maintained for times ranging form 3.5 weeks to 7 months. No major complications were observed, but skin excoriation occurred occasionally around the stoma sites in all dogs. CONCLUSION: Diverting colostomy is a technique that is suitable for use in treatment of dogs with obstruction or leakage involving the distal colon or rectum.     

Ras-p21,p53在阴茎癌腹股沟淋巴结中的表达及临床意义

Objective: The aim of this study was to investigate the expression and clinical significance of ras-p21 and p53proteins in inguinal lymph nodes with penis carcinoma. Methods: The clinical data of 44 patients of penis (squamous) carcinoma and 40 non-tumor patients from 1990 to 2002 in our hospital were added to our research, 84 inguinal lymph nodes were got by lymph node biopsy from each patient at random. Pathological examination showed that 18 cases of cancer group were metastatic carcinoma as group A, the other 26 cases were inflammatory affection as group B. 20 cases of non-tumor group were nonspecific inflammatory inguinal lymph nodes as group C and the other 20 cases were normal lymph nodes as group D, all the 84 cases in our research were investigated by immunohistochemistry to detect the expression of ras-p21 and p53protein. Results: Immunohistochemistry demonstrated that the expression of as-p21 and p53 protein were significantly higher in cancer group A (88.89%, 72.22%) and B (30.77%, 23.08%) than in control group C (5%, 0%) and group D (0%, 0%.). The expression of two proteins showed significant differences between group A and group B (P ＜ 0.01), and no significant differences between group B and group C (P ＞ 0.05). The expression of two proteins showed significant difference between group A and control group (C + D) (P ＜ 0.01). The expression of two proteins showed significant differences between cases of cancer groups (A + B) and control groups (C + D) (P ＜ 0.01). Significant differences were showed between group (A + B) and group D with the expression of ras-p21 and p53 (P ＜ 0.01). The expression of ras-p21 and p53 in three different differentiated groups were G1 (well-differentiated) group: (22.73%, 13.64%), G2 (moderate-differentiated) group: (81.25%, 68.75%), G3 (poorly differentiated) group: (100%, 83.33%). There was significant differences between G1 group and G3 group (P ＜ 0.05), and no significant differences between G1 group and G2 group, G2 group and G3 group (P ＞ 0.05). There was significant differences between three clinical stages with the expression of ras-p21 and p53 (P ＜ 0.05). Conclusion: Ras-p21 and p53 protein werehighly expressed in cancer groups in this study, while, two proteins hardly detected from control groups. If the inflammatory lymph nodes of penile cancer patients show the positive expression of p21 and p53 protein, the inguinal lymph nodes also need dissection, which is important to improve the diagnosis of inguinal lymph node metastasis rate and patient survival of penile cancer. Ras-p21 and p53 protein detection can act an objective indicator of tumor metastasis and prognosis, and also for our treatment of penile cancer in the inguinal lymph node dissection surgery provides determine indicators.     

Colour Doppler flow in normal axillary lymph nodes

81 women with carcinoma of the breast who underwent axillary nodal dissection were studied pre-operatively with colour Doppler ultrasound. The presence of colour Doppler flow was demonstrated in 83.6% of normal lymph nodes compared with 87.5% of metastatic lymph nodes. Using the presence of colour Doppler signal as the sole diagnostic criterion for the diagnosis of metastasis gave a sensitivity of 92.5%, specificity of 9.52%, accuracy of 50%, positive predictive value of 49.3% and negative predictive value of 57.1%. Using grey scale sonographic criteria, where a metastatic node was defined as a node with loss of central fatty hilum and/or eccentric cortical hypertrophy, a sensitivity of 79.5%, specificity of 94.0%, accuracy of 87.6%, positive predictive value of 91.2% and negative predictive value of 85.5% were obtained. Colour Doppler studies of the axillary nodes in a second group of 106 women who attended for breast cancer screening and had no significant breast or axillary pathology also showed colour Doppler signal in 86.7% of nodes. It is concluded that colour Doppler flow signals can be demonstrated in both normal and metastatic axillary lymph nodes, and is highly non-specific when used as the sole diagnostic criterion in the diagnosis of malignancy.     

Tumors of the retinal pigment epithelium metastasize to inguinal lymph nodes and spleen in tyrosinase-related protein 1/SV40 T antigen transgenic mice

The pigment epithelium of the retina (RPE) is derived from the optic cup and is essential for function and development of the eye. We produced a transgenic mouse line that expresses simian virus (SV40) transforming sequences under control of the 1.4 kb tyrosinase-related protein 1 (TRP-1) promoter, targeting expression of T antigen (Tag) to the RPE. In transgenic embryos, RPE cells proliferated in the anterior part of the eye and near the optic nerve. This resulted in formation of tumors, which were pigmented and of epithelial origin. In 3 months-old mice, pigmented cells were detected in spleen and inguinal lymph nodes. In spleen, tyrosinase, TRP-1 and SV40 Tag were expressed and tyrosinase was enzymatically active. Pigmented regions were positive for an epithelial marker, cytokeratin. Cell lines were established from tumor and metastases and kept in culture for more than 2 months. These were pigmented, and maintained expression of tyrosinase, TRP-1, cytokeratin and SV40 Tag. This demonstrates that RPE tumor cells metastasize to lymph node and spleen. In conclusion, the metastasis from TRP-1/Tag RPE tumors towards spleen and lymph nodes serves as potential tool to investigate biology and metastasis of tumors derived from the pigment epithelium.     

Dexamethasone stimulation of glutaminase expression in mesenteric lymph nodes

Cystic lymphatic malformations (CLM) are superficial vascular hemodynamically inactive malformations of the lymphatic compartment. We propose a new approach which uses a sclerosing agent as an alternative to surgical resection. In the past nine years we treated 70 patients with CLM. Fifty-five percent were younger than five years of age with a male preponderance and most (80%) of the CLM were located in the maxillofacial region. They usually presented with functional impairment from the mass effect; others had infections, bleeding, or inflammation. The CLM were injected under fluoroscopic control with a sclerosing agent, Ethibloc, which dries up the pockets and reduces the mass. On follow-up the results were good in 62%, unchanged in 5%, and continued progression in 20%. Fifteen percent underwent surgery failures (24%) occurred in mixed forms of cystic and cellular lymphangiomas. Complications were minors. Percutaneous embolization is useful for CLM, with minimal risk, absence of scar, and it avoids surgery. It should be the first line of treatment for these lesions.     

Magnetic resonance spectroscopy detects cancer in draining lymph nodes

The spread of cancer cells to draining lymph nodes is an important prognostic factor for many cancers and influences postoperative therapy in patients. Histopathology is used routinely to assess if lymph nodes contain metastases. There are, however, time and resource constraints on the volume of lymph node tissue that can be examined by the pathologist in a routine laboratory (less than 2% of each node), thus major sampling errors are possible. Conventional histopathology also relies on identifying aggregates of malignant cells for a positive diagnosis. Proton (1H) magnetic resonance (MR) spectroscopy can detect chemical changes, specifically increased levels of lactate, choline, fucose and amino acids, in lymph nodes infiltrated by cancer. Increase in lactate indicates the presence of anaerobically respiring cells, whereas choline reports that the cells are replicating. Since MR spectroscopy can identify early infiltration by malignant cells, before cell clusters are visible under the light microscope, it detects micrometastases in lymph nodes missed histopathologically. Furthermore, MR spectroscopy eliminates sampling errors since the entire lymph node is examined.     

Technetium-99m-MDP uptake in hilar lymph nodes in sarcoidosis

We describe a patient with unexplained hypercalcemia who under went bone scintigraphy, which demonstrated marked tracer uptake within the hilar lymph nodes. The pattern strongly suggested sarcoidosis, which was subsequently confirmed by bronchoscopy-directed biopsy.     

Peroperative radiologic findings of axillary lymph nodes in breast cancer

The series consists of 49 operable breast cancers, prospectively registered over a five month period. The removed axillary fat was peroperatively radiologically examined by trained radiologist, and the result was reported to the surgeon. Afterwards it was sent to the pathologist for a thorough histopathological examination. Peroperative radiographic examination showed that 30.6% of the resected axillary fat contained less than ten lymph nodes. Subsequent pathological examination found that only 8.2% actually contained less than ten lymph nodes. We conclude that peroperative radiological examination of removed axillary fat is not a reliable method to assess the number of lymph nodes removed during the surgical procedure. In our hands, a careful anatomical dissection removing all axillary fatty tissue and lymphatics including level I and II seems to be the method of choice.     

Pathology of the lymph nodes in patients with malignant melanoma

The poor survival rate for patients with regional lymph node metastases of malignant melanoma reflects the strong association between lymph node and subsequent visceral metastases. The authors discuss clinical considerations, pathologic risk factors, selective lymphadenectomy, examination of lymph node dissections, difficulties of diagnosis, and prognosis.     

Malignant blue nevus with metastasis to lymph nodes and brain

We report a patient who developed malignant transformation of a cellular blue nevus. At the age of 19 years the congenital, pigmented tumor on the left buttock was histopathologically diagnosed as cellular blue nevus. Thirty years later the tumor dramatically increased in size, involving the entire left buttock within several months. Multiple biopsies revealed the presence of a cellular blue nevus within the papillary dermis and an invasive, pleomorphic pigmented sarcoma in the depth of the tissue spreading into subcutis and skeletal muscle. Both benign and malignant cells were S100+, vimentin+ and HMB-45+, but only the malignant tumor cells stained positive for the proliferating cell nuclear antigen. General examination disclosed multiple metastases in the paraaortal lymph nodes and the retroperitoneum as well as a single brain metastasis. Despite palliative therapy with ionizing radiation and chemotherapy, the patient developed generalized metastases and died within weeks. This case clearly confirms that cellular blue nevi have the potential for malignant transformation and that the malignant variant may behave aggressively just as a malignant melanoma.     

Differentiation between benign and metastatic cervical lymph nodes with ultrasound

OBJECTIVE: The differentiation between benign and metastatic lymph nodes with ultrasound (US) is based primarily on the evaluation of size, shape, margin and internal echo structure. The aim of this study is to determine whether these parameters are reliable indicators and to correlate internal echo structure and histopathological findings. MATERIALS AND METHODS: Seventy-one nodes in 21 patients with pathologically proven oral squamous cell carcinoma were examined. The shortest diameter, the short/long diameter ratio (S/L ratio), margins and internal echo structure of the lymph node were evaluated by US. The internal echo structure was divided into six patterns: homogeneous hypoechoic, homogeneous hyperechoic, heterogeneous, eccentric hyperechoic, centric hyperechoic and anechoic pattern. In addition, internal echo structure was correlated with histopathological findings. RESULTS: In 71.4% of the metastatic nodes, the shortest diameter was more than 10 mm and the S/L ratio was higher than that of benign nodes (average 0.71). Eleven (84.6%) of the 13 lymph nodes with irregular margins were metastatic. Heterogeneous and anechoic patterns were observed in metastatic nodes, whereas homogeneous hypoechoic and eccentric hyperechoic patterns were present in benign nodes. On ultrasonography with the corresponding histopathological findings, echogenic areas in the homogeneous hyperechoic, heterogeneous and centric hyperechoic patterns of metastatic nodes proved to be necrosis or fibrosis. Eccentric hyperechoic areas in benign nodes corresponded to the hilus and surrounding fatty tissue. CONCLUSIONS: The shortest diameter, S/L ratio, margin and internal echo structure were considered to be critical indicators to differentiate between benign and metastatic nodes. Secondary changes caused by tumour infiltration, necrosis, or fibrosis should be assessed when metastatic lymph nodes are differentiated from benign ones by internal echo structure.     

Breast carcinoma associated with necrotic granulomas in axillary lymph nodes

Administration of leptin during undernutrition improves reproductive function, but whether this occurs at the level of the brain, pituitary, or gonads is not yet clear. The present study tested the hypothesis that one important mechanism is the control of pulsatile gonadotropin-releasing hormone (GnRH) secretion. Our approach was to determine if leptin could prevent the marked suppression of pulsatile luteinizing hormone (LH) secretion which occurs during fasting. Leptin (3 micrograms/g i.p.; three times/48 h) or vehicle was administered during a 48-hour fast in adult ovariectomized and estrogen-treated ovariectomized rats (n = 5-7/group). LH was measured in blood samples collected every 6 min for 2 h before and after fasting. In vehicle-treated animals, plasma insulin and leptin levels decreased after fasting. As expected, the LH pulse frequency also decreased markedly. When circulating leptin remained artificially elevated during fasting, the suppression of LH pulse frequency did not occur. Leptin treatment maintained a high LH pulse frequency in the presence or absence of estrogen. The finding that leptin modulates LH pulse frequency indicates that this fat-derived hormone conveys information about nutrition to mechanisms which regulate pulsatile gonadotropin-releasing hormone secretion. Because this occurs in the absence of estrogen, the mechanism does not necessarily involve modulation of negative feedback.     

Lymphocyte emigration from high endothelial venules in rat lymph nodes

Sequential events during lymphocyte emigration from high endothelial venuses (HEV) were studied by scanning and transmission electron microscopy combined with regional perfusion techniques. The results indicate that blood lymphocytes selectively adhere to HEV surfaces through microvilli which attach to shallow pits on the luminal surfaces of high endothelial cells. These intercellular contact points resist hydrodynamic and osmotic shearing forces, but can be disrupted by treatments which remove endothelial glycocalyx, hydrolyse lymphocyte surface glycoproteins, or chelate divalent cations. After this initial attachment phase, lymphocytes enter apical clefts between endothelial cells where they assume a motile configuration characterized by loss of microvilli and formation of irregular surface folds. Intramural lymphocytes adhere to adjacent endothelial cells through macular and villous contacts. Fibrillar electron-dense material traverses the 15-20 nm gap at these points of adhesion. Microtubules and microfilaments are also seen around areas of cytoplasmic constriction in these motile lymphocytes. The migrating lymphocytes show cytoplasmic polarity which is oriented in the direction of movement as they pass through extracellular spaces in the venular wall and cross successive laminations in the perivascular sheath to enter the node. Since these lymphocytes enter channels between endothelial cells which are stained by intralymphatic injections with horseradish peroxidase, it is suggested that their entry into the node depends upon migration along a chemotactic gradient.     

Ultrasonographic appearance of normal superficial cervical and subiliac lymph nodes in cattle

The superficial cervical and the subiliac lymph nodes of 18 healthy, non-pregnant Simmental cows with a mean (sd) age of 5-6 (1.6) years were examined ultrasonographically in transverse and longitudinal planes with a real-time B-mode unit equipped with a 7.5 MHz linear-transducer. The position, demarcation and echogenicity of the lymph nodes were examined, and the craniocaudal and lateromedial diameters of each lymph node were measured three times within a period of six weeks. The pole to pole length of the lymph nodes was determined with a tape measure on the surface of the skin because the whole length could not be imaged in a single scan field. The gross anatomical and histological results showed that the lymph nodes were normal. Ultrasonographically, they were well demarcated from the adjoining muscular and subcutaneous tissue. Their internal structure was characterised by an anechoic to hypoechoic cortical zone corresponding to the lymphoid tissue, and an echogenic medullary zone, where the lymphatic sinuses converge towards the hilus and produce numerous acoustic interfaces. In all the lymph nodes, the hilar area had an echoic to hyperechoic appearance. The mean (sd) pole to pole length of the superficial cervical lymph nodes was 15.5 (3.2) cm and of the subiliac lymph nodes 13.5 (2.4) cm. The mean craniocaudal and lateromedial diameters of the superficial cervical lymph nodes were 2.8 (0.3) cm and 1.6 (0.3) cm, and those of the subiliac lymph nodes were 2.4 (0.4) cm and 1.1 (0.3) cm. The ultrasonographic morphology of these normal lymph nodes was consistent and provides basic reference data for the investigation of lymphadenopathies in cattle.