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Regional Lymph Node Metastases (regional + lymph_node_metastase)
Selected AbstractsClinical and pathological data of 10 malignant pheochromocytomas: Long-term follow up in a single instituteINTERNATIONAL JOURNAL OF UROLOGY, Issue 3 2007Kuo-How Huang Background: Malignant pheochromocytomas are rare. Many controversies still exists in clinical practice. We report the clinical and histological data of long-term follow up in 10 patients with malignant pheochromocytoma. Methods: The clinical charts of 10 patients with malignant pheochromocytoma from a single institute were reviewed. The diagnosis of pheochromocytoma was confirmed at surgery. All patients had metastases in sites where chromaffin tissue was normally absent. Results: The median follow-up period was 5.5 years (range, 2,20 years). Extra-adrenal tumors occurred in four patients including paraganglioma tumors in three cases and bladder tumor in one case. Regional lymph node metastases were noted in six patients. Distant metastases were located in the lungs of two patients, in the bones of two patients and in the liver of one patient. Histological characteristics were not helpful for diagnosis of malignancy and for prediction of prognosis. Metastases were present in postoperative pathology in seven patients. In another three patients, metastases were discovered 6 months to 10 years after surgery. Three patients received chemotherapy and one patient received combination therapy of high-dose 131I-meta-iodobenzylguanidine (131I-MIBG) therapy and chemotherapy. All patients achieved long-term survival except for two who died of metastasis 1.5 years and 2 years after diagnosis. Conclusions: Early complete resection and adjunctive lymphadenectomy can cure malignancy. Close long-term follow up for more than 10 years after surgery is necessary in patients with pheochromocytoma. The possibility of malignancy should be kept in mind even though the initial pathology is benign. [source] Salivary duct carcinoma with neuroendocrine features: Report of a case with cytological and immunohistochemical studyDIAGNOSTIC CYTOPATHOLOGY, Issue 3 2004Juan B. Laforga M.D. Abstract We report a salivary duct carcinoma (SDC) of parotid gland in a 75-year-old male. Initially, it was studied by fine-needle aspiration, which disclosed features of malignancy consistent with a high-grade carcinoma. Histologically, the tumor showed typical features of SDC, predominantly with a solid and apocrine pattern. The aggressive behavior of this tumor was documented by facial palsy and the presence of 12 regional lymph node metastases. Immunohistochemical study showed positivity for cytokeratins (AE1/AE3), cytokeratin 7, GCDFP-15, C-erbB-2, Mib-1, topoisomerase II ,, p53, and androgen receptors. Diffuse positivity with chromogranin-A, synaptophysin, and Grimelius stains was also observed, suggesting endocrine features. Phosphotungstic acid hematoxylin, antimitochondrial antigen, progesterone and estrogen receptors, cytokeratin 20, and S-100 stains were negative. To our knowledge, this is the first case reported of SDC exhibiting neuroendocrine differentiation. Diagn. Cytopathol. 2004;31:189,192. © 2004 Wiley-Liss, Inc. [source] The natural course of cutaneous melanomaJOURNAL OF SURGICAL ONCOLOGY, Issue 4 2004Ulrike Leiter MD Abstract The natural course of cutaneous melanoma (CM) is determined by its metastatic spread and depends on tumor thickness, ulceration, gender, localization, and the histologic subtype of the primary tumor. CM metastasis develops via three main metastatic pathways and occurs as satellite or in-transit metastasis, as regional lymph node metastasis or as distant metastasis at the time of primary recurrence. About 50% of all CM patients with tumor progression firstly develop regional lymph node metastases. In the other 50% the first metastases are satellite or in-transit metastases (about 20%), or immediately distant metastases (about 30%). Development of distant metastasis appears to be an early event in metastatic spread and may in the majority of cases originate from the primary tumor, only few cases may develop secondarily to locoregional metastasis. Reporting of organ involvement in distant metastasis greatly differs between the results of imaging techniques and autopsy results in respect to the metastatic patterns detected, pointing out that there is a need of improved imaging systems. Proliferation, neovascularization, lymphangiogenesis, invasion, circulation, and embolism are important steps in the pathogenesis of CM metastasis, with tumor vascularity as an important independent significant prognostic factor. The expression of chemokine receptors in cancer cells associated with the expression of the respective chemokine receptor ligands in the target sites of the metastasis is an interesting observation which may stimulate the development of new therapeutic strategies. J. Surg. Oncol. 2004;86:172,178. © 2004 Wiley-Liss, Inc. [source] Metastatic pathways and time courses in the orderly progression of cutaneous melanomaBRITISH JOURNAL OF DERMATOLOGY, Issue 1 2002F. Meier SummaryBackground,,It is known that two-thirds of patients who develop clinical metastases following treatment of a primary cutaneous melanoma initially present with locoregional metastases and one-third initially present with distant metastases. However, few reports in the literature give detailed figures on different metastatic pathways in cutaneous melanoma. Objectives,,The aim of the present study was to perform a detailed analysis of the different metastatic pathways, the time course of the development of metastases and the factors influencing them. Methods,,In a series of 3001 patients with primary cutaneous melanoma at first presentation, 466 subsequently developed metastasis and were followed-up over the long term at the University of Tuebingen, Germany between 1976 and 1996. Different pathways of metastatic spread were traced. Associated risk factors for the different pathways were assessed. Differences in survival probabilities were calculated by the Kaplan,Meier method and evaluated by the log-rank test. Results,,In 50·2% of the patients the first metastasis after treatment of the primary tumour developed in the regional lymph nodes. In the remaining half of the patient sample the first metastasis developed in the lymphatic drainage area in front of the regional lymph nodes, as satellite or in-transit metastases (21·7%) or as direct distant metastases (28·1%). Anatomical location, sex and tumour thickness were significant risk factors for the development of metastasis by different pathways. The most important risk factor appeared to be the location of the primary tumour. The median intervals elapsing before the first metastasis differed significantly between the different metastatic pathways. The direct distant metastases became manifest after a median period of 25 months, thus later than the direct regional lymph node metastases (median latency period, 16 months) and the direct satellite and in-transit metastases (median latency period, 17 months). In patients who developed distant metastases the period of development was independent of the metastatic route. The time at which the distant metastases developed was roughly the same (between 24 and 30 months after the detection of the primary tumour), irrespective of whether satellite or in-transit metastases, lymph node metastases or distant metastases were the first to occur. Conclusions,,The time course of the development of distant metastasis was more or less the same irrespective of the metastatic pathway; this suggests that in patients with in-transit or satellite metastasis or regional lymph node metastasis, haematogenic metastatic spread had already taken place. Thus, the diagnostic value of sentinel lymph node biopsy and the therapeutic benefit of elective lymph node dissection may be limited, as satellite and in-transit metastases or direct distant metastases will not be detected and haematogenous spread may already have taken place when the intervention is performed. [source] Should adjuvant radiotherapy be recommended following resection of regional lymph node metastases of malignant melanomas?BRITISH JOURNAL OF DERMATOLOGY, Issue 1 2001D. Fuhrmann Background ,Several authors have recommended adjuvant radiotherapy following resection of regional lymph node metastases in cutaneous malignant melanoma. There is, however, little evidence from controlled trials that patients benefit from this treatment. Objectives ,To evaluate the usefulness of adjuvant radiotherapy following resection of lymph node metastases in cutaneous malignant melanoma. Methods ,We performed a retrospective study comparing 58 patients who underwent radiotherapy following resection of regional lymph node metastases with 58 controls from another centre who exclusively underwent regional lymphadenectomy. Patients and their controls were matched with respect to the number of tumour-bearing lymph nodes (1 vs. >,1) and to gender, although the proportion of thick tumours was greater in the irradiation group. Results ,The overall survival curves were almost identical in the two groups. There were nine disease recurrences in the study group and 12 in the control group (not significant). Regional recurrences in the irradiated patients were usually accompanied by metastases at other sites. Conclusions ,The present study does not support the recommendation of adjuvant radiotherapy following resection of regional lymph node metastases in patients with malignant melanoma. [source] Value of preoperative diagnostic modalities in patients with recurrent thyroid carcinomaBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 9 2000A. Frilling Background The prognosis of differentiated thyroid carcinoma is usually excellent, but the majority of patients who develop a recurrence have a higher risk of death from the disease. Beside clinical examination, several diagnostic tools, such as ultrasonography, 131I scanning, [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) and thyroglobulin (TG) measurement under raised thyroid-stimulating hormone in serum can detect tumour recurrences. This prospective study compared the value of different diagnostic modalities in the detection of recurrent differentiated thyroid cancer. Methods From April 1992 to October 1999, 181 patients with thyroid carcinoma, of whom 150 had a well differentiated tumour, subjected to surgical treatment were identified prospectively. Some 107 patients (71 per cent) presented with primary tumour and 43 patients (29 per cent) with recurrent disease. The patients with tumour recurrence were evaluated regarding the mode of detection of recurrent disease, including clinical examination, ultrasonography, fine-needle biopsy (FNB), TG measurement and FDG-PET, the surgical treatment and outcome. Results Some 63 per cent of patients presented with regional lymph node metastases and 37 per cent with local recurrence. None of the patients with local recurrence was operated on for primary tumour in this department. In 87 per cent the recurrence was detected by clinical examination. Ultrasonography and 131I scan revealed suspicious findings in 97 and 69 per cent respectively. FNB disclosed abnormal cytological findings in 95 per cent. There were pathological TG levels in 86 per cent of patients. Among patients with a raised level of TG and negative scan results, 13 underwent FDG-PET, with pathological findings in 82 per cent. Conclusion In patients with well differentiated thyroid carcinoma, ultrasonography and FNB are the most sensitive methods for the detection of local recurrence or regional lymph node metastases. FDG-PET is a useful diagnostic tool in patients with a negative 131I scan and a raised level of TG. © 2000 British Journal of Surgery Society Ltd [source] Metastatic melanoma to lymph nodes in patients with unknown primary sitesCANCER, Issue 9 2006Janice N. Cormier M.D., M.P.H. Abstract BACKGROUND The natural history of metastatic melanoma in lymph nodes in the absence of a known primary site (MUP) has been defined poorly; thus, treatment guidelines for patients with MUP are not clear-cut. METHODS The authors conducted a retrospective analysis of consecutive patients with melanoma (from 1990 to 2001) who underwent surgical resection for melanoma metastatic to regional lymph nodes. Among those patients, 71 patients with MUP and 466 control patients who had regional lymph node metastases of similar stage with a known primary site were identified. Associations between clinicopathologic factors and survival were estimated by using the Cox proportional hazards model. RESULTS After they underwent lymph node dissection, patients with MUP were classified with N1b disease (47%), N2b disease (14%), or N3 disease (39%). With a median follow-up of 7.7 years, the 5-year and 10-year overall survival rates were 55% and 44%, respectively, for patients with MUP, compared with 42% and 32%, respectively, for the control group (P = .04). In multivariate analyses, age 50 years or older, male gender, and N2b or N3 disease status were identified as adverse prognostic factors, and MUP was identified as a favorable prognostic factor (hazard ratio, 0.61; 95% confidence interval, 0.42,0.86; P = .006) for overall survival. CONCLUSIONS The relatively favorable long-term survival of patients with MUP in the current study suggested that patients with MUP have a natural history that is similar to (if not better than) the survival of many patients with Stage III disease. Therefore, patients with MUP should be treated with an aggressive surgical approach with curative intent and should be considered for Stage III adjuvant therapy protocols. Cancer 2006. © 2006 American Cancer Society. [source] Tumor blood flow interruption after radiotherapy strongly inhibits tumor regrowthCANCER SCIENCE, Issue 7 2008Katsuyoshi Hori To clarify the therapeutic significance of interrupting tumor blood flow after irradiation, we investigated X-irradiation-induced changes in hemodynamic parameters (blood flow, extravasation and washout of fluorescein isothiocyanate-dextran, and interstitial fluid pressure) in a variant of Yoshida sarcoma, LY80. Tumors in anesthetized male Donryu rats received local irradiation (10 Gy). At 48 h after irradiation, tumor blood flow increased significantly; at 72,96 h after irradiation, a 2,2.5-fold increase was observed. All parameters then consistently showed improved tumor microcirculation, which probably contributed to regrowth of cancer because certain cells survived irradiation. Rats received an intravenous dose (10 mg/kg) of a combretastatin derivative, AC7700 (AVE8062), which interrupts tumor blood flow and disrupts tumor vessels. At all times evaluated after irradiation, AC7700 completely stopped tumor blood flow. Radiotherapy efficacy was significantly enhanced when combined with AC7700: AC7700 given 48 h after irradiation, when tumor blood flow increased significantly, remarkably suppressed tumor regrowth compared with AC7700 given 48 h before irradiation. Also, postirradiation AC7700 completely inhibited not only primary tumor regrowth but also regional lymph node metastases in half of tumor-bearing rats and led to a significant improvement in survival. These results strongly suggest that the combination effect was enhanced via interruption of increased tumor blood flow after irradiation. This therapeutic combination and timing may have important benefits, even in tumors with low sensitivity to either treatment alone, because the effect was considerably greater than additive. Our data thus show that destruction of tumor microcirculation after irradiation is quite effective for preventing cancer recurrence. (Cancer Sci 2008; 99: 1485,1491) [source] | ||||||||||