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Yamazaki H, Suzuki G, Aibe N, Shiomi H, Oh RJ, Yoshida K, Nakamura S, Konishi K, Matsuyama T, Ogita M. Re-irradiation for isolated neck recurrence in head and neck tumor: impact of rN category. Sci Rep 2024; 14:3107. [PMID: 38326404 PMCID: PMC10850055 DOI: 10.1038/s41598-024-53438-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/31/2024] [Indexed: 02/09/2024] Open
Abstract
Unresectable, isolated lymph node recurrence after radiotherapy is rare but a candidate for re-irradiation. However, severe toxicity is anticipated. Therefore, this study aimed to explore the efficacy and toxicity of re-irradiation in isolated lymph node recurrence of head and neck lesions. We analyzed 46 patients who received re-irradiation for lymph node recurrence without local progression. The primary tumor sites included the oral cavity in 17 patients, the hypopharynx in 12, the oropharynx in seven, the larynx in three, the nasopharynx in two, and other sites. During a median follow-up time of 10 months, the median survival time was 10.6 months, and the 1-year overall survival rate was 45.5%. The 1-year local control and progression-free survival rates were 49.8% and 39.3%, respectively. According to univariate analysis, age (≥ 65 years), the interval between treatment (≥ 12 months), rN category (rN1), and gross tumor volume (GTV < 25 cm3) were predisposing factors for better survival. In the multivariate analysis, the rN category and interval were identified as statistically significant predictors. Late toxicity grade ≥ 3 occurred in four patients (8.6%). These were all Grade 5 carotid blowout syndrome, which associated with tumor invasion of the carotid artery and/ or high doses administration for the carotid artery. Small-volume rN1 tumor that recur after a longer interval is a feasible candidate for re-irradiation. However, strict patient selection and meticulous care for the carotid are required.
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Affiliation(s)
- Hideya Yamazaki
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan.
- CyberKnife Center, Soseikai General Hospital, Kyoto, Japan.
| | - Gen Suzuki
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Norihiro Aibe
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Hiroya Shiomi
- CyberKnife Center, Soseikai General Hospital, Kyoto, Japan
| | - Ryoong-Jin Oh
- Department of Radiation Oncology, Miyakojima IGRT Clinic, Osaka, Japan
| | - Ken Yoshida
- Department of Radiology, Kansai Medical University, Hirakata, Japan
| | - Satoaki Nakamura
- Department of Radiology, Kansai Medical University, Hirakata, Japan
| | - Koji Konishi
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Tomohiko Matsuyama
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan
| | - Mikio Ogita
- Radiotherapy Department, Fujimoto Hayasuzu Hospital, Miyakonojo, Japan
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Mukherjee R, Roychowdhury A, Guha S. Platysma Sign: A Feature of Extra-capsular Spread. Indian J Surg Oncol 2023; 14:907-908. [PMID: 38187859 PMCID: PMC10766894 DOI: 10.1007/s13193-023-01815-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/06/2023] [Indexed: 01/09/2024] Open
Abstract
A 60-year-old gentleman presented with a large swelling on the left side of his neck which was diagnosed as a metastatic cervical lymph node. It infiltrated the platysma muscle and caused partial contracture. This is known as Platysma sign. Presence of this sign indicates extracapsular spread and shows poor prognosis. Supplementary Information The online version contains supplementary material available at 10.1007/s13193-023-01815-8.
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Ishibashi-Kanno N, Yamagata K, Hara T, Takaoka S, Fukuzawa S, Uchida F, Bukawa H. Prognostic prediction using maximum standardized uptake value ratio of lymph node-to-primary tumor in preoperative PET-CT for oral squamous cell carcinoma. J Stomatol Oral Maxillofac Surg 2023; 124:101489. [PMID: 37146793 DOI: 10.1016/j.jormas.2023.101489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 05/02/2023] [Indexed: 05/07/2023]
Abstract
This study aimed to calculate the ratio of maximum standardized uptake values of cervical lymph nodes to maximum standardized uptake values of primary tumors measured by preoperative fluorodeoxyglucose positron-emission tomography in oral cancer patients, and to retrospectively examine the prognostic association and evaluate whether it could be a prognostic factor. We retrospectively examined consecutive Japanese patients diagnosed with oral squamous cell carcinoma who underwent oral cancer resection and cervical dissection between January 2014 and December 2018. The study included 52 patients aged 39-89 years (median age 66.5 years), excluding non-cervical dissection surgery and/or non-underwent preoperative positron-emission tomography. The maximum standardized uptake value of the cervical lymph nodes and primary tumor was measured, and the ratio of maximum standardized uptake values of the lymph nodes to that of the primary tumor was calculated. The median follow-up of 52 patients was 1,465 days (198-2,553 days), and overall survival was significantly worse in patients with a high lymph node-to-tumor standardized uptake values ratio (>0.4739) (5 years, 58.8% vs. 88.2%; P<0.05). Pretreatment lymph node-to-tumor standardized uptake values ratio can be easily calculated, and as a predictor of prognosis, it may be of assistance when considering the treatment strategy for oral cancer.
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Affiliation(s)
- Naomi Ishibashi-Kanno
- Department of Oral and Maxillofacial Surgery, Institute of Medicine, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Kenji Yamagata
- Department of Oral and Maxillofacial Surgery, Institute of Medicine, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tadashi Hara
- Department of Radiology, Institute of Medicine, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki, 305-8575, Japan
| | - Shohei Takaoka
- Department of Oral and Maxillofacial Surgery, Institute of Medicine, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki, 305-8575, Japan
| | - Satoshi Fukuzawa
- Department of Oral and Maxillofacial Surgery, Institute of Medicine, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki, 305-8575, Japan
| | - Fumihiko Uchida
- Department of Oral and Maxillofacial Surgery, Institute of Medicine, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hiroki Bukawa
- Department of Oral and Maxillofacial Surgery, Institute of Medicine, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki, 305-8575, Japan
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Fonseca D, Kodandapani S, Babu RV, Rao C, Rao S. Metastatic NUT Carcinoma in a Child. Indian J Otolaryngol Head Neck Surg 2023; 75:2355-2358. [PMID: 37636631 PMCID: PMC10447817 DOI: 10.1007/s12070-023-03691-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/06/2023] [Indexed: 08/29/2023] Open
Abstract
Nuclear protein of the testis (NUT) carcinoma is a rare and aggressive malignancy associated with rearrangements of the NUT gene on chromosome 15q14 .This entity is often under diagnosed and there is limited literature regarding its biology and optimal management. We report a case of pediatric NUT carcinoma presenting as a mass involving the nasal septum with associated bilateral cervical lymphadenopathy. CT and MRI of PNS revealed soft tissue lesion involving cartilaginous and bony septum and tip of nose .Histopathology of cervical lymph node and IHC with NUT confirmed the diagnosis of metastatic NUT carcinoma. NUT carcinoma has a dismal prognosis despite aggressive multimodality management. As new NUT targeting drugs using BET inhibitors are emerging, the correct and prompt recognition of NC is the key to improve patient outcome.
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Affiliation(s)
- Daphne Fonseca
- Department of Laboratory Medicine, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana State 500034 India
| | - Suseela Kodandapani
- Department of Pathology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana State 500034 India
| | | | - Chandrasekhara Rao
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana State 500034 India
| | - Subramanyeshwar Rao
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana State 500034 India
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Tamagawa K, Otsuki N, Shimoda H, Morita N, Furukawa T, Teshima M, Shinomiya H, Nibu KI. Incidence and spread pattern of lymph node metastasis from submandibular gland cancer. Eur Arch Otorhinolaryngol 2023; 280:4233-4238. [PMID: 37212862 PMCID: PMC10382349 DOI: 10.1007/s00405-023-08020-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 05/08/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVES To clarify the indication of neck dissection (ND) for patient with submandibular gland (SMG) cancer. METHODS A total of 43 patients with SMG cancer were retrospectively analyzed. Forty-one patients underwent ND: Levels I-V in 19 patients, Levels I-III in 18 patients, and Level Ib in 4 patients. The other two patients did not undergo ND, since preoperative diagnoses were benign. Postoperative radiotherapy was performed in 19 patients with positive surgical margin, high grade cancer or stage IV disease. RESULTS LN metastases were pathologically confirmed in all patients with cN + and 6 out of 31 patients with cN-. No patients developed regional recurrence during follow-up periods. Ultimately, LN metastases were pathologically confirmed in 17 of 27 high grade, one out of 9 intermediate grade, but not in 7 low grade. CONCLUSIONS Prophylactic neck dissection should be considered in T3/4 and high grade SMG cancers.
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Affiliation(s)
- Kotaro Tamagawa
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan
| | - Naoki Otsuki
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan.
- Department of Otolaryngology-Head and Neck Surgery, Hyogo Prefectural Harima-Himeji General Medical Center, 3-264, Kamiya-Cho, Himeji, Hyogo, 670-8560, Japan.
| | - Hikari Shimoda
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan
| | - Naruhiko Morita
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan
| | - Tatsuya Furukawa
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan
| | - Masanori Teshima
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan
| | - Hirotaka Shinomiya
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan
| | - Ken-Ichi Nibu
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan
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Liu Z, Huang Y, Wang X, Li JY, Zhang C, Yang Y, Zhang J. The cervical lymph node contributes to peripheral inflammation related to Parkinson's disease. J Neuroinflammation 2023; 20:93. [PMID: 37038192 PMCID: PMC10088204 DOI: 10.1186/s12974-023-02770-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/20/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Peripheral inflammation is an important feature of Parkinson's disease (PD). However, if and how CNS pathology is involved in the peripheral inflammation in PD remains to be fully investigated. Recently, the existence of meningeal lymphatics and its involvement in draining cerebral spinal fluid (CSF) to the cervical lymph node has been discovered. It is known that meningeal lymphatic dysfunction exists in idiopathic PD. The deep cervical lymph node (dCLN) substantially contributes to the drainage of the meningeal lymphatics. In addition, one of the lymphatics draining components, CSF, contains abundant α-synuclein (α-syn), a protein critically involved in PD pathogenesis and neuroinflammation. Thus, we began with exploring the possible structural and functional alterations of the dCLN in a PD mouse model (A53T mice) and investigated the role of pathological α-syn in peripheral inflammation and its potential underlying molecular mechanisms. METHODS In this study, the transgenic mice (prnp-SNCA*A53T) which specifically overexpressed A53T mutant α-syn in CNS were employed as the PD animal model. Immunofluorescent and Hematoxylin and eosin staining were used to evaluate structure of dCLN. Inflammation in dCLNs as well as in bone-marrow-derived macrophages (BMDMs) was assessed quantitatively by measuring the mRNA and protein levels of typical inflammatory cytokines (including IL-1β, IL-6 and TNF-α). Intra-cisterna magna injection, flow cytometric sorting and electrochemiluminescence immunoassays were applied to investigate the lymphatic drainage of α-syn from the CNS. RNA-seq and Western blot were used to explore how pathological α-syn mediated the inflammation in PD mice. RESULTS The results unequivocally revealed substantially enlarged dCLNs, along with slow lymphatic flow, and increased inflammation in the dCLNs of A53T mice. Oligomeric α-syn drained from CSF potently activated macrophages in the dCLN via endoplasmic reticulum (ER) stress. Notably, inhibition of ER stress effectively suppressed peripheral inflammation in PD mice. CONCLUSIONS Our findings indicate that lymph node enlargement is closely related to macrophage activation, induced by meningeal lymphatics draining oligomeric α-syn, and contributes to the peripheral inflammation in PD. In addition, ER stress is a potential therapeutic target to ameliorate PD pathogenesis.
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Affiliation(s)
- Zongran Liu
- Department of Pathology, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310002, Zhejiang, China
- Department of Pathology, Peking University Health Science Center, Beijing, 100191, China
| | - Yang Huang
- Department of Pathology, Peking University Health Science Center, Beijing, 100191, China
| | - Xuejing Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
- Institute of Parkinson and Movement Disorder, Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Jia-Yi Li
- Neural Plasticity and Repair Unit, Department of Experimental Medical Science, Wallenberg Neuroscience Center, Lund University, Lund, Sweden
- Institute of Health Sciences, China Medical University, Shenyang, 110122, Liaoning, China
| | - Can Zhang
- Department of Pathology, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310002, Zhejiang, China
| | - Ying Yang
- Department of Pathology, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310002, Zhejiang, China.
- Department of Pathology, Peking University Health Science Center, Beijing, 100191, China.
| | - Jing Zhang
- Department of Pathology, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310002, Zhejiang, China.
- National Human Brain Bank for Health and Disease, Zhejiang University, Hangzhou, 310002, Zhejiang, China.
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Romić M, Blažeković I, Mateša N, Franceschi M, Šiško-Markoš I, Kusić Z, Fröbe A, Jukić T. SIMULTANEOUS METASTASES OF PAPILLARY THYROID CARCINOMA AND NEUROENDOCRINE TUMOR OF THE CECUM TO CERVICAL LYMPH NODES: A CASE REPORT. Acta Clin Croat 2023; 62:230-233. [PMID: 38304356 PMCID: PMC10829970 DOI: 10.20471/acc.2023.62.01.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/11/2021] [Indexed: 02/03/2024] Open
Abstract
We present a case of a patient with simultaneous cervical lymph node metastasis of papillary thyroid cancer (PTC) and cecum neuroendocrine tumor (NET). A 45-year-old male patient with the diagnosis of metastatic NET of the cecum underwent fine needle aspiration (FNA) of a positron emission tomography with 18F-fluorodeoxyglucose (18F-FDG PET) positive nodule in the left thyroid lobe. Due to FNA finding suspect of PTC, the patient underwent total thyroidectomy with central neck dissection. Histopathologic finding revealed PTC of the left thyroid lobe and small solitary lymph node PTC metastasis in the central neck region. Postoperative evaluation with neck ultrasound (US) revealed two enlarged suspected lymph nodes in cervical regions III and IV on the left side of the neck and the patient underwent FNA with measurement of thyroglobulin (Tg) in the aspirates. The FNA finding of the cervical lymph node in the region III revealed PTC metastasis with high Tg value in the aspirate, while FNA finding of the cervical lymph node in the region IV revealed NET metastasis with low Tg value in the aspirate. Postoperative serum Tg value was 17.75 µg/L and the patient underwent 5550 MBq iodine-131 (I-131) therapy. A year after I-131 therapy, follow-up neck US demonstrated complete cure of PTC cervical lymph node metastasis in the region III and stable in size NET cervical lymph node metastasis in the region IV. To our knowledge, this is the first report of simultaneous occurrence of cervical lymph node metastases of PTC and NET of the cecum.
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Affiliation(s)
- Matija Romić
- Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Ivan Blažeković
- Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Neven Mateša
- Department of Pathology and Cytology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Maja Franceschi
- Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Ines Šiško-Markoš
- Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Zvonko Kusić
- Croatian Academy of Sciences and Arts, Zagreb, Croatia
| | - Ana Fröbe
- Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Tomislav Jukić
- Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
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Xiao J, Meng S, Zhang M, Li Y, Yan L, Li X, Yang Z, Zhang Y, Luo Y. Optimal method for detecting cervical lymph node metastasis from papillary thyroid cancer. Endocrine 2023; 79:342-348. [PMID: 36472754 DOI: 10.1007/s12020-022-03213-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 09/29/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Papillary thyroid cancer (PTC) is often accompanied by cervical lymph node metastases (LNM). This study compared the diagnostic performance of fine needle aspiration (FNA), the combination of FNA and thyroglobulin measurement in the washout (FNA-Tg), and core needle biopsy(CNB) in order to determine the optimal method in detecting cervical LNM from PTC. METHODS PTC patients with suspicious cervical lymph nodes, who underwent ultrasonography-guided FNA, or CNB before surgery were retrospectively reviewed between January 2021 and April 2022. Patients' demographics, lymph node size, and results of FNA, FNA-Tg, CNB and surgical pathology were collected. Sensitivitity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy and the area under the curves (AUC) of receiver operating characteristic were obtained. RESULTS FNA-Tg had a higher AUC with a threshold of 55 ng/mL than that with a threshold of 1 ng/mL (0.782 vs. 0.636, P = 0.005). The sensitivity of the combination of FNA and FNA-Tg was higher than that of FNA alone (91.3% vs. 81.0%, P = 0.01), but it was not different from that of CNB (91.3% vs. 88.0%, P > 0.05). No significant difference was found in specificity, PPV, NPV, accuracy and AUC among FNA alone, CNB alone, and the combination of FNA and FNA-Tg. CONCLUSIONS FNA-Tg is useful to improve the sensitivity of FNA. The diagnostic performance of the combination of FNA and FNA-Tg is better than that of FNA or FNA-Tg alone, but is not different from that of CNB in detecting LNM from PTC.
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Affiliation(s)
- Jing Xiao
- Department of Ultrasound, the First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, China
| | - Shuyu Meng
- Department of Ultrasound, the First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, China
| | - Mingbo Zhang
- Department of Ultrasound, the First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, China
| | - Yingying Li
- Department of Ultrasound, the First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, China
| | - Lin Yan
- Department of Ultrasound, the First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, China
| | - Xinyang Li
- Department of Ultrasound, the First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, China
- School of Medicine, Nankai University, Tianjin, China
| | - Zhen Yang
- Department of Ultrasound, the First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, China
| | - Yan Zhang
- Department of Ultrasound, the First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, China.
| | - Yukun Luo
- Department of Ultrasound, the First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, China.
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Sgro JM, Campisi ES, Selvam S, Greer MLC, Alexander S, Ngan B, Campisi P. Cervical lymph node biopsies in the evaluation of children with suspected lymphoproliferative disorders: Experience in a tertiary pediatric setting. J Pediatr Surg 2022; 57:1525-1531. [PMID: 34563360 DOI: 10.1016/j.jpedsurg.2021.08.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/19/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND/PURPOSE The objectives of this study were: (1) to determine the incidence of lymphoproliferative disorders in a cohort of patients requiring a biopsy at a tertiary pediatric center; and (2) to elucidate the demographic, clinical, laboratory and diagnostic imaging characteristics associated with a malignant diagnosis. METHODS A retrospective review of pediatric cervical lymph node biopsies performed between 2012 and 2019 at a tertiary center was undertaken. Demographic data, clinical presentations, laboratory results, diagnostic imaging findings, and pathology results were compiled and analyzed to identify characteristics associated with a malignant diagnosis. RESULTS Malignancy was identified in 49.5% of patients (55/111) subjected to a cervical lymph node biopsy. The median age of patients with a benign diagnosis was lower than malignant diagnosis (11.0 vs. 14.0 years, p < 0.01). Mediastinal lymphadenopathy based on chest radiography and/or computed tomography scan was identified in 37/49 malignant cases (75.5%) CONCLUSION: In this retrospective study, 49.5% of biopsies performed at a tertiary pediatric setting yielded a malignant diagnosis. Traditional clinical characteristics such as weight loss, night sweats and nodal texture were not informative when derived retrospectively. The most valuable features identified were increased age, increased long and short axis measurements of the involved node(s), and the presence of mediastinal lymphadenopathy. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jonathan M Sgro
- Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, 555 University Ave., Toronto, Ontario M5G 1 × 8, Canada
| | - Emma S Campisi
- Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, 555 University Ave., Toronto, Ontario M5G 1 × 8, Canada
| | - Swathi Selvam
- Department of Diagnostic Imaging, Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, Ontario M5G 1 × 8, Canada
| | - Mary-Louise C Greer
- Department of Diagnostic Imaging, Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, Ontario M5G 1 × 8, Canada
| | - Sarah Alexander
- Division of Hematology/Oncology, Department of Pediatrics, Hospital for Sick Children, M5G 1 × 8, Toronto, Ontario, Canada
| | - Bo Ngan
- Department of Pediatric Laboratory Medicine, Hospital for Sick Children, Toronto, Ontario M5G 1 × 8, Canada
| | - Paolo Campisi
- Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, 555 University Ave., Toronto, Ontario M5G 1 × 8, Canada.
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10
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Zhang W, Chu J, Yang G, Ni T. Correlation between physical characteristics of biopsy specimen and disease of cervical lymph node after contrast-enhanced ultrasound. BMC Surg 2022; 22:223. [PMID: 35690851 PMCID: PMC9188253 DOI: 10.1186/s12893-022-01671-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/25/2022] [Indexed: 12/03/2022] Open
Abstract
Background To investigate the correlation between physical characteristics and disease of cervical lymph node biopsy specimens after contrast-enhanced ultrasound. Methods All patients were biopsied after CEUS, 235 patients were divided into three groups A, B and C according to the physical characteristics of specimens: 92 patients in group A were complete tissue specimens; 113 patients in group B were discontinuous tissue specimens. There were 30 patients in group C, including a small number of tissue and floc, purulent and bloody specimens. Pathological examination, pathogen culture examination and Gene X-Pert MIB examination were completed for all patients in the three groups, and statistical analysis was conducted on the integrity and traits of the specimens. Results Group A included 92 intact tissue specimens, 21 with reactive hyperplasia, 17 with lymphoma, 12 with metastatic carcinoma, 13 with lymphadenopathy, 15 with necrotizing lymphadenitis, and rare lymphadenopathy. In group B, 113 patients were treated with intermittent tissue specimens, including infected lymph nodes, lymphoma in 1 case, metastatic carcinoma in 3 cases and sarcoidosis in 1 case. There were 30 patients in group C, including a small amount of tissue and floc, purulent and bloody specimens, all of which were infected lymph nodes. The χ2 value of malignant and benign lymph nodes was 42.401, p = 0.000. Conclusion The physical characteristics of cervical lymph node biopsy specimens after CEUS are correlated with the disease, which has guiding significance for postoperative specimen selection.
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Affiliation(s)
- Wenzhi Zhang
- Department of Ultrasound, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine (Red Cross Hospital of Hangzhou, Integrated Chinese and Western Medicine Hospital of Zhejiang Province), 310003, Hangzhou, China
| | - Jie Chu
- Department of Ultrasound, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine (Red Cross Hospital of Hangzhou, Integrated Chinese and Western Medicine Hospital of Zhejiang Province), 310003, Hangzhou, China
| | - Gaoyi Yang
- Department of Ultrasound, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine (Red Cross Hospital of Hangzhou, Integrated Chinese and Western Medicine Hospital of Zhejiang Province), 310003, Hangzhou, China.
| | - Tu Ni
- Department of Ultrasound, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine (Red Cross Hospital of Hangzhou, Integrated Chinese and Western Medicine Hospital of Zhejiang Province), 310003, Hangzhou, China
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11
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Affiliation(s)
- Xianqing Song
- General Surgery Department, Ningbo Fourth Hospital, No. 291 Donggu Road, Dandong Street, Xiangshan County, Ningbo, Zhejiang, 315000, PR China.
| | - Ning Wang
- Pelvic Floor Rehabilitation Centre, Xiangshan Bay Maternity Hospital, No. 508 Xiangshan Bay Road, Dandong Street, Xiangshan County, Ningbo, Zhejiang, 315000, PR China.
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Nguyen HCB, Mady LJ, Panara K, Andrianus S, Cooper K, Chen IH, Chalian AA, Brody RM. Metastatic Meningioma of the Neck: A Case Report and Systematic Review. ORL J Otorhinolaryngol Relat Spec 2022; 84:361-369. [PMID: 35114675 DOI: 10.1159/000521076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/18/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although meningiomas are the most common central nervous system neoplasms, extracranial metastases are exceedingly rare. There are even fewer reports of metastatic meningiomas to the neck. METHODS We described a patient with multiply recurrent orbital meningioma with metastasis to the neck found incidentally during neck exploration for composite resection and free tissue reconstruction. We performed a systematic review for all records pertaining to metastatic meningiomas to the cervical regions. RESULTS We found 9 previous reports of cervical metastatic meningiomas. Almost all cases underwent extensive local resection. There was no evidence of an association between the histological grade of the tumor and risk of metastasis to the neck. Cervical lymph node dissemination is more common in patients presenting after previous primary tumor resection. CONCLUSIONS In the context of a neck mass, our findings suggest that metastatic meningioma should be included in the differential diagnosis, especially in patients with previous resections.
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Affiliation(s)
- Hoang C B Nguyen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,
| | - Leila J Mady
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kush Panara
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stefen Andrianus
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kumarasen Cooper
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Isaac H Chen
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ara A Chalian
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert M Brody
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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13
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Cai D, Wu S. Efficacy of logistic regression model based on multiparametric ultrasound in assessment of cervical lymphadenopathy - a retrospective study. Dentomaxillofac Radiol 2022; 51:20210308. [PMID: 34609901 PMCID: PMC8802707 DOI: 10.1259/dmfr.20210308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES To investigate whether a multiparametric ultrasound (MPUS) diagnostic model improves differential diagnosis of benign and malignant cervical lymph nodes. METHODS MPUS evaluation was performed on 87 lesions in 86 patients, and related characteristics and parameters of the patients and lesions were studied and logistic regression models based on the MPUS characteristics of cervical lymph nodes were built. A receiver operating characteristic curve and area under the curve (AUC) were built for the evaluation of diagnostic performances. RESULTS Of the 87 lesions in 86 patients, there were 31 benign and 56 malignant lesions. Regression models for Duplex ultrasound and MPUS were established. The Duplex ultrasound regression model showed a sensitivity, specificity, positive predictive value and negative predictive value of 94.4, 61.3, 86.3 and 80.9%, respectively. The predictive accuracy was 82.4%, and the AUC was 0.861. The MPUS regression model showed a sensitivity, specificity, positive predictive value and negative predictive value of 98.1, 61.3, 81.5 and 95.0%, respectively. The predictive accuracy was 84.7%, and the AUC was 0.894. The differences in AUCs between the Duplex ultrasound model and MPUS model, ultrasound model and ultrasonic elastography (UE), and Duplex ultrasound and UE were not significant (all p > 0.05); the differences in AUCs between the MPUS model and Duplex ultrasound, Duplex ultrasound model and Duplex ultrasound, and MPUS model and UE were significant (all p < 0.05). CONCLUSIONS The Duplex ultrasound and MPUS models achieve significantly higher diagnostic performance for differentiating between benign and malignant cervical lymph nodes.
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Affiliation(s)
| | - Size Wu
- Department of Ultrasound, The First Affiliated Hospital of Hainan Medical University, Haikou, China
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14
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Chintale SG, Kirdak VR, Jatale SP, Shaikh KA. Huge Atypical Sub Mental Swelling: A Rare Presentation of Tuberculosis of Neck. Indian J Otolaryngol Head Neck Surg 2021; 73:519-522. [PMID: 34692465 DOI: 10.1007/s12070-020-02075-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/17/2020] [Indexed: 11/29/2022] Open
Abstract
As we know tuberculosis is common disease in developing country since historical days. But now a days cases of HIV increases in all over country since last 2 decades. Incidence of tuberculosis also increased despite of treatment coverage for tuberculosis through nationwide antibuberculosis program in our developing country. We reported one case of huge sub mental swelling in 55 years old male patient having symptoms of swelling since 2 years and difficulty in breathing since 1 month. This on FNAC gives nonspecific lymphadenitis later confirmed on excisional biopsy comes out to be tuberculosis.
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Affiliation(s)
- Sambhaji G Chintale
- Department of Otorhinolaryngology, JIIUS IIMSR, Warudi, Tq Badnapur Dist., Jalna, 431202 India.,Cosmo ENT Superspeciality Hospital and Research Center Aurangabad, Kamgar Chauk, Cidco n3, Aurangabad, 431005 India
| | - Vilas R Kirdak
- Department of Otorhinolaryngology, JIIUS IIMSR, Warudi, Tq Badnapur Dist., Jalna, 431202 India
| | - Sonali P Jatale
- Department of Otorhinolaryngology, JIIUS IIMSR, Warudi, Tq Badnapur Dist., Jalna, 431202 India
| | - Kaleem A Shaikh
- Department of Otorhinolaryngology, JIIUS IIMSR, Warudi, Tq Badnapur Dist., Jalna, 431202 India
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15
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Uchida Y, Komatsu S, Ogura T. A case of cervical lymph node tuberculosis and metastatic squamous cell carcinoma in the same lymph node. Respir Med Case Rep 2021; 34:101485. [PMID: 34381681 DOI: 10.1016/j.rmcr.2021.101485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 07/03/2021] [Accepted: 07/23/2021] [Indexed: 11/21/2022] Open
Abstract
We report a rare coexistence of tuberculosis and squamous cell carcinoma (SCC) of the same lymph node (LN). A 74-year-old woman with a swollen right cervix underwent computed tomography, which showed a nodule in the right lung and swollen LNs of the mediastinum and right supraclavicular fossa. She was diagnosed with LN tuberculosis; the puncture cytology of the clavicular LN was class IV. Anti-tuberculosis treatment was initiated. Her neck was compressed due to LN enlargement, and dyspnea appeared. A biopsy was performed to diagnose the SCC. We propose that malignancy should be considered if the patient has a narrowed airway due to an enlarged LN or if the response to tuberculosis treatment is poor.
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Grant CN, Aldrink J, Lautz TB, Tracy ET, Rhee DS, Baertschiger RM, Dasgupta R, Ehrlich PF, Rodeberg DA. Lymphadenopathy in children: A streamlined approach for the surgeon - A report from the APSA Cancer Committee. J Pediatr Surg 2021; 56:274-281. [PMID: 33109346 DOI: 10.1016/j.jpedsurg.2020.09.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/19/2020] [Accepted: 09/24/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND/PURPOSE Lymphadenopathy is a common complaint in children. Pediatric surgeons are often called upon to evaluate, treat, and/or biopsy enlarged lymph nodes. With many nonsurgical causes in the differential diagnosis, the surgeon plays the important role of providing reassurance and timely diagnosis while minimizing the pain and morbidity associated with surgical interventions in children. The purpose of this summary paper is to provide a management guide for surgeons working up children with lymphadenopathy. MATERIALS/METHODS The English language literature was searched for "lymphadenopathy in children". All manuscript types were considered for review, regardless of medical specialty, with emphasis placed on published guidelines, algorithms, and reviews. After thorough review of these manuscripts and cross-referencing of their bibliographies, the attached algorithm was developed, with emphasis on the role and timing of surgical intervention. RESULTS The APSA Cancer Committee developed the attached algorithm to fill a gap in the surgical literature. It outlines lymphadenopathy workup and treatment with emphasis on the role and timing of surgical intervention. CONCLUSION This review defines and summarizes the common etiologies and presentations of lymphadenopathy in children, and offers a straightforward algorithm for evaluation of and treatment with an emphasis on malignancy risk and surgical management. TYPE OF STUDY Summary paper. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Christa N Grant
- Division of Pediatric Surgery, Penn State Children's Hospital, Department of Surgery, Milton S. Hershey Medical Center, Hershey, PA.
| | - Jennifer Aldrink
- Division of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Timothy B Lautz
- Division of Pediatric Surgery, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL
| | - Elisabeth T Tracy
- Division of Pediatric Surgery, Duke University Medical Center, Durham, NC
| | - Daniel S Rhee
- Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Reto M Baertschiger
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati, OH
| | - Peter F Ehrlich
- Division of Pediatric Surgery, Mott Children's Hospital, University of Michigan Medical Center, Ann Arbor, MI
| | - David A Rodeberg
- Division of Pediatric Surgery, East Carolina Medical Center, Greenville, NC
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Darré T, Doukouré B, Djiwa T, Amana B, Bissa H, Napo-Koura G. Cervical lymphadenopathy of Togolese children in a tropical context: clinicopathological study. Trop Doct 2020; 51:96-99. [PMID: 32814507 DOI: 10.1177/0049475520947882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our study describes the epidemiology and aetiology of cervical lymphadenopathy in children diagnosed between 2003 and 2017 at the pathology laboratory of Lomé, Togo. A total of 221 cases were collected. The average age of diagnosis of the study population was 9.8 ± 0.3 years and consisted of 118 (53.4%) boys. HIV was confirmed by indirect ELISA test in 69 (31.2%) cases. The cohort consisted of infections (n = 128, 57.9%), tumours (n = 85, 38.5%) and others (n = 8, 1.6%). The main infectious aetiology was tuberculosis (n = 84). Tumour aetiology consisted of 79 primary malignancies and three metastatic cases. Primary tumours consisted predominantly of lymphoma (n = 74), with Burkitt's lymphoma (n = 44) being the most common. Tuberculosis on a background of HIV infection remains the dominant cause of cervical lymphadenopathy in the tropical region of Togo.
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Affiliation(s)
- Tchin Darré
- MD, Professor, Department of Pathology, University Teaching Hospital of Lomé, Togo
| | - Brahima Doukouré
- MD, Professor, Department of Pathology, University Teaching Hospital of Cocody, Abidjan, Ivory Coast
| | - Toukilnan Djiwa
- MD, Assistant-Professor, Department of Pathology, University Teaching Hospital of Lomé, Togo
| | - Bathokédeou Amana
- MD, Professor, Department of Head and Neck Surgical, University Teaching Hospital of Lomé, Togo
| | - Haréfétéguéna Bissa
- MD, Assistant-Professor, Department of Stomatology, University Teaching Hospital of Lomé, Togo
| | - Gado Napo-Koura
- MD, PHD, Professor, Department of Pathology, University Teaching Hospital of Lomé, Togo
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18
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Abstract
The blood-brain barrier (BBB) impedes the efficient delivery of systemically administered drugs to brain tumors, thus reducing the therapeutic efficacy. To overcome the limitations of intravascular delivery, convention-enhanced delivery (CED) was introduced to infuse drugs directly into the brain tumor using a catheter with a continuous positive pressure. However, tissue distribution and retention of the infused drugs are significantly hindered by microenvironmental factors of the tumor such as the extracellular matrix and lymphatic drainage system in the brain. Here, we leveraged a liposomal formulation to simultaneously improve tissue distribution and retention of drugs infused in the brain tumor via the CED method. Various liposomal formulations with different surface charge, PEGylation, and transition temperature (Tm) were prepared to test the cellular uptake in vitro, and the tissue distribution and retention in the brain. In in vitro studies, PEGylated liposomal formulations with a positive surface charge and high Tm showed the most efficient cellular uptake among the tested formulations. In in vivo studies, the liposomal formulations were infused directly into the brain via the CED method. PEGylated liposomal formulations with a positive surface charge and high Tm showed more efficient distribution and retention in both normal and tumor tissues while only-PEGylated formulations displayed rapid clearance from the tissues to cervical lymph nodes. Furthermore, we demonstrated that the CED of liposomal everolimus prepared with the PEGylated formulation with a positive surface charge and high Tm resulted in superior therapeutic effects for glioblastoma treatment compared to other formulations. Graphical abstract.
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Affiliation(s)
- Yunho Han
- Department of Bio and Brain Engineering and KAIST Institute for Health Science and Technology, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Ji-Ho Park
- Department of Bio and Brain Engineering and KAIST Institute for Health Science and Technology, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea.
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Boscoe EF, Hararah MK, Lovell M, Kelley P. Benign tumoral melanosis of a cervical lymph node in a child. Int J Pediatr Otorhinolaryngol 2020; 132:109916. [PMID: 32035349 DOI: 10.1016/j.ijporl.2020.109916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/28/2020] [Accepted: 01/28/2020] [Indexed: 11/19/2022]
Abstract
We present a pediatric case of benign tumoral melanosis in a cervical lymph node arising from congenital pigmented lesions of the anterior neck. This is the first reported pediatric case not associated with regressed melanoma or trauma. Tumoral melanosis is a rare phenomenon which describes a pigmented lesion like melanoma; however, histology demonstrates melanin-laden macrophages without malignant cells. In the few reported cases, tumoral melanosis has arisen in the skin or lymph node and associated with a regressed melanoma, pigmented basal cell carcinoma or mycosis fungoides. We discuss the pathology of this disease process, and the work up in a pediatric patient.
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Affiliation(s)
- Elizabeth F Boscoe
- Department of Otolaryngology, University of Colorado School of Medicine, 12631 E. 17th Ave., B-205, Aurora, CO, 80045, USA.
| | - Mohammad K Hararah
- Department of Otolaryngology, University of Colorado School of Medicine, 12631 E. 17th Ave., B-205, Aurora, CO, 80045, USA
| | - Mark Lovell
- Department of Pathology, Children's Hospital Colorado, 13123 E. 16th Ave., Aurora, CO, 80045, USA
| | - Peggy Kelley
- Department of Otolaryngology, Children's Hospital Colorado, 12631 E. 17th Ave., B-205, Aurora, CO, 80045, USA
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Sağlampınar Karyağar S, Karyağar S, Güven O, Üstün O, Atar Y, Uyar Y. The Predictive Value of Proportional Evaluation Based on the Metabolic Activity of Cervical Lymph Nodes on PET/CT Imaging in Patients with Larynx Cancer. Mol Imaging Radionucl Ther 2020; 29:59-64. [PMID: 32368876 PMCID: PMC7201430 DOI: 10.4274/mirt.galenos.2019.92300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives We aimed to evaluate the proportional values of maximum standardized uptake value (SUVmax) for cervical lymph nodes on 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for prediction of the presence of metastasis in patients with larynx squamous cell cancer (LSCC). Methods This retrospective study involved 43 patients with LSCC. All patients underwent resection of the primary tumor and neck dissection within 4 weeks after undergoing 18F-FDG PET/CT examinations. Receiver operating characteristic (ROC) analysis was performed to evaluate the lymph node SUVmax/primary tumor SUVmax (SUVmaxLN/SUVmaxPT), lymph node SUVmax/aortic SUVmax (SUVmaxLN/SUVmaxA), and lymph node SUVmax/ liver SUVmax (SUVmaxLN/SUVmaxL) ratios for diagnosis of lymph node metastasis. Results SUVmaxLN/SUVmaxA, SUVmaxLN/SUVmaxL, and SUVmaxLN/SUVmaxPT rates were significantly higher in metastatic lymph nodes compared to non-metastatic nodes. ROC analysis for metastasis showed that the cut-off thresholds were 3.87 for SUVmaxLN; 1.78 for SUVmaxLN /SUVmaxA; 1.08 for SUVmaxLN/SUVmaxL; and 0.36 for SUVmaxLN/SUVmaxPT. The diagnostic sensitivity, specificity and AUC were 83.7%, 77%, 0.856 for SUVmaxLN; 79.7%, 84%, 1.78 for SUVmaxLN/SUVmaxA; 84.1%, 76%, 0.833 for SUVmaxLN/SUVmaxL; and 53.6%, 76%, 0.666 for SUVmaxLN/SUVmaxPT, respectively. Conclusion SUVmaxLN/SUVmaxA, SUVmaxLN/SUVmaxL, and SUVmaxLN/SUVmaxPT ratios can be safely used for diagnosis of cervical lymph node metastasis in patients with LSCC.
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Affiliation(s)
- Sevda Sağlampınar Karyağar
- University of Health Sciences Turkey, İstanbul Okmeydanı Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Savaş Karyağar
- University of Health Sciences Turkey, İstanbul Okmeydanı Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Osman Güven
- University of Health Sciences Turkey, İstanbul Okmeydanı Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Onur Üstün
- University of Health Sciences Turkey, İstanbul Okmeydanı Training and Research Hospital, Clinic of Otorhinolaryngology, İstanbul, Turkey
| | - Yavuz Atar
- University of Health Sciences Turkey, İstanbul Okmeydanı Training and Research Hospital, Clinic of Otorhinolaryngology, İstanbul, Turkey
| | - Yavuz Uyar
- University of Health Sciences Turkey, İstanbul Okmeydanı Training and Research Hospital, Clinic of Otorhinolaryngology, İstanbul, Turkey
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Wright OJ, Bashyam A, Pitkin L, Di Palma S. Case Report: Colorectal cancer metastasis to a cervical lymph node - an unusual source of a neck lump. F1000Res 2020; 9:266. [PMID: 33552474 PMCID: PMC7845154 DOI: 10.12688/f1000research.22560.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2020] [Indexed: 11/20/2022] Open
Abstract
Colorectal cancer (CRC) is the third most common cancer worldwide, and approximately 25% of patients already have metastases at the time of diagnosis. The most common metastatic sites for CRCs are the liver, lung, bone and brain and peritoneum. Cervical lymph node metastases in CRC are rare, particularly in the absence solid organ involvement. Here we present a case of a 73-year-old female patient who, following resection of a poorly differentiated caecal adenocarcinoma, re-presented four years later with a left level IV lymph node which was ultimately found to contain metastatic adenocarcinoma.
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Affiliation(s)
- Oliver J Wright
- Otolaryngology Department, Frimley Park Hospital, Portsmouth Rd, Frimley, GU16 7UJ, UK
| | - Anthony Bashyam
- Otolaryngology Department, Frimley Park Hospital, Portsmouth Rd, Frimley, GU16 7UJ, UK
| | - Lisa Pitkin
- Otolaryngology Department, Frimley Park Hospital, Portsmouth Rd, Frimley, GU16 7UJ, UK
| | - Silvana Di Palma
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, GU2 7XX, UK
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22
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Kim Y, Roh JL, Song DE, Cho KJ, Choi SH, Nam SY, Kim SY. Risk factors for posttreatment recurrence in patients with intermediate-risk papillary thyroid carcinoma. Am J Surg 2020; 220:642-7. [PMID: 32035626 DOI: 10.1016/j.amjsurg.2020.01.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/18/2020] [Accepted: 01/26/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Papillary thyroid carcinoma (PTC) is generally associated with favorable outcomes; however, intermediate-risk requires further evaluation. We therefore examined risk factors for posttreatment recurrence in patients with intermediate-risk PTC. METHODS This study involved 1782 patients who underwent thyroidectomy for intermediate-risk PTC. Univariate and multivariate Cox proportional hazard regression analyses were used to identify the significant factors predictive of posttreatment recurrence-free survival (RFS). RESULTS Of intermediate-risk factors, univariate analyses showed that clinical and pathological cervical lymph node (LN) positivity (cN1 and pN1), aggressive histology, and multifocality with microscopic extrathyroidal extension were significantly associated with RFS outcomes (all P < 0.05). In multivariate analyses, cN1, >5 pN1, and posttreatment radioactive iodine (RAI)-avid metastatic foci of intermediate risk remained the independent factors predictive of RFS (all P < 0.05). The combination of any three or more of these intermediate-risk factors appeared to increase the posttreatment recurrence rate. CONCLUSION Clinical nodal positivity, the number of positive LNs, and the presence of RAI-avid metastatic foci in the ATA intermediate-risk category might independently decrease RFS in patients with intermediate-risk PTC.
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Nikkhah M. Unusual Appearance of Basaloid SCC in Tonsil: A Case Report. Indian J Otolaryngol Head Neck Surg 2019; 71:890-2. [PMID: 31742090 DOI: 10.1007/s12070-019-01693-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 06/23/2019] [Indexed: 10/26/2022] Open
Abstract
Basaloid squamous cell carcinoma (BSCC) is a variant of oral squamous cell carcinoma, is an aggressive, high grade variant and rare subtype of the head and neck SCC that less common in tonsils. Here, we are reporting a case of BSCC involving the tonsil with an extension on the cervical lymph node region.
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Oikawa Y, Michi Y, Tsushima F, Tomioka H, Mochizuki Y, Kugimoto T, Osako T, Nojima H, Yokokawa M, Kashima Y, Harada H. Management of retropharyngeal lymph node metastasis in oral cancer. Oral Oncol 2019; 99:104471. [PMID: 31678766 DOI: 10.1016/j.oraloncology.2019.104471] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 10/19/2019] [Accepted: 10/25/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Retropharyngeal lymph node (RPLN) metastasis is extremely rare, and prognosis is significantly poor in oral cancer. We retrospectively examined the management of RPLN metastases in oral cancer. MATERIALS AND METHODS A total of 1247 patients with oral cancer were treated at our department from January 2002 and December 2016. Among these patients, 374 (30%) had histologically positive lymph node metastases. Of these, 15 patients (1.2%) were diagnosed with RPLN metastases. We evaluated the diagnostic period, size, recurrence pattern, laterality, treatment, and therapeutic outcomes. The Kaplan-Meier method was used to determine overall survival (OS) among the RPLN metastasis group, cervical lymph node (CLN) metastases group, and treatment methods group for RPLN metastases. RESULTS One patient had RPLN involvement at the initial treatment, and RPLN involvement in other patients was found subsequently. The mean duration in confirming RPLN metastases was 228 days (range, 50-867 days). Surgical therapy was performed in 5 patients, chemoradiotherapy in 7 patients, and best supported care (BSC) in 3 patients. The cumulative 5-year OS rate for the RPLN metastasis group (n = 15) was 38.1%, compared with the rate of 71.3% for the CLN group (n = 359). Regarding the therapeutic approach for RPLN metastases, OS rates were 80.0% (n = 5) in the surgical therapy group, 28.6% (n = 7) in the chemoradiotherapy group, and 0% (n = 3) in the BSC group. CONCLUSION Early detection and surgical treatment of RPLN metastases are associated with increased survival rate in oral cancer.
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Affiliation(s)
- Yu Oikawa
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Yasuyuki Michi
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Fumihiko Tsushima
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hirofumi Tomioka
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yumi Mochizuki
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takuma Kugimoto
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshimitsu Osako
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hitomi Nojima
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Misaki Yokokawa
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshihisa Kashima
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroyuki Harada
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Alvarez W, Lai LH, Grant SJ, Sabath DE, Dillon J. Burkitt lymphoma of the maxilla in a HIV positive male - Presentation and review of diagnostic laboratory tests. Oral Maxillofac Surg Cases 2019; 5. [PMID: 33282691 PMCID: PMC7714209 DOI: 10.1016/j.omsc.2019.100113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Burkitt lymphoma (BL) is a highly aggressive, B cell non-Hodgkin lymphoma (NHL) that is rare outside Africa. We report a case of HIV-associated BL originating in the right maxillary sinus in a 31-year-old Hispanic male living in Washington, USA. We also highlight the diagnostic challenges in arriving at the diagnosis when the patient initially presented with a painless right facial swelling. Rapid diagnosis and treatment are critical because BL is one of the fastest-growing tumors. Treatment involves brief duration of high intensity chemotherapy and central nervous system prophylaxis. It is important for oral and maxillofacial surgeons to recognize this disease and understand the necessary steps to treat this aggressive tumor.
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Affiliation(s)
- William Alvarez
- Tufts University. Former Resident, Department of Oral and Maxillofacial Surgery, University of Washington, Seattle, WA, USA
| | - Li Han Lai
- Department of Oral and Maxillofacial Surgery, University of Washington, Seattle, WA, USA
| | - Shakira J Grant
- Division of Hematology-Oncology, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Daniel E Sabath
- Departments of Laboratory Medicine and Medicine, University of Washington, Seattle, WA, USA
| | - Jasjit Dillon
- Oral and Maxillofacial Surgery, Harborview Medical Center, Department of Oral and Maxillofacial Surgery, University of Washington, Seattle, WA, USA
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Yuan LG, Mao YS. [Thoracic recurrent laryngeal nerve lymph node metastasis guides the cervical lymph node dissection of patients with esophageal cancer]. Zhonghua Zhong Liu Za Zhi 2019; 41:10-4. [PMID: 30678411 DOI: 10.3760/cma.j.issn.0253-3766.2019.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Three-field lymph node dissection improved the postoperative survival and accuracy of pathological staging of patients with esophageal cancer, and reduced the postoperative local recurrence rate of esophageal cancer patients. However, this surgical procedure enlarged the trauma, cansed more complications, prolonged postoperative hospital stays, and seriously impaired the postoperative adjuvant therapy. Therefore, selection of patients who are suitable for three-field lymph node dissection is extremely important. The special anatomical location of recurrent laryngeal nerve lymph nodes is potentially suitable for it to serve as sentinel lymph node for the evacuation of cervical lymph nodes dissection in esophageal cancer. The guiding value of recurrent laryngeal nerve lymph node metastasis in cervical lymph node dissection of thoracic esophageal cancer is reviewed.
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Pordanjani SR, Sabour S. Reliability of sonoelastography in predicting pediatric cervical lymph node malignancy: methodological issues on reliability and prediction. Pediatr Surg Int 2019; 35:271-2. [PMID: 30259087 DOI: 10.1007/s00383-018-4346-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2018] [Indexed: 10/28/2022]
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Qian X, Sinikovic B, Schreiber F, Ochsenreither S, Klinghammer K, Wollenberg B, Kaufmann AM, Albers AE. pN status predicts outcomes in surgically treated pT1-pT2 patients of various disease stages with squamous cell carcinoma of the head and neck: a 17-year retrospective single center cohort study. Eur Arch Otorhinolaryngol 2018; 275:2787-95. [PMID: 30159726 DOI: 10.1007/s00405-018-5108-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 08/24/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The optimal treatment for a substantial proportion of patients with pT1-pT2 squamous cell carcinomas of the head and neck (SCCHN) remains to be refined. The extent of surgery, role and potential benefit of adjuvant treatment are to be balanced against therapy-induced side effects. We compared the outcomes of surgery with or without adjuvant radiotherapy (RT) or chemotherapy (CRT) and investigated the prognostic value of established clinicopathological parameters. METHODS Data were retrospectively collected for 227 patients who were treated by surgery alone (n = 31), RT (n = 87) and CRT (n = 109) in a single center. RESULTS Patients with stage I/II disease who had received adjuvant RT showed a better disease-free survival (DFS) (P = 0.04) than those who had received adjuvant CRT treatment. Conversely, patients with stage III/IV disease who had received CRT showed a better overall survival (OS) (P = 0.003) and DFS (P = 0.03) than those who had received surgery alone or adjuvant RT without chemotherapy. Survival analysis demonstrated that patients with pN0 to pN1 had better OS (P = 0.02), disease-specific survival (DSS) (P = 0.003), DFS (P = 0.02) and metastases free survival (MFS) (P = 0.002) compared to patients with pN2 to pN3. Multivariate analysis showed that the pN status was an independent factor for OS (P = 0.03), DSS (P = 0.04), relapse-free survival (P = 0.03), DFS (P = 0.03). CONCLUSION The pN status is the most important prognostic factor for pT1 to pT2 SCCHN. Adjuvant CRT was associated with significantly better survival outcomes in patients with pN1 and pN2-3 or more advanced stage, while adjuvant RT showed significantly better outcomes in patients with pN0.
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Sakurai D, Uchida R, Ihara F, Kunii N, Nakagawa T, Chazono H, Hanazawa T, Motohashi S, Okamoto Y. Immunosuppressive property of submandibular lymph nodes in patients with head and neck tumors: differential distribution of regulatory T cells. BMC Res Notes 2018; 11:479. [PMID: 30012191 PMCID: PMC6048882 DOI: 10.1186/s13104-018-3587-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 07/10/2018] [Indexed: 12/26/2022] Open
Abstract
Objective Different sensitizations and immune responses are thought to be induced in response to antigens at different mucosal sites between the oral floor and nose. The aim of this study was to investigate differences in the distributions of lymphocyte subsets in the submandibular (SM) and upper jugular (UJ) lymph nodes (LNs), which are supposed to be regional LNs of the oral floor and nasal mucosa, respectively. SMLNs and UJLNs were collected from patients with head and neck tumors who underwent surgical resection. The populations of T cells, Natural Killer (NK) cells, Natural Killer T (NKT) cells, regulatory T cells (Tregs) and dendritic cells (DCs) in LNs without metastasis were analyzed by flow cytometry. The high-affinity IgE receptor (FcεRI) expression of LN cells were also evaluated. Results The proportions of CD4+CD25+Foxp3+ Tregs, CD4+CD45RA−Foxp3high effector Tregs and FcεRIα+CD33+CD11c+ DCs were significantly larger in SMLNs compared with UJLNs, while those of CD3+ T cells, CD3−CD56+ NK cells, CD3+Vα24+Vβ11+ NKT cells, and CD123+CD303+ DCs did not show any significant differences between SMLNs and UJLNs. The differential distributions of CD4+CD25+Foxp3+ Tregs were observed regardless of tumor region, LN metastasis and clinical staging. These data indicate that SMLNs may have immunosuppressive properties compared with UJLNs. Electronic supplementary material The online version of this article (10.1186/s13104-018-3587-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daiju Sakurai
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Ryosuke Uchida
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Fumie Ihara
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.,Department of Medical Immunology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Naoki Kunii
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Takuya Nakagawa
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Hideaki Chazono
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Toyoyuki Hanazawa
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Shinichiro Motohashi
- Department of Medical Immunology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Yoshitaka Okamoto
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
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Houcine Y, Romdhane E, Blel A, Ksentini M, Aloui R, Lahiani R, Znaidi N, Ben Salah M, Rammeh S. Evaluation of fine needle aspiration cytology in the diagnosis of cervical lymph node lymphomas. J Craniomaxillofac Surg 2018; 46:1117-1120. [PMID: 29779620 DOI: 10.1016/j.jcms.2018.04.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 04/06/2018] [Accepted: 04/23/2018] [Indexed: 10/17/2022] Open
Abstract
PURPOSE Surgical biopsy examination is the gold standard for the diagnosis of lymph node lymphomas. Fine-needle aspiration cytology (FNAC) is a quick and safe method in the management of cervical lymph nodes. Its value in confirming recurrent or residual lymphoma is well established. However, its role in the primary diagnosis of lymph node lymphoma remains controversial. The aim of this study was to assess, in our experience, the reliability of FNAC in the diagnosis of cervical lymph node lymphomas. MATERIALS AND METHODS This was a retrospective study carried out over a 6-year period (January 2011 to December 2016) and conducted at the Cytology Unit in our Pathology Department (Charles Nicolle Hospital, Tunisia). The measures of diagnostic accuracy of FNAC in the diagnosis of cervical lymph node lymphomas were calculated taking histopathology as the gold standard. RESULTS A total of 937 FNA samples were obtained from 851 patients. The diagnosis of lymphoma was obtained in 65 cases (6.9%). Cytological diagnoses of lymphoma were as follows: 28 (44%) Hodgkin lymphoma, 17 (25%) high-grade lymphoma, 15 (23%) low-grade lymphoma, and 5 (8%) "suggestive of lymphoma." FNAC of cervical lymph nodes had a sensitivity of 95.5%, specificity of 98.7%, positive predictive value (PPV) of 97.7%, and negative predictive value (NPP) of 97.5%. CONCLUSION The present study demonstrated that cytology is capable to detect nodes suspicious for the presence of lymphoma precisely, in terms of low- or high-grade lymphoma, which is a relevant and very achievable first step in the management of patients with cervical lymph node lymphoma.
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Affiliation(s)
- Yoldez Houcine
- Pathology Department, (Head of the department: Soumaya Rammeh PhD), Charles Nicolle Hospital, Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia.
| | - Emna Romdhane
- Pathology Department, (Head of the department: Soumaya Rammeh PhD), Charles Nicolle Hospital, Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Ahlem Blel
- Pathology Department, (Head of the department: Soumaya Rammeh PhD), Charles Nicolle Hospital, Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Meriem Ksentini
- Pathology Department, (Head of the department: Soumaya Rammeh PhD), Charles Nicolle Hospital, Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Raoudha Aloui
- Pathology Department, (Head of the department: Soumaya Rammeh PhD), Charles Nicolle Hospital, Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Rim Lahiani
- Ear, Nose and Throat Department, (Head of the department: Mamia Ben Salah PhD), Charles Nicolle Hospital, Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Nadia Znaidi
- Pathology Department, (Head of the department: Soumaya Rammeh PhD), Charles Nicolle Hospital, Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Mamia Ben Salah
- Ear, Nose and Throat Department, (Head of the department: Mamia Ben Salah PhD), Charles Nicolle Hospital, Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Soumaya Rammeh
- Pathology Department, (Head of the department: Soumaya Rammeh PhD), Charles Nicolle Hospital, Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
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Wang Y, He SS, Bao Y, Cai XY, Chen HY, Yang XL, Chen DM, Lu LX, Chen Y. Cervical lymph node carcinoma metastasis from unknown primary site: a retrospective analysis of 154 patients. Cancer Med 2018; 7:1852-1859. [PMID: 29608251 PMCID: PMC5943546 DOI: 10.1002/cam4.1458] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/22/2018] [Accepted: 02/28/2018] [Indexed: 01/01/2023] Open
Abstract
Despite advances in diagnosis and treatment, the existence of cervical lymph node carcinoma of unknown primary site (CCUP) has always been an urgent problem worldwide. There is still no consensus on the optimal management for CCUP. In this retrospective review, we analyze the clinical characteristics of CCUP patients treated at our institution and examine how these characteristics and treatments were associated with survival. Clinicopathologic features, treatments, and survival outcomes of 154 CCUP patients were collected from the hospital records and analyzed. Survival was estimated by Kaplan–Meier methods and compared by the log‐rank test. Cox proportional hazards regression analysis was used to assess the factors independently associated with overall survival (OS) and progression‐free survival (PFS). Median follow‐up period was 26.44 months (range, 0.53–146.53 months). Multivariate analysis showed N stage, pathologic type, and lymph node extranodal extension (ENE) to be independent prognostic factors for OS in CCUP patients, but not PFS. Subgroup analysis of patients who received radiotherapy showed that radiotherapy to the pharyngeal mucosa was associated with better OS (P = 0.045), but not with better PFS. Advanced N stage, nonsquamous cell carcinoma, and lymph node ENE predict poor prognosis in patients with CCUP. In addition, radiotherapy to suspicious mucosa is accompanied by better OS. These study findings should be useful to clinicians when selecting the treatment approach.
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Affiliation(s)
- Yan Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Sha-Sha He
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Yong Bao
- Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiu-Yu Cai
- Department of VIP Region, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Hai-Yang Chen
- Department of Radiation Oncology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xing-Li Yang
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Dan-Ming Chen
- Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Li-Xia Lu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Yong Chen
- Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Geerdes-Fenge HF, Pongratz P, Liese J, Reisinger EC. Vacuum-assisted closure therapy of paradoxical reaction in tuberculous lymphadenopathy caused by Mycobacterium africanum. Infection 2018; 46:427-30. [PMID: 29330673 DOI: 10.1007/s15010-017-1112-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 12/27/2017] [Indexed: 12/21/2022]
Abstract
A 26-year-old HIV-negative male from Ghana was treated for cervical, intrathoracic and abdominal lymph node tuberculosis (TB) and tuberculous hepatitis. Penetration of the thoracic trachea by a mediastinal lymph node had caused bronchomucosal TB. Sputum culture grew M. africanum, sensitive to all first-line antituberculous drugs. Four weeks after the beginning of directly observed treatment with isoniazid, rifampin, pyrazinamide and ethambutol, the right cervical lymph node increased in size, liquefied and caused a spontaneous fistula. A biopsy of the necrotized lymph node revealed rare acid-fast bacilli with a positive PCR for Mycobacterium tuberculosis complex. After debridement, vacuum-assisted closure therapy was performed for 6 weeks. Five months after the beginning of antituberculous therapy, a second paradoxical reaction occurred, with painful swelling of two contralateral supraclavicular lymph nodes. Extirpation of one node yielded a positive PCR for M. tuberculosis complex; the culture was negative. Antituberculous treatment was continued, and additional treatment with oral prednisolone 20 mg daily for 1 month tapering over 10 weeks was introduced, resulting in a decrease in lymphadenopathy. Antituberculous treatment was continued for a total of 9 months. The outcome was favorable, no further lymphadenopathy occurred over the following 6 months.
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Abstract
For decades, the brain has been considered an immune-privileged organ, meaning that the brain was mainly ignored by the immune system and that the presence of immune cells, notably of the adaptive arm, was a hallmark of pathological conditions. Over the past few decades, the definition of the immune privilege continues to be refined. There has been evidence accumulating that shows that the immune system plays a role in proper brain function. This evidence may represent an effective source of therapeutic targets for neurological disorders. In this chapter, we discuss the recent advances in understanding the immunity of the brain and describe how tertiary lymphoid structures can be generated in the central nervous system, which might represent a new avenue to treat neurological disorders.
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Sun R, Zhang H, Liu K, Fan J, Li G, Song X, Li C. Clinicopathologic Predictive Factors of Cervical Lymph Node Metastasis in Differentiated Thyroid Cancer. Acta Otorrinolaringol Esp (Engl Ed) 2017; 69:149-155. [PMID: 29162220 DOI: 10.1016/j.otorri.2017.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 06/05/2017] [Accepted: 06/15/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cervical lymph node metastasis (LNM) has been proven to be a predictor for locoregional recurrence in differentiated thyroid carcinoma (DTC). Clinicopathological features could be effective predictive factors for central and lateral LNM of DTC, and provide references to surgeons for cervical neck dissection. METHODS Retrospective analysis of clinicopathological data was performed on 420 patients who underwent initial surgery from 2010 to 2015. RESULTS The incidence of central and lateral LNM was calculated. Of 420 patients, 247 (58.8%) exhibited central LNM, and 185 (44.1%) exhibited lateral LNM. There were 29 (6.9%) cases confirmed to have skip metastasis. Univariate and multivariate analysis revealed that tumour location, tumour size, multifocality, capsular invasion, affected lobes, and age were independent predictors of central LNM. Tumour location, capsular invasion, affected lobes, and tumour size were independent predictors of lateral LNM. CONCLUSIONS Our findings suggest that tumour location, affected lobes, capsular invasion, age, tumour size and multifocality may be taken as predictive factors for cervical LNM of DTC. Meticulous perioperative evaluation of cervical LNM and prophylactic cervical lymph node dissection that aims to remove the occult lymph nodes may be an option for DTC with risk factors.
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Affiliation(s)
- Ronghao Sun
- Department of Head and Neck Surgery, Sichuan Cancer Hospital, Chengdu, China
| | - Hua Zhang
- Department of Otolaryngology-Head and Neck Surgery, the Affiliated Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Kun Liu
- Department of Head and Neck Surgery, Sichuan Cancer Hospital, Chengdu, China
| | - Jinchuan Fan
- Department of Head and Neck Surgery, Sichuan Cancer Hospital, Chengdu, China
| | - Guojun Li
- Department of Head and Neck Surgery; Epidemiology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Xicheng Song
- Department of Otolaryngology-Head and Neck Surgery, the Affiliated Yuhuangding Hospital of Qingdao University, Yantai, China.
| | - Chao Li
- Department of Head and Neck Surgery, Sichuan Cancer Hospital, Chengdu, China.
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Yuan X, Lv J, Dong H, Wang J. Does cervical lymph node recurrence after oesophagectomy or definitive chemoradiotherapy for thoracic oesophageal squamous cell carcinoma benefit from salvage treatment? Interact Cardiovasc Thorac Surg 2017; 24:792-795. [PMID: 28453803 DOI: 10.1093/icvts/ivw441] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 12/20/2016] [Indexed: 11/13/2022] Open
Abstract
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'Does cervical lymph node recurrence after oesophagectomy or definitive chemoradiotherapy for thoracic oesophageal squamous cell carcinoma benefit from salvage treatment?' Altogether, 659 articles were found using the reported search, of which 8 represented the best evidence to answer the clinical question. The authors, journal, date, country of publication, patient group studied, study type, relevant outcomes and results of these articles were tabulated. All were retrospective or institutional reports. Seven of the 8 articles suggested that cervical lymphadenectomy (LD) or multimodal treatment with LD and radiotherapy (RT)/chemoradiotherapy (CRT) was associated with good outcomes in patients with cervical lymph node (LN) recurrence after curative oesophagectomy for thoracic oesophageal squamous cell carcinoma (ESCC). Salvage cervical LD was the main treatment and could achieve locoregional disease control and prolonged survival. It was safe with no postoperative mortality, although minor LD complications such as recurrent laryngeal nerve palsy were observed. Most reports highlighted that a solitary cervical LN relapse after curative oesophagectomy could be considered a good prognostic indicator for salvage cervical LD or multimodal treatment. Patients with microscopic residual tumour after salvage cervical LD or suspected extensive metastasis might benefit from a combination of LD and CRT. One article described salvage RT alone, again with a positive effect on survival. Conversely, data suggested that salvage LD in patients after definitive CRT for thoracic ESCC was not likely to control locoregional disease.
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Affiliation(s)
- Xiaoli Yuan
- Comprehensive Wards, Sichuan Cancer Hospital and Institute, Chengdu, China
| | - Jiahua Lv
- Department of Radiation Oncology, Sichuan Cancer Hospital and Institute, Chengdu, China
| | - Hang Dong
- Comprehensive Wards, Sichuan Cancer Hospital and Institute, Chengdu, China
| | - Jiuhui Wang
- Comprehensive Wards, Sichuan Cancer Hospital and Institute, Chengdu, China
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Habib MA, Rahman QB, Hossain S, Imon AA, Kundu GC. Effectiveness of Preoperative Lymphoscintigraphy for the Detection of Cervical Lymph Node Metastasis in Patients with Oral Squamous Cell Carcinoma. Ann Maxillofac Surg 2017; 7:30-36. [PMID: 28713733 PMCID: PMC5502512 DOI: 10.4103/ams.ams_176_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background: Oral squamous cell carcinoma (OSCC) is one of the most common malignant tumor. OSCC is the malignancy of squamous epithelium of oral cavity, which is the sixth most common malignancy reported worldwide and one with highest mortality rate among all malignancies. Aims: The aims of this study is to assess the diagnostic performance of lymphoscintigraphy (LSG) for the detection of cervical lymph node metastasis in patients with OSCC. Materials and Methods: This was a prospective study done in Oral and Maxillofacial Surgery Department and National Institute of Nuclear Medicine and Allied Science, Bangabandhu Sheikh Mujib Medical University during July 2015–June 2016. Thirty-six patients with OSCC were included in this study. Radioisotope technique was used in the detection of cervical metastases in patients with histologically proven OSCC. Patients were assessed by LSG after diagnosis of OSCC, and then, it was compared with postoperative histopathology report. Results: Lymphoscintigraphically out of 36 patients, 23 had lymphatic channel obstruction where histologically 20 patients had lymph node metastasis. There were 20 true positive cases, 13 true negative cases, and 3 false positive cases but no false negative case was found. The test of validity result reveals that sensitivity 100.0%, specificity 81.25%, accuracy 96.66%, positive predictive value 86.96%, and negative predictive value 100.0%. Conclusion: LSG for the detection of cervical lymph node metastasis has an important role for the management of OSCC. It is also cost-effective and decreases the morbidity.
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Affiliation(s)
- Md Ahsan Habib
- Department of Oral and Maxillofacial Surgery, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka-1000, Bangladesh
| | - Quazi Billur Rahman
- Department of Oral and Maxillofacial Surgery, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka-1000, Bangladesh
| | - Shakhawat Hossain
- Department of Oral and Maxillofacial Surgery, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka-1000, Bangladesh
| | - Ashik Abdullah Imon
- Department of Oral and Maxillofacial Surgery, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka-1000, Bangladesh
| | - Gokul Chand Kundu
- Department of Oral and Maxillofacial Surgery, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka-1000, Bangladesh
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Suzuki M, Yokota M, Nakamura Y, Ozaki S, Murakami S. Intranasal administration of IL-35 inhibits allergic responses and symptoms in mice with allergic rhinitis. Allergol Int 2017; 66:351-356. [PMID: 27707583 PMCID: PMC7130026 DOI: 10.1016/j.alit.2016.08.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 08/27/2016] [Accepted: 08/30/2016] [Indexed: 12/09/2022] Open
Abstract
Background IL-35 was recently identified as an anti-inflammatory cytokine. We previously reported that recombinant fusion protein of murine IL-35 and human IgG1 Fc fragment (rIL-35) reduced Th2 cytokines (IL-4 and IL-5) in vitro. However, it is unclear whether IL-35 can attenuate nasal allergic responses and symptoms of allergic rhinitis in vivo. Methods To investigate the in vivo effect of IL-35 on allergic rhinitis in mice, mice were sensitized with ovalbumin (OVA). Intranasal administration of rIL-35 and intranasal challenge of OVA were then performed. Nasal symptoms were estimated after the last nasal challenge. Nasal tissue and cervical lymph nodes (CLN) were collected. OVA-specific IgE in sera, OVA-specific T cell response, and the production of cytokines (IL-4, IL-5, and IL-10) stimulated by the OVA antigen were measured. The transcription level of Foxp3 and the frequency of CD4+CD25+ regulatory T cells were also measured. Results rIL-35 significantly inhibited the number of sneezes and nasal rubbing movements. It also reduced the number of eosinophils in the nasal mucosa and significantly decreased the level of OVA-specific IgE, the OVA-specific T cell proliferation, and the production of IL-4 and IL-5. Furthermore, rIL-35 significantly increased the production of IL-10, the transcription level of Foxp3, and the frequency of CD4+CD25+ regulatory T cells. Conclusions This study showed for the first time that rIL-35 inhibits nasal allergic responses and symptoms in mice, and that rIL-35 increases IL-10, Foxp3, and CD4+CD25+ regulatory T cells in CLN. This study also suggests that intranasal administration of IL-35 can attenuate allergic rhinitis.
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Mishra N, Rath KC, Upadhyay UN, Raut S, Baig SA, Birmiwal KG. Preoperative evaluation of cervical lymph nodes for metastasis in patients with oral squamous cell carcinoma: A comparative study of efficacy of palpation, ultrasonography and computed tomography. Natl J Maxillofac Surg 2017; 7:186-190. [PMID: 28356691 PMCID: PMC5357936 DOI: 10.4103/0975-5950.201368] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Oral cancer is a major health threat in a country like India, where patients frequently present with advanced disease with regional dissemination to cervical lymph nodes. The management and prognosis depend on the status of cervical lymph nodes. Thus, it becomes imperative to diagnose and evaluate them preoperatively. AIM This study aims to compare the efficacy of palpation, ultrasonography (USG) and computed tomography (CT) in the preoperative evaluation of cervical lymph node for metastasis in patients with oral squamous cell carcinoma. SETTINGS Department of Oral and Maxillofacial Surgery, SCB Dental College and Hospital, Cuttack, Odisha, India. METHODOLOGY A total of thirty patients of either sex of age group 20-70 years, diagnosed with oral cancer were randomly selected for the study and subjected to palpation, USG and computer tomography followed by histopathology for confirmation. The results were evaluate statistically by sensitivity, specificity, positive predictive value, and negative predictive value and accuracy. RESULTS For level IA palpation, USG and CT were equally sensitive (100%) and specific (100%). Although palpation, USG and CT were equally sensitive (80%) for level IB, the specificity of palpation (70%) <USG (95%) = CT (95%). For level II sensitivity of palpation (25%) <USG (75%) <CT (100%) whereas specificity was CT (84.6%) <palpation (92.3%) <USG (100%). CONCLUSION CT (96.1%) and USG (97.7%) were more accurate than palpation (92.7%), for detection of metastasis in cervical lymph nodes in patients with oral squamous cell carcinoma. CT along with USG should be used for accurate preoperative evaluation of cervical lymph node.
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Affiliation(s)
- Niranjan Mishra
- Department of Oral and Maxillofacial Surgery, SCB Dental College and Hospital, Cuttack, Odisha, India
| | - Krushna Chandra Rath
- Department of Oral and Maxillofacial Surgery, City Hospital, Berhampur, Ganjam, Odisha, India
| | - Upendra Nath Upadhyay
- Department of Radiology and Imaging, Hitech Medical College and Hospital, Bhubaneswar, Odisha, India
| | - Subhrajit Raut
- Department of Oral and Maxillofacial Surgery, Hitech Dental College and Hospital, Bhubaneswar, Odisha, India
| | - Shadab Ali Baig
- Department of Oral and Maxillofacial Surgery, SCB Dental College and Hospital, Cuttack, Odisha, India
| | - Krishna Gopal Birmiwal
- Department of Oral and Maxillofacial Surgery, SCB Dental College and Hospital, Cuttack, Odisha, India
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Chahed H, Hachicha H, Berriche A, Abdelmalek R, Mediouni A, Kilani B, Amor MB, Benaissa HT, Besbes G. Paradoxical reaction associated with cervical lymph node tuberculosis: predictive factors and therapeutic management. Int J Infect Dis 2016; 54:4-7. [PMID: 27810522 DOI: 10.1016/j.ijid.2016.10.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 10/23/2016] [Accepted: 10/24/2016] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The aims of this study were to determine predictive factors of paradoxical reaction in patients with cervical lymph node tuberculosis (TB) and to discuss the therapeutic management of this condition. MATERIALS AND METHODS A retrospective study was performed of 501 patients managed for cervical lymph node TB over a period of 12 years (from January 2000 to December 2011). Statistical data were analyzed using IBM SPSS Statistics version 20.0. RESULTS Paradoxical reaction occurred in 67 patients (13.4%), with a median delay to onset after starting TB treatment of 7 months. Lymph node size ≥3cm and associated extra-lymph node TB were independently associated with paradoxical reaction. Treatment consisted of surgical excision (71.6%), restarting quadruple therapy (10.4%), reintroduction of ethambutol (23.8%), and addition of ciprofloxacin (20.8%); steroids were given in two cases . All patients recovered after an average treatment duration of 14.91±7.03 months. CONCLUSION The occurrence of paradoxical reaction in cervical lymph node TB seems to be predicted by associated extra-lymph node TB and a swelling size ≥3cm. The treatment of paradoxical reaction remains unclear and more randomized trials are necessary to improve its management.
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Affiliation(s)
- Houda Chahed
- Faculty of Medicine, Université de Tunis El Manar, Tunis, Tunisia; Otorhinolaryngology Department, Rabta Hospital, Jebel Lakhdar Bab Saadoune, 1007 Tunis, Tunisia.
| | - Hela Hachicha
- Faculty of Medicine, Université de Tunis El Manar, Tunis, Tunisia; Otorhinolaryngology Department, Rabta Hospital, Jebel Lakhdar Bab Saadoune, 1007 Tunis, Tunisia
| | - Aida Berriche
- Faculty of Medicine, Université de Tunis El Manar, Tunis, Tunisia; Infectious Diseases Department, Rabta Hospital, Tunis, Tunisia
| | - Rim Abdelmalek
- Faculty of Medicine, Université de Tunis El Manar, Tunis, Tunisia; Infectious Diseases Department, Rabta Hospital, Tunis, Tunisia
| | - Azza Mediouni
- Faculty of Medicine, Université de Tunis El Manar, Tunis, Tunisia; Otorhinolaryngology Department, Rabta Hospital, Jebel Lakhdar Bab Saadoune, 1007 Tunis, Tunisia
| | - Badreddine Kilani
- Faculty of Medicine, Université de Tunis El Manar, Tunis, Tunisia; Infectious Diseases Department, Rabta Hospital, Tunis, Tunisia
| | - Mohamed Ben Amor
- Faculty of Medicine, Université de Tunis El Manar, Tunis, Tunisia; Otorhinolaryngology Department, Rabta Hospital, Jebel Lakhdar Bab Saadoune, 1007 Tunis, Tunisia
| | - Hanene Tiouiri Benaissa
- Faculty of Medicine, Université de Tunis El Manar, Tunis, Tunisia; Infectious Diseases Department, Rabta Hospital, Tunis, Tunisia
| | - Ghazi Besbes
- Faculty of Medicine, Université de Tunis El Manar, Tunis, Tunisia; Otorhinolaryngology Department, Rabta Hospital, Jebel Lakhdar Bab Saadoune, 1007 Tunis, Tunisia
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Ripoll E, Montironi C, Alós L, Pujol T, Berenguer J, Oleaga L. Oropharyngeal Syphilis: Imaging and Pathologic Findings in Two Patients. Head Neck Pathol 2016; 11:399-403. [PMID: 27699642 PMCID: PMC5550383 DOI: 10.1007/s12105-016-0758-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 09/23/2016] [Indexed: 12/29/2022]
Abstract
Syphilis is a widespread infection with increasing frequency in developed countries, especially among men who have sex with men. We present two cases of oropharyngeal syphilis in two middle-aged men who presented with a painless tonsillar ulcer and progressive enlargement of cervical lymph nodes suspected of being a tonsillar tumour. A pathologic analysis of the ulcer led to an accurate diagnosis. We review the imaging and pathologic findings to emphasize the importance of taking syphilis into account in the differential diagnosis.
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Affiliation(s)
- Enric Ripoll
- Radiology Department, Hospital Clínic de Barcelona, Villarroel 170, Barcelona, Spain
| | - Carla Montironi
- Pathology Department, Hospital Clínic de Barcelona, Villarroel 170, Barcelona, Spain
| | - Llucia Alós
- Pathology Department, Hospital Clínic de Barcelona, Villarroel 170, Barcelona, Spain
| | - Teresa Pujol
- Radiology Department, Hospital Clínic de Barcelona, Villarroel 170, Barcelona, Spain
| | - Joan Berenguer
- Radiology Department, Hospital Clínic de Barcelona, Villarroel 170, Barcelona, Spain
| | - Laura Oleaga
- Radiology Department, Hospital Clínic de Barcelona, Villarroel 170, Barcelona, Spain
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Ryoo I, Suh S, You SH, Seol HY. Usefulness of Microvascular Ultrasonography in Differentiating Metastatic Lymphadenopathy from Tuberculous Lymphadenitis. Ultrasound Med Biol 2016; 42:2189-2195. [PMID: 27353493 DOI: 10.1016/j.ultrasmedbio.2016.05.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/22/2016] [Accepted: 05/16/2016] [Indexed: 06/06/2023]
Abstract
This study was undertaken to evaluate the usefulness of vascular pattern analysis on microvascular ultrasonography in distinguishing metastatic lymphadenopathy from tuberculous lymphadenitis, compared with conventional power Doppler ultrasonography, and to evaluate inter-observer agreement for microvascular ultrasonography. Thirty-four patients with metastatic lymphadenopathy and 27 patients with tuberculous lymphadenitis were included. The level of inter-observer agreement was excellent or good for all aspects of vascular pattern analysis on both ultrasonographic examinations. Vascular distribution, internal vascularity and internal vascular features of lymph nodes on microvascular ultrasonography differed significantly different (p ≤ 0.002) between metastatic lymphadenopathy and tuberculous lymphadenitis. A central vascular pattern with displacement was prevalent in metastasis, and an avascular pattern was more frequent in tuberculosis. Internal vascularity of metastasis was higher than that of tuberculosis. Vascular patterns on power Doppler ultrasonography did not differ significantly. Vascular pattern analysis using microvascular ultrasonography can be helpful in differentiating metastatic lymphadenopathy from tuberculous lymphadenitis with good inter-observer agreement.
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Affiliation(s)
- Inseon Ryoo
- Department of Radiology, Korea University Guro Hospital, College of Medicine, Seoul, Korea
| | - Sangil Suh
- Department of Radiology, Korea University Guro Hospital, College of Medicine, Seoul, Korea.
| | - Sung-Hye You
- Department of Radiology, Korea University Anam Hospital, College of Medicine, Seoul, Korea
| | - Hae Young Seol
- Department of Radiology, Korea University Guro Hospital, College of Medicine, Seoul, Korea
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Chen L, Butler KA, Bell DA. Fine needle aspiration cytology of cervical lymph node involvement by ovarian serous borderline tumor. Cytojournal 2016; 13:16. [PMID: 27563339 PMCID: PMC4977969 DOI: 10.4103/1742-6413.187052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 02/26/2016] [Indexed: 01/27/2023] Open
Abstract
Serous borderline tumor (SBT) involving a cervical lymph node is extremely rare. In addition, fine needle aspiration (FNA) cytology of the involved cervical lymph node shares tremendous morphologic similarity with other low-grade papillary carcinomas. Thus, it can be easily misdiagnosed as metastatic carcinoma. A 42-year-old female had a history of bilateral SBT and postbilateral salpingo-oophorectomy. She presented with left cervical lymphadenopathy 6 months later. FNA cytology showed a low-grade papillary neoplasm with psammoma bodies. Needle core biopsy along with immunostains was diagnostic of cervical lymph node involvement (LNI) of SBT. although extremely rare, cervical LNI can be found in patients with SBTs. FNA cytology, sometimes, is indistinguishable from metastatic papillary adenocarcinoma. Cell block or needle core biopsy is essential to make the correct diagnosis.
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Affiliation(s)
- Longwen Chen
- Address: Division of Anatomic Pathology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Kristina A Butler
- Department of Obstetrics and Gynecology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Debra A Bell
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
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An YS, Yoon JK, Lee SJ, Jeong SH, Lee HW. Clinical significance of post-treatment 18F-fluorodeoxyglucose uptake in cervical lymph nodes in patients with diffuse large B-cell lymphoma. Eur Radiol 2016; 26:4632-4639. [PMID: 27193777 DOI: 10.1007/s00330-016-4365-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 02/15/2016] [Accepted: 04/11/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES We assessed the clinical significance of FDG uptake in cervical lymph nodes after treatment of patients with DLBCL. METHODS In total, 87 patients with DLBCL were enrolled. All patients had newly appeared FDG uptake in cervical lymph nodes on PET/CT during follow-up after cessation of therapy. Cervical lymph nodes were finally diagnosed as benign or malignant according to histopathological findings or follow-up PET. Clinical characteristics and PET findings were compared between groups and factors associated with malignant lesions were evaluated. RESULTS Only 8 (9.2 %) patients with cervical lymph nodes with FDG uptake ultimately had malignancy. FDG uptake lymph nodes appeared significantly earlier in the malignant group than in patients with benign FDG uptake (p = 0.013). Primary nodal lymphoma was more frequent in patients with cancer spread than in those with benign FDG uptake in lymph nodes (p < 0.001). CONCLUSION Most cervical lymph nodes with FDG uptake (about 91 %) appearing after treatment of malignant DLBCL were ultimately benign. The elapsed time between the end of therapy and the appearance of cervical lymph nodes with FDG uptake and the primary sites of lymphomas are helpful clues in determining which cases are malignant. KEY POINTS • About 91 % appearing after treatment of DLBCL were benign. • Elapsed time between therapy and FDG uptake was associated with malignancy. • Primary sites of lymphoma are helpful clues to determine malignancy.
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Affiliation(s)
- Young-Sil An
- Department of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, Woncheon-dong, Yeongtong-gu, Gyeonggi-do, Suwon-si, Korea, 443-749.
| | - Joon-Kee Yoon
- Department of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, Woncheon-dong, Yeongtong-gu, Gyeonggi-do, Suwon-si, Korea, 443-749
| | - Su Jin Lee
- Department of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, Woncheon-dong, Yeongtong-gu, Gyeonggi-do, Suwon-si, Korea, 443-749
| | - Seong Hyun Jeong
- Department of Hematology-Oncology, Ajou University School of Medicine, Woncheon-dong, Yeongtong-gu, Gyeonggi-do, Suwon, Korea
| | - Hyun Woo Lee
- Department of Hematology-Oncology, Ajou University School of Medicine, Woncheon-dong, Yeongtong-gu, Gyeonggi-do, Suwon, Korea
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Shi JH, Xu YY, Pan QZ, Sui GQ, Zhou JP, Wang H. The value of combined application of ultrasound-guided fine needle aspiration cytology and thyroglobulin measurement for the diagnosis of cervical lymph node metastases from thyroid cancer. Pak J Med Sci 2015; 31:1152-5. [PMID: 26649004 PMCID: PMC4641273 DOI: 10.12669/pjms.315.6726] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: The aim of this study was to explore the diagnostic value of ultrasound-guided (US-guided) fine-needle aspiration cytology (FNAC), thyroglobulin measurement on fine-needle aspiration (FNA-Tg), combined US-guided FNAC, and the ratio between FNA-Tg and serum Tg (FNA-Tg/serum Tg) for patients with cervical lymph node (CLN) metastases from thyroid carcinoma. Methods: We selected 148 patients with thyroid cancer with suspicious CLN metastases who met the inclusion criteria. FNAC findings, FNA-Tg levels, and serum Tg levels were evaluated before surgical treatment. The results of FNAC and FNA-Tg from CLNs were analyzed retrospectively. Results: Ninety-four of 148 cases were metastatic and 54 were benign. The sensitivity, specificity, and accuracy of FNAC were 68.1%, 100.0%, and 79.7%, respectively. The sensitivity, specificity, and accuracy of FNA-Tg/serum Tg were 91.5%, 88.9%, and 90.5%, respectively. The sensitivity, specificity, and accuracy of FNA-Tg [10 ng/mL] were 98.9%, 68.5%, and 87.8%, respectively. The sensitivity, specificity, and accuracy of combined US-guided FNAC and FNA-Tg/serum Tg were 95.7%, 96.3%, and 95.9%, respectively. There was a statistically significant difference between FNAC and combined US-guided FNAC and FNA-Tg/serum Tg for sensitivity, specificity, and accuracy (P < 0.05). Conclusion: The method of FNA-Tg/serum Tg is sensitive enough for diagnosing CLN metastases from thyroid cancer. The combined application of US-guided FNAC and FNA-Tg/serum Tg contributes to improving the accuracy of diagnosing CLN metastases in patients with thyroid cancer.
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Affiliation(s)
- Jia-Hong Shi
- Jia-hong Shi, Department of Ultrasonography, China-Japan Union Hospital of Jilin University, Changchun 130033, China
| | - Ying-Ying Xu
- Ying-ying Xu, Department of Ultrasonography, China-Japan Union Hospital of Jilin University, Changchun 130033, China
| | - Qi-Zheng Pan
- Qi-zheng Pan, Department of Anesthesia, China-Japan Union Hospital of Jilin University, Changchun 130033, China
| | - Guo-Qing Sui
- Guo-qing Sui, Department of Ultrasonography, China-Japan Union Hospital of Jilin University, Changchun 130033, China
| | - Jian-Ping Zhou
- Jian-ping Zhou, Department of Ultrasonography, China-Japan Union Hospital of Jilin University, Changchun 130033, China
| | - Hui Wang
- Hui Wang, Department of Ultrasonography, China-Japan Union Hospital of Jilin University, Changchun 130033, China
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Du J, Bai X, Lu Y, Wang H, Zhao J, Liu J, Wang H, Sui X, Fang Q. Diagnostic Efficacy of Ultrasonographic Characteristics of Thyroid Carcinoma in Predicting Cervical Lymph Node Metastasis. Ultrasound Med Biol 2015; 42:S0301-5629(15)00533-5. [PMID: 26620222 DOI: 10.1016/j.ultrasmedbio.2015.08.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 08/26/2015] [Accepted: 08/31/2015] [Indexed: 06/05/2023]
Abstract
The goals of this study were to determine the ultrasonographic characteristics of thyroid carcinoma (TC) and to explore the diagnostic efficacy of these ultrasonographic characteristics in predicting cervical lymph node metastasis (LNM). From June 2012 to June 2014, a total of 186 TC patients were recruited from the Central Hospital of Chengde City, Hebei, China. We divided them into two groups: the metastatic group comprised 129 nodules (n = 86), and the non-metastatic group 117 nodules (n = 100). Univariate and multivariate analyses were used to evaluate the relationship between ultrasonographic characteristics and cervical LNM. Spectral Doppler ultrasound was employed to estimate peak systolic velocity, pulsatility index and resistive index. Receiver operating characteristic curves were drawn to evaluate the efficacy of ultrasonographic characteristics in predicting cervical LNM. The sensitivity, specificity, positive predictive value and negative predictive value of ultrasonographic diagnosis were 81.40% (105/129), 92.32% (108/117), 92.11% (105/114) and 81.82% (108/132), respectively. Cervical LNM in TC frequently occurred at the cervical level VI (37.98%) and was located mainly in the middle pole (46.51%) or lower pole (41.09%). Peak systolic velocity and resistive index values were significantly higher in the metastatic group than in the non-metastatic group (both p < 0.001). Multivariate analysis revealed that nodular diameter, capsular invasion, microcalcification and flow grade were risk factors for TC patients with cervical LNMs (all p < 0.05). Furthermore, receiver operating characteristic curve analysis revealed that nodular diameter, capsular invasion, microcalcification and flow grade had excellent accuracy in predicting cervical LNM. We conclude that ultrasonographic characteristics of TC, including maximum nodular diameter, capsular invasion, microcalcification and flow grade, may predict cervical LNM.
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Affiliation(s)
- Jianwen Du
- Department of Ultrasound Diagnostics, Chengde Central Hospital, Chengde, China
| | - Xianshu Bai
- Department of Ultrasound Diagnostics, Chengde Central Hospital, Chengde, China
| | - Yue Lu
- Department of Ultrasound Diagnostics, Chengde Central Hospital, Chengde, China
| | - Haili Wang
- Department of Ultrasound Diagnostics, Chengde Central Hospital, Chengde, China
| | - Jingjie Zhao
- Department of Pathology, Chengde Central Hospital, Chengde, China
| | - Jianwei Liu
- Department of Pathology, Chengde Central Hospital, Chengde, China
| | - Hong Wang
- Department of Ultrasound Diagnostics, Chengde Central Hospital, Chengde, China.
| | - Xin Sui
- Department of Ultrasound, Third Hospital of Hebei Medical University, Shi Jiazhuang, China
| | - Qinmao Fang
- Department of Ultrasound, Third Hospital of Hebei Medical University, Shi Jiazhuang, China
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Pinto A, Wieshmann H, Triantafyllou A, Shaw R. Tattoo-pigmented cervical lymph node that masqueraded as the sentinel lymph node in oral squamous cell carcinoma. Br J Oral Maxillofac Surg 2015; 53:886-7. [PMID: 26188933 DOI: 10.1016/j.bjoms.2015.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 06/15/2015] [Indexed: 11/25/2022]
Abstract
We describe a case of a pigmented cervical lymph node mimicking the sentinel node during sentinel lymph node biopsy (SLNB) on a patient with oral squamous cell carcinoma (OSCC). The patient had extensive tattoos on his neck. This pigmented lymph node was not identified to be the sentinel lymph node using static and dynamic lymphoscintigraphy. Subsequent histological analysis revealed tattoo pigment within this lymph node. It is important during cervical SLNB to be aware that cutaneous tattoos can pigment lymph nodes.
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Honda K, Ishiyama K, Suzuki S, Oumi E, Sato T, Kawasaki Y, Saito H, Ishikawa K. Sentinel lymph node biopsy using computed tomographic lymphography in patients with early tongue cancer. Acta Otolaryngol 2015; 135:507-12. [PMID: 25761497 PMCID: PMC4487571 DOI: 10.3109/00016489.2015.1010126] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Conclusions: Because computed tomography (CT) lymphography provides preoperative images of anatomic relationships between a tumor, its associated lymph vessels, and the sentinel lymph node (SLN), it may aid in directing the SLN biopsy for management of early tongue cancer. Objectives: SLN biopsy using a radioisotope (RI) generally has been performed in head and neck cancer. However, this method can be performed only at institutions that are licenced for its use. In this study, we evaluated the utility of performing SLN biopsy in patients with early tongue cancer using the newly developed technique of CT lymphography. Methods: Enrolled in this study were 31 patients with T1N0 or T2N0 tongue cancer. CT images were obtained before and after injection of iopamidol into the peritumoral region and the SLN was identified as the first enhanced lymph node. SLN biopsy was performed using CT lymphographic guidance combined with blue dye injection. Results: The SLN was detected by CT lymphography in 28 cases (90.3%). By intraoperative frozen section examination, metastases to SLNs were found in 4 (14.3%) (T1N0, 1 patient; T2N0, 3 patients) of the 28 patients. Of these four, SLN micrometastases were found in one patient.
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Affiliation(s)
- Kohei Honda
- Department of Otorhinolaryngology-Head and Neck Surgery
- Correspondence: Kohei Honda, Department of Otorhinolaryngology-Head and Neck Surgery, Akita University Graduate School of Medicine, Akita, Japan 010-8543. +81 18 836 2622.
| | - Koich Ishiyama
- Department of Radiology, Akita University Graduate School of Medicine, Akita, Japan
| | | | - Eigo Oumi
- Department of Otorhinolaryngology-Head and Neck Surgery
| | - Teruyuki Sato
- Department of Otorhinolaryngology-Head and Neck Surgery
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Hu YY, Zhang X, Long W, Lin XP, Zhang YR, Li YH, Xiao ZZ, Zheng RL, Liang PY, Fan W. Cervical lymph node hyperplasia on [(18)F]-fluorodeoxyglucose positron emission tomography/computed tomography scan after treatment of children and adolescents with malignant lymphoma. Eur J Radiol 2015; 84:1378-82. [PMID: 25882963 DOI: 10.1016/j.ejrad.2015.03.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 03/13/2015] [Accepted: 03/16/2015] [Indexed: 11/23/2022]
Abstract
PURPOSE To define imaging manifestations and clinical prognosis of cervical lymph node hyperplasia using [(18)F]-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) scanning after treatment of children and adolescents with malignant lymphoma. METHODS Children and adolescent patients with malignant lymphoma who had high FDG uptake in their cervical lymph nodes via PET/CT after treatment, which was not due to tumor recurrence or residue, were retrospectively analyzed. RESULTS Twenty-seven patients with a median age of 12 years were included; 11 had Hodgkin's disease and 16 had non-Hodgkin's lymphoma. The time from PET/CT scan to completion of therapy was 1-36 months, 85.2% (23/27) of which took place within 12 months. Three patients had confirmed lymph node follicular hyperplasia by biopsy, while all 27 patients achieved disease-free survival during the follow-up period. The maximum standardized uptake values (SUVmax) of cervical lymph nodes were 2.2-16.2 and the maximum short axis ranged from 0.3 to 1.2 cm. Cervical lymph node hyperplasia was noted in neck levels I-V, and neck level II bilaterally had the highest incidence (100%). Bilateral cervical lymph node hyperplasia was symmetrical in terms of both the SUVmax and affected locations. Thymic hyperplasia and nasopharyngeal lymphoid hyperplasia were both observed in 24 patients (88.9%). There was no relationship in terms of the SUVmax between cervical lymph nodes and thymic tissue, cervical nodes or nasopharyngeal lymphoid tissue. CONCLUSION Cervical lymph node hyperplasia with high FDG uptake on PET/CT scans found after treating children and adolescents with malignant lymphoma can be benign processes. Awareness of this possibility may help avoid invasive procedures and over-treatment.
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Bhargava EK, Rathore PK, Raj A, Meher R, Rana K. Diagnostic Efficacy of Computed Tomography in Detecting Cervical Metastases in Clinically N0 Head and Neck Squamous Cell Carcinoma. Indian J Otolaryngol Head Neck Surg 2015; 68:25-9. [PMID: 27066405 DOI: 10.1007/s12070-015-0837-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/02/2015] [Indexed: 12/19/2022] Open
Abstract
The search for a single non-invasive highly accurate diagnostic modality for identification of cervical metastasis in head and neck squamous cell carcinoma (HNSCC) is yet to bear fruit. Thirty proven cases of HNSCC with no palpable neck nodes were selected, requiring surgery for the primary tumour. Detailed clinical evaluation and contrast enhanced computed tomography (CECT) scans were done. Patients underwent elective neck dissection along with surgery for the primary tumour. Specimens were sent for histopathological examination (HPE), considered gold standard. Results of CECT were compared with HPE. Clinical examination had a NPV of 80 % and CECT had a sensitivity, specificity, PPV, NPV, and accuracy of 83, 75, 45.5, 94.7, and 76.7 % respectively. A CECT may be added to the initial assessment of a patient of HNSCC, allowing for earlier diagnosis of nodal metastasis that may allow for a better chance at survival.
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Affiliation(s)
- Eishaan K Bhargava
- Department of Otorhinolaryngology-Head and Neck Surgery, Maulana Azad Medical College and associated Loknayak, G.N.E.C., and GB Pant Hospitals, Bahadur Shah Zafar Marg, New Delhi, 110002 Delhi India
| | - Praveen K Rathore
- Department of Otorhinolaryngology-Head and Neck Surgery, Maulana Azad Medical College and associated Loknayak, G.N.E.C., and GB Pant Hospitals, Bahadur Shah Zafar Marg, New Delhi, 110002 Delhi India
| | - Anoop Raj
- Department of Otorhinolaryngology-Head and Neck Surgery, Maulana Azad Medical College and associated Loknayak, G.N.E.C., and GB Pant Hospitals, Bahadur Shah Zafar Marg, New Delhi, 110002 Delhi India
| | - Ravi Meher
- Department of Otorhinolaryngology-Head and Neck Surgery, Maulana Azad Medical College and associated Loknayak, G.N.E.C., and GB Pant Hospitals, Bahadur Shah Zafar Marg, New Delhi, 110002 Delhi India
| | - Kanika Rana
- Department of Otorhinolaryngology-Head and Neck Surgery, Maulana Azad Medical College and associated Loknayak, G.N.E.C., and GB Pant Hospitals, Bahadur Shah Zafar Marg, New Delhi, 110002 Delhi India
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Khajanchi M, Bambarkar S, Gadgil A, Roy N. Cervical Node Tuberculosis in Adults of an Urban Middle Class Community: Incidence and Management. Indian J Otolaryngol Head Neck Surg 2016; 68:345-51. [PMID: 27508138 DOI: 10.1007/s12070-015-0832-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 01/27/2015] [Indexed: 10/24/2022] Open
Abstract
The aim of this study is to estimate the incidence of cervical node tuberculosis (TB) in an urban middle class population and to describe an effective protocol for management of cervical lymphadenopathy. The present study is a prospective observational study conducted over two years (2007-2009) in a community hospital in Mumbai, India. All adults (age ≥14 years) presenting with cervical lymphadenopathy, not resolving were included and their details of history and examination were noted. All patients were subjected to fine needle aspiration cytology (FNAC) and biopsy was done selectively as indicated. The response at 1, 3 and 6 months of starting anti tuberculous treatment (ATT) were noted. A total of 191 patients were included in this study. The mean age was 41 years and male to female ratio was 1:1.1 in patients with cervical lymphadenopathy. A history of contact with a patient of TB was the most significantly associated history seen in patients diagnosed to have TB of cervical nodes (p < 0.001). TB (38.7%) followed by reactive nodes (37.6%) were the most common etiologies. A 90.6% response rate was seen in patients taking 6 months ATT for cervical node TB. The incidence of adult (≥14 years) cervical node TB was 52/100,000 people in an urban middle class community in Mumbai. A single swelling in the neck without other associated symptoms or signs was the commonest mode of presentation of TB of the neck nodes. A history of contact with TB, demonstrated an association with the final diagnosis of tuberculous lymphadenopathy.
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