scholarly journals Unusual Case of Uterine Intravascular Leiomyomatosis with Lymphatic Spread to Pelvic Lymph Nodes

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S74-S74
Author(s):  
H Siatecka ◽  
R Masand
Keyword(s):  
Smooth Muscle ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Vena Cava ◽  
Rare Condition ◽  
Endometrial Stromal Sarcoma ◽  
Pelvic Lymph Node ◽  
Lymphatic Spread ◽  
Regional Lymph Nodes ◽  
Pelvic Lymph Nodes

Abstract Introduction/Objective Intravascular leiomyomatosis, also known as intravenous leiomyomatosis, is characterized by presence of smooth muscle within venous spaces in the myometrium, usually in conjunction with a leiomyoma. Although presence of tumor within lymphatics in addition to veins are alluded to in literature, exclusively lymphatic spread with lymph node metastases have not been previously reported. Methods/Case Report A 50-year-old woman presented with left flank pain. CT pelvis showed an enlarged uterus with multiple large leiomyomata as well as pelvic lymph node enlargement. Hysterectomy with bilateral salpingo- ophorectomy and pelvic lymph node dissection was performed. Gross examination revealed multifibroid uterus. Separately sent pelvic lymph nodes showed well-circumscribed, whorled lesions resembling leiomyoma. Microscopically, in addition to typical leiomyomata, a 11.5 cm intramural tumor with epithelioid cells, very rare mitoses and no necrosis was identified. Adjacent to this mass, several large endothelial lined spaces (positive for D240 and negative for CD31), consistent with lymphatics, showed intravascular extension of the same epithelioid tumor. All the pelvic lymph nodes were replaced by the tumor. Due to the unusual morphology and pattern of spread, immunohistochemical stains were performed to rule out an endometrial stromal sarcoma and lymphangioleiomyomatosis. The lesion was positive for desmin, caldesmon, and negative for CD10 and HMB45. Ki67 was extremely low (<1%). Based on morphology and immunophenotype, the tumor was consistent with an epithelioid leiomyoma with highly unusual lymphatic spread through myometrial vessels to regional lymph nodes. Results (if a Case Study enter NA) NA Conclusion Intravascular leiomyomatosis is a rare condition with no reported progression to malignancy. Typically, benign smooth muscle is present in veins within the myometrium of a leiomyomatous uterus with progressive spread to the right heart via the inferior vena cava. We present the first report of a rare case of intravascular leiomyomatosis with spread exclusively via lymphatics to pelvic lymph nodes.

DISTRIBUTION OF PELVIC LYMPH NODES IS NOT SYMMETRIC. RESULTS FROM AN EXTENDED PELVIC LYMPH NODE DISSECTION SERIES

2009 ◽  
Vol 181 (4S) ◽  
pp. 100-101 ◽  
Author(s):  
Firas Abdollah ◽  
Alberto Briganti ◽  
Andrea Gallina ◽  
Nazareno Suardi ◽  
Umberto Capitanio ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Pelvic Lymph Node Dissection ◽  
Pelvic Lymph Node ◽  
Node Dissection ◽  
Pelvic Lymph Nodes

Low risk endometrial cancer: A study of pelvic lymph node metastasis

2003 ◽  
Vol 13 (1) ◽  
pp. 38-41 ◽  
Author(s):  
M. Watanabe ◽  
Y. Aoki ◽  
H. Kase ◽  
K. Fujita ◽  
K. Tanaka
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Pelvic Lymph Node ◽  
Tumor Diameter ◽  
Primary Therapy ◽  
Pelvic Lymph Nodes ◽  
Node Metastasis ◽  
Pelvic Lymph Node Metastasis

The aim of our study was to find preoperative or intraoperative pathologic indicators that would discriminate a subgroup of early corpus cancers that would not require lymphadenectomy. A retrospective review of the medical records of 107 patients with endometrioid adenocarcinoma, FIGO grade 1 or 2 tumor, myometrial invasion ≤50%, and no intraoperative evidence of macroscopic extrauterine spread was performed. Clinicopathologic risk factors were analyzed with Fisher ′s exact test with regards to pelvic lymph node metastasis. The median age of the patients was 54 years. Pelvic lymph node metastasis was observed in five of 107 patients (4.7%), where two patients with small tumors of 2 cm or less had positive pelvic lymph nodes. The presence of positive pelvic lymph nodes did not correlate with depth of invasion, histologic grade, cervical invasion, peritoneal cytology, menopausal status, preoperative serum CA125 level, or primary tumor diameter. Only lymphvascular space involvement (P < 0.0001) was significantly correlated to pelvic lymph node metastasis. We suggest that all patients with endometrial cancer who are taken to the operating room for primary therapy should be prepared to undergo extended surgical staging, except when clinical or operative factors increase patients' morbidity.

Use of VEGFR1 expression in benign pelvic lymph nodes to predict biochemical recurrence in patients with high-risk prostate cancer.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 205-205
Author(s):  
Sumanta Kumar Pal ◽  
Wang Zhang ◽  
Jiehui Deng ◽  
Yong Liu ◽  
Karen L. Reckamp ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Node ◽  
High Risk ◽  
Clinical Outcome ◽  
Lymph Nodes ◽  
Biochemical Recurrence ◽  
Pelvic Lymph Node ◽  
Pelvic Lymph Nodes ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

205 Background: High-risk prostate cancer (PCa) is a heterogeneous disease, and biomarkers that accurately predict clinical outcome within this subset are lacking. The pre-metastatic niche (PMN) represents one possible biomarker—this harbinger of future metastasis may be characterized by infiltration of VEGFR1+ cells [Kaplan et al Nature 139:820, 2005]. Given the predilection of PCa to spread to nodal sites, the association between VEGFR1 expression in benign pelvic lymph nodes and clinical outcome was examined. Methods: The City of Hope Prostate Cancer Registry (COH PCR) was used to identify 46 patients with high-risk PCa (baseline PSA > 20, pT3a-4 disease, or biopsy Gleason 8–10) who had undergone radical prostatectomy and pelvic lymph node dissection (PLND). The COH PCR prospectively collects clinical data associated with patients undergoing prostatectomy at the institution, and warehouses available clinical specimens. Benign tissue specimens derived from PLND were acquired for each patient, and were stained for VEGFR1 expression. VEGFR1+ cell clusters were counted within 8 distinct 40x fields, and the cluster count was averaged. Results: VEGFR1+ clustering in benign PLND specimens was a significant predictor of biochemical recurrence on multivariate Cox proportional hazards analysis, and outperformed other variables including established prognostic factors such as age, extracapsular spread, seminal vesicle invasion, and the aforementioned high-risk features. Patients with increased VEGFR1+ clustering pelvic lymph node tissue had a shorter interval to biochemical recurrence (HR 0.18, P<0.10). Conclusions: These preliminary results indicate that increased VEGFR1+ cell clustering in benign nodal tissue may predict poorer clinical outcome in patients with high-risk PCa. VEGFR1+ cells (a purported constituent of the PMN) represents a targetable entity. A randomized, phase II study employing axitinib (VEGFR1 IC50=1 nM) as neoadjuvant therapy in patients with high-risk PCa is nearing initiation at City of Hope ( NCT01385059 ).

Incidental Small Lymphocytic Lymphoma/Chronic Lymphocytic Leukemia in Pelvic Lymph Nodes Excised at Radical Prostatectomy

2003 ◽  
Vol 127 (5) ◽  
pp. 567-572 ◽  
Author(s):  
Edward G. Weir ◽  
Jonathan I. Epstein
Keyword(s):  
Lymph Node ◽  
Radical Prostatectomy ◽  
Lymph Nodes ◽  
Diagnostic Accuracy ◽  
Hodgkin Lymphoma ◽  
Pelvic Lymph Node ◽  
Cell Phenotype ◽  
Small Lymphocytic Lymphoma ◽  
Pelvic Lymph Nodes ◽  
Non Hodgkin Lymphoma

Abstract Context.—Incidental non-Hodgkin lymphoma is often unrecognized at the time of radical prostatectomy in patients with prostate cancer because of nonspecific symptoms and an inconspicuous pathology. The early identification of lymphoma allows optimal long-term management and prevention of significant morbidity. Objective.—To show the subtlety of pathologic findings in cases of non-Hodgkin lymphoma in pelvic lymph nodes and the need for scrupulous attention to detail for diagnostic accuracy. Design.—Histologic and immunohistochemical profiles of 18 consecutive cases of small lymphocytic lymphoma (SLL) incidentally identified in pelvic lymph node dissections were reviewed and compared with 22 cases of benign pelvic lymph node dissections. Results.—Malignant nodes were grossly enlarged and averaged 3.2 cm in their greatest dimension. Histologically, 16 of the SLL cases were characterized by diffuse architectural effacement with obliterated sinuses and rare cortical follicles. Twelve of these cases showed evidence of pseudofollicles. Two cases showed an interfollicular growth pattern with occasional small pseudofollicles. In contrast, benign pelvic lymph nodes averaged 1.7 cm in their greatest dimension. Although most were architecturally distorted by fibrosis, all benign nodes were notable for patent sinuses. Immunohistochemistry was diagnostically helpful in several cases with equivocal morphology. All malignant cases had a B-cell phenotype with aberrant coexpression of T-cell–related antigens typical of SLL. Conclusion.—Incidental low-grade non-Hodgkin lymphoma identified at radical prostatectomy is often overlooked by both the urologist and the pathologist. Although malignant pelvic lymph node dissections frequently lack overt manifestations of lymphoma, attention to subtle morphologic features coupled with lymph node size and immunohistochemical findings should permit diagnostic accuracy.

Modern Radiodiagnostics Technology of Metastasises in Pelvic Lymph Nodes

2017 ◽  
pp. 100-108
Author(s):  
V. N. Diomidova ◽  
O. A. Еfimova
Keyword(s):  
Lymph Node ◽  
Magnetic Resonance ◽  
Lymph Nodes ◽  
Metastatic Lymph Node ◽  
Magnetic Resonance Tomography ◽  
Visual Images ◽  
Pelvic Lymph Nodes ◽  
High Information Content ◽  
Pelvic Cancer ◽  
High Information

The analysis of the diagnostic informativeness of modern radiodiagnosticis methods in determining metastatic lymph node of pelvic cancer gynecological organs according to domestic and foreign publications. At the present stage methods of obtaining visual images pelvic lymph nodes are radiodiagnostics technologies (radiological, ultrasound, magnetic resonance tomography, scintigraphic). The analysis has shown that the researches devoted to diagnostic informational content of modern methods of radiodiagnosis in a differentiation of nature of damage of pelvic lymph nodes aren't enough. According to the literature, the most rational and perspective method for radiodiagnosis metastatics lymph node is a magnetic resonance imaging due to the high information content and thus specificity. At the same time, the continued relevance of further study of methods of radiodiagnostics in order to find the optimal one for the assessment of pelvic lymph nodes.

BIOPSY OF THE SIGNALING LYMPH NODES IN GASTRIC CANCER - CURRENT STATUS OF THE PROBLEM AND PROSPECTS

2018 ◽  
Vol 64 (3) ◽  
pp. 335-344
Author(s):  
Aleksey Karachun ◽  
Yuriy Pelipas ◽  
Oleg Tkachenko ◽  
D. Asadchaya
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Nodes ◽  
Stomach Cancer ◽  
Current Status ◽  
Regional Lymph Nodes ◽  
Systematic Analysis ◽  
Tumor Spread ◽  
Special Value

The concept of biopsy of sentinel lymph node as the first lymph node in the pathway of lymphogenous tumor spread has been actively discussed over the past decades and has already taken its rightful place in breast and melanoma surgery. The goal of this method is to exclude vain lymphadenectomy in patients without solid tumor metastases in regional lymph nodes. In the era of minimally invasive and organ-saving operations interventions it seems obvious an idea to introduce a biopsy of sentinel lymph node in surgery of early gastric cancer. Meanwhile the complexity of lymphatic system of the stomach and the presence of so-called skip metastases are factors limiting the introduction of a biopsy of sentinel lymph node in stomach cancer. This article presents a systematic analysis of biopsy technology of signaling lymph node as well as its safety and oncological adequacy. Based on literature data it seems to us that the special value of biopsy of sentinel lymph nodes in the future will be in the selection of personalized surgical tactics for stomach cancer.

scholarly journals Hepatocellular carcinoma with regional lymphadenopathy caused by sarcoid-like reaction: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Tomoko Mizota ◽  
Masato Suzuoki ◽  
Saya Kaku ◽  
Kenichi Mizunuma ◽  
Kazuto Ohtaka ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Granulomatous Inflammation ◽  
Giant Cells ◽  
Epithelioid Cell ◽  
Imaging Modalities ◽  
Hepatoduodenal Ligament ◽  
Regional Lymph Nodes ◽  
Multiple Imaging

Abstract Background Sarcoid-like reaction (SLR) is a histological pattern of granulomatous inflammation that is clinically differentiated from sarcoidosis. Since SLR is known to occur in several neoplasias and occasionally causes lymphadenopathy and mimics metastatic malignancy, it needs to be considered whether lymphadenopathy is due to metastasis or SLR for the choice of cancer treatment. Few cases of hepatocellular carcinoma (HCC) with SLR have been reported. Here, a case of HCC with lymphadenopathy diagnosed as SLR without metastasis is presented. Case presentation A 69-year-old woman was admitted to our hospital because of upper abdominal pain. She tested positive for hepatitis C virus ribonucleic acid. Imaging modalities showed an 81 × 65-mm-sized tumor with multiple nodules in segment 3 and a 17 × 12-mm-sized tumor in segment 5 with a common HCC enhancement pattern. In addition, a lymph node in the hepatoduodenal ligament was enlarged at 13 mm in size, suggesting the metastasis of HCC. Hepatectomy of the lateral segment and segment 5 and lymph node dissection in the hepatoduodenal ligament were performed. Both tumors in segments 3 and 5 were pathologically diagnosed as HCC without vessel invasion. The tumors contained necrotic cells and epithelioid cell granulomas with multinucleated giant cells, which is typically observed in sarcoidosis. The dissected lymph nodes also contained epithelioid cell granulomas, as well as giant cells with asteroid bodies. There was no malignancy in the lymph nodes. The pathological findings suggested the coexistence of malignancy and sarcoidosis. However, since the patient did not show any typical findings of pulmonary or cardiac sarcoidosis, the case was diagnosed as HCC with SLR in the primary lesion and regional lymph nodes. Conclusions SLR needs to be considered in the differential diagnosis when a cancer patient develops lymphadenopathy. However, lymphadenopathy due to SLR is indistinguishable from that due to metastasis even when using multiple imaging modalities. Pathological examinations may be helpful for the diagnosis.

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