Cystic Lesion of Dissected Pararectal Lymph Node in a Female Patient With Rectal Carcinoma: A Rare Pattern of Nodal Metastasis Mimicking a Serous Inclusion Cyst

Nodal metastatic foci of colorectal carcinoma are usually solid nodules. Serous inclusions are occasionally found in lymph nodes, particularly in female patients, and they occasionally form cysts. An 86-year-old woman was treated with laparoscopic low anterior resection and D3 lymph node dissection for advanced rectal carcinoma. A cyst with serous fluid and no necrotic debris was found within one of the dissected pararectal lymph nodes. Histologically, the cyst was lined by low columnar-to-cuboid epithelium with mild nuclear atypia, mimicking a serous inclusion cyst. Immunohistochemically, the epithelial cells were positive for caudal type homeobox 2 and negative for Wilms’ tumor suppressor gene1. Immunohistochemistry for p53 showed a diffuse strong positivity, indicating a mutant TP53 as seen in primary rectal carcinoma. Thus, the nodal cystic lesion was confirmed to be a metastatic lesion. It is important to carefully assess a nodal cystic lesion to confirm whether it is benign or malignant.

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Metastatic lymph node ratio in stage III rectal carcinoma is a valuable prognostic factor even with less than 12 lymph nodes retrieved: a prospective study

The American Journal of Surgery ◽

10.1016/j.amjsurg.2013.07.022 ◽

2014 ◽

Vol 207 (6) ◽

pp. 824-831 ◽

Cited By ~ 16

Author(s):

Khaled M. Madbouly ◽

Khaled S. Abbas ◽

Ahmed M. Hussein

Keyword(s):

Lymph Node ◽

Prognostic Factor ◽

Lymph Nodes ◽

Prospective Study ◽

Rectal Carcinoma ◽

Lymph Node Ratio ◽

Metastatic Lymph Node ◽

Stage Iii ◽

Node Ratio ◽

A Prospective Study

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Lymph node yield during surgery after neoadjuvant therapy compared to surgery without neoadjuvant therapy in patients with esophageal, gastric, pancreatic, or rectal carcinoma: systematic review and meta-analysis

10.21203/rs.3.rs-421834/v1 ◽

2021 ◽

Author(s):

Ulrich Ronellenfitsch ◽

Nika Maximov ◽

Juliane Friedrichs ◽

Jörg Kleeff

Keyword(s):

Systematic Review ◽

Lymph Node ◽

Neoadjuvant Chemotherapy ◽

Lymph Nodes ◽

Neoadjuvant Therapy ◽

Rectal Carcinoma ◽

Meta Analysis ◽

Lymph Node Yield ◽

Gastrointestinal Carcinomas ◽

Node Yield

Abstract Background: The lymph node yield is an important surrogate parameter for assessing the oncological radicality of the resection of gastrointestinal carcinomas and a prognostic factor in these diseases. It remains unclear if and to what extent neoadjuvant chemotherapy, radiotherapy or chemoradiotherapy, which have become established treatments for carcinoma of the esophagus, stomach, and rectum and are increasingly used in pancreatic carcinoma, affect the lymph node yield. This systematic review and meta-analysis intents to summarize the available evidence on the topic.Methods: Studies comparing oncological resection of esophageal, stomach, pancreatic and rectal carcinoma with and without prior neoadjuvant therapy are eligible for inclusion regardless of study design. Publications will be identified with a defined search strategy in the electronic databases PubMed and Cochrane Library. The primary endpoint of the analysis is the number of lymph nodes identified in the resected specimen. Secondary endpoints include number of harvested metastatic lymph nodes, operation time, postoperative complications, pTNM staging, and overall and recurrence-free survival time. Using suitable statistical methods, the endpoints between patients with and without neoadjuvant therapy as well as in defined subgroups (neoadjuvant chemotherapy, neoadjuvant radiotherapy, neoadjuvant chemoradiotherapy, and esophageal, gastric, pancreatic, and rectal cancer) will be compared Discussion: This systematic review with meta-analysis is conducted with the aim of summarizing the available evidence regarding the oncological surrogate marker lymph node yield in patients with gastrointestinal carcinomas undergoing surgery after neoadjuvant treatment compared to those operated without neoadjuvant therapy.Systematic review registration: This systematic review has been submitted for registration at PROSPERO, ID: 218459.

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Local behavior and lymph node metastases of Wilms' tumor: accuracy of computed tomography

Radiologia Brasileira ◽

10.1590/s0100-39842014000100007 ◽

2014 ◽

Vol 47 (1) ◽

pp. 9-13 ◽

Cited By ~ 2

Author(s):

Eduardo Just da Costa e Silva ◽

Giselia Alves Pontes da Silva

Keyword(s):

Computed Tomography ◽

Lymph Node ◽

Positive Predictive Value ◽

Lymph Nodes ◽

Negative Predictive Value ◽

Predictive Value ◽

Wilms Tumor ◽

Local Behavior ◽

Adjacent Organ Invasion ◽

Organ Invasion

Objective To evaluate the accuracy of computed tomography for local and lymph node staging of Wilms' tumor. Materials and Methods Each case of Wilms' tumor was evaluated for the presence of abdominal lymph nodes by a radiologist. Signs of capsule and adjacent organ invasion were analyzed. Surgical and histopathological results were taken as the gold standard. Results Sensitivity was 100% for both mesenteric and retroperitoneal lymph nodes detection, and specificity was, respectively, 12% and 33%, with positive predictive value of 8% and 11% and negative predictive value of 100%. Signs of capsular invasion presented sensitivity of 87%, specificity of 77%, positive predictive value of 63% and negative predictive value of 93%. Signs of adjacent organ invasion presented sensitivity of 100%, specificity of 78%, positive predictive value of 37% and negative predictive value of 100%. Conclusion Computed tomography tumor showed low specificity and low positive predictive value in the detection of lymph node dissemination. The absence of detectable lymph nodes makes their presence unlikely, and likewise regarding the evaluation of local behavior of tumors.

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Re: How many lymph nodes are enough? Assessing the adequacy of lymph node yield for staging in favorable histology Wilms tumor

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2020.05.048 ◽

2020 ◽

Vol 55 (11) ◽

pp. 2536

Author(s):

Kiarash Taghavi

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Wilms Tumor ◽

Lymph Node Yield ◽

Favorable Histology ◽

Node Yield

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A study of metastatic lesions of lymph nodes by fine needle aspiration cytology

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20174589 ◽

2017 ◽

Vol 5 (10) ◽

pp. 4523

Author(s):

Pratibha Meena ◽

Ranu Tiwari Mishra

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Metastatic Lymph Node ◽

Transitional Cell ◽

Final Diagnosis ◽

Metastatic Lesion ◽

Primary Malignancy ◽

Cervical Lymph Nodes ◽

Male Predominance ◽

Metastatic Lesions

Background: FNAC is rapidly emerging as a useful tool in the diagnosis of metastatic lesion of lymph nodes. FNAC not only confirms or excludes metastasis in a case of a known primary malignancy but, also, in most cases helps to detect occult primary malignancy. Aim of present study was to determine the frequency of metastatic lesions of lymph nodes.Methods: This retrospective study was done of all metastatic lymph node lesions reported on FNAC, in the department of pathology, NSCB medical college, Jabalpur from January 2014 to December 2014 (One Year).Results: Total cases of 400 lymph node aspiration were done, of which 120 cases were clinically suspicious of metastasis. Cytology results were positive for metastasis in 97 cases (80.8%). The most common site of aspiration was cervical lymph nodes (75.2%). Maximum number of cases of metastasis were in 51-60 years age group with male predominance (male:female 2.6:1). The most common metastasis was squamous cell carcinoma seen in 74 cases (76.2%), followed by metastatic mammary carcinoma (10.3%), remaining were adenocarcinoma, undifferentiated carcinoma, malignant melanoma, papillary thyroid carcinoma and transitional cell carcinoma.Conclusions: FNAC is a rapid, safe and cost-effective technique. It gives early and accurate results with minimal invasion and reduces the need for surgical biopsies, thus saves cost and time to reach the final diagnosis. It is therefore concluded that FNAC is a useful tool in diagnosing metastatic lesions of lymph nodes with a good certainty.

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Pattern of regional metastasis in papillary thyroid cancer: our experience of 86 cases

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20193914 ◽

2019 ◽

Vol 7 (9) ◽

pp. 3362

Author(s):

Rajjyoti Das ◽

Jagannath D. Sharma ◽

Amal Ch Kataki ◽

Chandi R. Kalita ◽

Nizara Baishya

Keyword(s):

Thyroid Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Lymph Nodes ◽

Neck Dissection ◽

Papillary Thyroid Cancer ◽

Nodal Metastasis ◽

Papillary Thyroid ◽

Node Metastasis ◽

Regional Metastasis

Background: Papillary thyroid cancer (PTC) have a high propensity for regional metastasis which ranges from 30- 80%. The objective of the study is to assess the pattern of lymph node metastasis and to plan the extent of neck dissection accordingly. Though central neck dissection (CND) is routinely done in PTC but the indication of extent of neck dissection is still controversial.Methods: The medical records of 86 patients with PTC who underwent total thyroidectomy (TT) and neck dissection at Dr. B. Borooah Cancer Institute(BBCI) from January 2010 to December 2014 were retrospectively reviewed.Results: Out of 86 patients 22 were males and 64 were females. The median age of presentation was 40.0 years. 43 out of 86 patients (50%) had cervical lymph node metastasis. Ipsilateral nodal metastasis was found in 37 patients (43.0%) and contralateral metastasis was found in only 6 patients (7.0%).Tumors with size more than 3cm had ipsilateral nodal metastasis in 21(56.7%) patients which is statistically significant (p 0.03).A strong association was found between level VI and the ipsilateral group of lymph nodes involving level II,III,IV and V.Conclusions: Majority of patients present with multiple level nodal metastasis, with the central compartment commonly involved. In view of the high incidence of metastatic lymph nodes in levels II, III, IV and level VI ,our study supports the recommendation for posterolateral and anterior neck dissection in patients with clinically positive neck nodes and tumor with aggressive criteria.

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Risk factors of the suprasternal lymph node metastasis in papillary thyroid carcinoma with clinical lateral cervical lymph node metastasis

10.21203/rs.3.rs-17663/v1 ◽

2020 ◽

Author(s):

Hyun-Keun Kwon ◽

Yong-Il Cheon ◽

Sung-Chan Shin ◽

Eui-Suk Sung ◽

Jin-Choon Lee ◽

...

Keyword(s):

Risk Factors ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Lymph Nodes ◽

Cervical Lymph Node ◽

Cervical Lymph Node Metastasis ◽

Nodal Metastasis ◽

Papillary Thyroid ◽

Inferior Pole ◽

Node Metastasis

Abstract Background: Metastatic lymph nodes are occasionally found in the suprasternal lymph nodes in patients with papillary thyroid cancer (PTC), but there are few studies on these lymph nodes. Therefore, we investigated the frequency and risk factors of suprasternal lymph node metastasis in PTC patients with lateral cervical lymph node metastasis.Methods: A total of 85 patients with cN1b PTC underwent total thyroidectomy with elective lateral neck dissection including the suprasternal lymph nodes. We analyzed the correlation between suprasternal lymph node metastasis and sex, age, tumor characteristics, and cervical lymph node metastasis status.Results: Eleven patients (12.9%) had pathological suprasternal lymph node metastasis. Suprasternal lymph node metastasis was associated with tumors located in the inferior pole and level IV lymph node metastasis.Conclusion: In cN1b PTC patients, especially those with inferior pole tumors and level IV nodal metastasis, the suprasternal lymph node should be routinely dissected.

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Optimal Range of Lymphadenectomy in Pathological Stage T1 and T2 Esophageal Squamous Cell Carcinoma

Frontiers in Oncology ◽

10.3389/fonc.2021.619556 ◽

2021 ◽

Vol 11 ◽

Author(s):

Hansheng Wu ◽

Weitao Zhuang ◽

Shujie Huang ◽

Xueting Guan ◽

Yuju Zheng ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Lymph Node ◽

Esophageal Squamous Cell Carcinoma ◽

Lymph Nodes ◽

Cell Carcinoma ◽

Squamous Cell ◽

Nodal Metastasis ◽

Added Value ◽

Optimal Range ◽

Radical Esophagectomy

BackgroundLymph node metastasis is a primary contributor to tumor progression in esophageal squamous cell carcinoma (ESCC), and the optimal extent of lymphadenectomy during esophagectomy remains controversial. This study aimed to investigate the appropriate number of lymph nodes to be dissected in pT1-2Nany stage ESCC to achieve the best prognosis and avoid missing positive lymph nodes (PLNs).MethodsA total of 497 patients with pT1 to pT2 esophageal cancer from two institutions were retrospectively analyzed and their surgical and pathological records were critically reviewed. Stepwise analyses were conducted by calculating a serial of hazard ratios and odd ratios to determine the optimal range of lymphadenectomy for overall survival (OS).ResultsThe best survival outcome can be obtained when the number of lymph node examined (NLNE) is 10–18 in pT1N0 ESCC, while the NLNE should exceed 24 in pT2N0 diseases. In patients with pT1-2Nany and pT2Nany ESCC, resection of 15–25 and 24–37 lymph nodes, respectively, could provide significant added value for identifying positive nodal metastasis. When the NLNE exceeds this appropriate range, resection of extra lymph node is not helpful to improve the probability of finding PLNs.ConclusionsFor ESCC patients undergoing radical esophagectomy, the optimal extent of lymphadenectomy is 15–25 for pT1Nany disease and 24–37 for pT2Nany disease.

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Impact of extra-nodal metastasis on survival in gastric cancer patients with lymph node involvement.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.57 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 57-57

Author(s):

Noriyuki Nishiwaki ◽

Masanori Tokunaga ◽

Kenichiro Furukawa ◽

Keiichi Fujiya ◽

Hayato Omori ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Prognostic Factor ◽

Lymph Nodes ◽

Cancer Patients ◽

Multivariable Analysis ◽

Lymph Node Involvement ◽

Nodal Metastasis ◽

Node Involvement ◽

Gastric Cancer Patients

57 Background: Extra-nodal metastasis (ENM) is defined as a tumor nodule without lymph node structure, and distinguished from lymph node metastasis by histological findings. Despite the possible difference in metastatic mechanism, both are counted as metastasized lymph nodes according to the 3rd English edition of Japanese Classification of Gastric Carcinoma, and thus the prognostic value of ENM remains unclear. The aim of this study was to clarify the clinicopathogical characteristics and prognostic impact of ENM in gastric cancer patients with lymph node involvement. Methods: This study included 388 patients who underwent curative gastrectomy for primary gastric cancer between January 2009 and August 2013. A total of 2093 pathologically positive tumor nodules, including both metastatic lymph nodes and ENM, were examined. Clinicopathological characteristics and survival outcomes were compared between an ENM positive (ENMP) group (95 patients) and an ENM negative (ENMN) group (293 patients). In addition, multivariable analysis was performed to clarify the independent prognostic factors. Results: ENM was found in 269 of 2093 tumor nodules (12.9 percent). The incidence of ENM was significantly higher in patients with large tumor size, high pathological T stage (pT), high pathological N stage (pN) and in those with macroscopic infiltrative tumors, vascular and lymphatic invasion. Three-year relapse free survival was significantly worse in the ENMP group (56.5%) than in the ENMN group (82.4%, p < 0.001). Multivariable analysis revealed that ENM as well as age, pT and histological type was an independent prognostic factor. Conclusions: ENM is an independent prognostic factor in gastric cancer patients with lymph node involvement. A new N classification stratified by the presence of ENM might be considered.

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