A case of synchronous intramucosal gastric carcinoma with multiple lymph node metastases

Abstract Background In Japan, the prevalence of synchronous multiple intramucosal gastric carcinoma is reported to be 5–15%. Here is a case of a synchronous small gastric carcinoma fulfilling the definite indication and curative criteria for endoscopic submucosal dissection with multiple lymph node metastases. Case presentation A Japanese woman in her fifties with a history of endoscopic resection for mucosal poorly differentiated adenocarcinoma was evaluated, with the UICC TNM classification stage being cT1aN0M0 cStageIA. She had undergone total gastrectomy with D1 + lymph node dissection. Histopathological examination revealed 16 individual sporadic lesions in the gastric body, with maximum diameter 3 mm and localization in the lamina propria. Twenty-seven nodes were resected, and metastasis of the carcinoma was revealed in 24 nodes. Conclusions Undifferentiated intramucosal gastric cancer has a relatively high probability of lymph node metastasis; however, synchronous early lesions are often overlooked. Frequent follow-up examinations may increase the detection of multiple gastric cancers.

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Pattern of lymph node metastases and its implication in radiotherapeutic clinical target volume delineation of regional lymph node in patients with gastric carcinoma

Radiotherapy and Oncology ◽

10.1016/j.radonc.2010.04.031 ◽

2010 ◽

Vol 96 (2) ◽

pp. 223-230 ◽

Cited By ~ 11

Author(s):

Yan Yi ◽

Jinming Yu ◽

Baosheng Li ◽

Fujun Yang ◽

Wei Huang ◽

...

Keyword(s):

Lymph Node ◽

Gastric Carcinoma ◽

Lymph Node Metastases ◽

Clinical Target Volume ◽

Regional Lymph Node ◽

Target Volume ◽

Target Volume Delineation ◽

Volume Delineation ◽

Node Metastases

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Sensitivity rate of ultrasound (US)-guided fine-needle aspiration cytology (FNAC) using the Berlin morphology criteria for lymph node metastases to reduce the need for surgical sentinel node (SN) staging in melanoma.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.8535 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 8535-8535 ◽

Cited By ~ 1

Author(s):

Christiane A. Voit ◽

Alexander Christopher Jonathan Van Akkooi ◽

Saskia Gooskens ◽

Petra Siegel ◽

Gregor Schaefer-Hesterberg ◽

...

Keyword(s):

Lymph Node ◽

Clin Oncol ◽

Lymph Node Metastases ◽

High Sensitivity ◽

Needle Aspiration ◽

Tumor Burden ◽

Maximum Diameter ◽

Node Metastases ◽

Rotterdam Criteria

8535 Background: US-guided-FNAC prior to surgical SN staging is emerging as a possible cost-effective addition to the staging of melanoma patients (pts). Formerly, sensitivity (sens) rates of lymph node US in melanoma were disappointing (20–40%). The introduction of the Berlin Morphology Criteria has significantly improved sens rates for US-FNAC (J Clin Oncol 2010;28(5):847-52). The aim of the current study was to report on 1000 patients the sens, specificity (spec), positive (PPV) and negative (NPV) predictive value rates of US-FNAC from our prospective database with prolonged follow-up. Methods: Since 2001, >1000 stage I / II consecutive melanoma pts have undergone US-FNAC prior to SN. All patients underwent lymphoscintigraphy. Peripheral Perfusion (PP), Loss of Central Echoes (LCE), Balloon Shaped (BS) were the Berlin Morphology Criteria which were registered. FNAC was performed in case of presence of any of these factors. SN tumor burden was measured according to the Rotterdam Criteria. All patients underwent SN or LND in case of positive FNAC. Results: Mean/median Breslow thickness was 2.56 / 1.57 mm (0.2 – 44 mm).Mean/median follow-up was 39 / 32 months (0 – 115). Ulceration was present in 24 %. SN positivity rates were 20 % (202 / 1000). Sens was 51 %. Spec, PPV and NPV were 99%, 91% and 89%. Sensitivity was highest for T4 tumors (77%). PP, LCE, BS had sens of 69%, 24%, 25%. SN tumor burden > 1 mm in largest diameter according to the Rotterdam Criteria was identified by US-FNAC in 86%. Threshold for positive FNAC was 0.4 mm in maximum diameter. Conclusions: The new criterion of Periferal Perfusion is of key importance to achieve the high sensitivity of US-FNAC according to the Berlin Morphology Criteria (J Clin Oncol 2010; 28:847-852) to identify lymph node metastases. Especially for T4 patients and in patients with advanced SN tumor burden it can reduce significantly the need for surgical SN staging. The EORTC Melanoma Group will launch the prospective validation study, USE FNAC, in 2012.

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The prognostic value of P53 in the nodal metastization of gastric cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e14673 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e14673-e14673

Author(s):

Luisa Quaresma ◽

Antonio CALDEIRA Fradique ◽

Fernanda Cabrita ◽

Alexandra Pupo ◽

Guedes DA Silva ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Prognostic Factor ◽

Gastric Carcinoma ◽

Lymph Node Metastases ◽

P53 Protein ◽

Mutant P53 ◽

P53 Expression ◽

Major Interest ◽

Node Metastases

e14673 Background: Lymph node Metastases play a major role as an independent prognostic factor in gastric cancer. Presence of distal lymph node metastases assumes a pejorative prognostic significance, and represents a problem in terms of therapeutic approach. For this reason it’s of major interest to find predictive markers of distal lymph node chain involvement. The P53 tumor suppressor gene, a product of the TP53 gene works normally as a brake on DNA replication, as suppressor of angiogenesis and triggering of apoptosis. The gene most frequently mutated in gastric cancer is the TP53, that is responsible for the production of P53 mutant protein, which forms inactive complex with the native protein, and manifest by the overexpression of p53 in immunocytochemistry. The overexpression of P53 gene has been considered a bad prognostic factor associated mainly with lymph node metastases. Methods: This study seeks to determine the relation between the expression of P53 and the presence of distal lymph node metastases as an indicator for an extended lymphadenectomy. A total of 50 patients undergoing surgery with D2 lymphadenectomy for gastric carcinoma with curative intent were enrolled in this work. Therefore it was evaluated in 1,786 lymph nodes the correlation between the P53 expression with tumor location, size, histological type, depth , number of nodes involved, number of distal lymph node metastases and the TNM stage. Results: In all parameters, mutant P53 protein related with indicators of poor prognosis. In particular has demonstrated a statistical significant correlation (p=0.019) with the presence of distal lymph node metastases. The main objective of this study which was finding a prognostic predictor of distal nodal metastases has been reached. Conclusions: Mutant P53 protein is a good prognostic indicator, for the presence of distal lymph node involvement in gastric carcinoma.

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CT for Predicting the Resectability of Lung Cancer

Acta Radiologica ◽

10.1177/028418519103200603 ◽

1991 ◽

Vol 32 (6) ◽

pp. 449-454 ◽

Cited By ~ 5

Author(s):

S. Lähde ◽

M. Päivänsalo ◽

P. Rainio

Keyword(s):

Lung Cancer ◽

Lymph Node ◽

Prospective Study ◽

Lymph Node Metastases ◽

Tnm Classification ◽

Staging System ◽

International Staging System ◽

Node Metastases ◽

A Prospective Study ◽

Infiltrative Tumor

In order to assess the accuracy of CT in predicting the resectability of lung cancer, a prospective study was performed on 96 patients undergoing thoracotomy. The tumors were classified preoperatively according to the TNM classification and the new international staging system for lung cancer, and scored as being resectable by lobectomy or pulmectomy, potentially resectable by lobectomy or pulmectomy, or nonresectable. Of the tumors predicted to be resectable or potentially resectable, 86.6% and 63% were radically resected, respectively, and the need for lobectomy versus pulmectomy was correctly estimated in 81.3% of them. The insufficiency of CT for defining lymph node metastases and infiltrative tumor growth was considered a marked disadvantage of the method.

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Case Report: Abdominal Lymph Node Metastases of Parathyroid Carcinoma: Diagnostic Workup, Molecular Diagnosis, and Clinical Management

Frontiers in Endocrinology ◽

10.3389/fendo.2021.643328 ◽

2021 ◽

Vol 12 ◽

Author(s):

Christina Lenschow ◽

Carmina Teresa Fuss ◽

Stefan Kircher ◽

Andreas Buck ◽

Ralph Kickuth ◽

...

Keyword(s):

Lymph Node ◽

Lymph Node Metastases ◽

Biochemical Recurrence ◽

Parathyroid Carcinoma ◽

Histopathological Examination ◽

Diagnostic Workup ◽

Endocrine Tumors ◽

Abdominal Lymph Node ◽

Surgical Specimen ◽

Node Metastases

Parathyroid carcinoma (PC) is an orphan malignancy accounting for only ~1% of all cases with primary hyperparathyroidism. The localization of recurrent PC is of critical importance and can be exceedingly difficult to diagnose and sometimes futile when common sites of recurrence in the neck and chest cannot be confirmed. Here, we present the diagnostic workup, molecular analysis and multimodal therapy of a 46-year old woman with the extraordinary manifestation of abdominal lymph node metastases 12 years after primary diagnosis of PC. The patient was referred to our endocrine tumor center in 2016 with the aim to localize the tumor causative of symptomatic biochemical recurrence. In view of the extensive previous workup we decided to perform [18F]FDG-PET-CT. A pathological lymph node in the liver hilus showed slightly increased FDG-uptake and hence was suspected as site of recurrence. Selective venous sampling confirmed increased parathyroid hormone concentration in liver veins. Abdominal lymph node metastasis was resected and histopathological examination confirmed PC. Within four months, the patient experienced biochemical recurrence and based on high tumor mutational burden detected in the surgical specimen by whole exome sequencing the patient received immunotherapy with pembrolizumab that led to a biochemical response. Subsequent to disease progression repeated abdominal lymph node resection was performed in 10/2018, 01/2019 and in 01/2020. Up to now (12/2020) the patient is biochemically free of disease. In conclusion, a multimodal diagnostic approach and therapy in an interdisciplinary setting is needed for patients with rare endocrine tumors. Molecular analyses may inform additional treatment options including checkpoint inhibitors such as pembrolizumab.

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