Breast Cancer Combined with Contralateral Neck Lymph Node Metastasis. Case Report

Background: Contralateral neck lymph node metastasis is rare for primary breast cancer. Its clinical stage and treatment principles are lack of authoritative guidelines. A 30-year-old breast cancer patient with contralateral neck lymph node metastasis is presented. The clinical treatment is discussed combined with current research.Case presentation: A 30-year-old woman presented with a right breast mass for 5 months and left neck lymph node enlargement for 5 days. The mammography showed a 33mm*14.3mm mass in the inner quadrant of right breast. The ultrasound showed several hypoechoic nodules on the left side of the neck. Rapid intraoperative pathological examination diagnosed right breast malignant tumor and poorly differentiated carcinoma of the left cervical lymph nodes. Then the right mastectomy was performed immediately. The patient was scheduled to administer chemotherapy, molecular targeted therapy, radiotherapy and endocrinotherapy after operation. The long-term efficacy remains to be seen.Conclusion: The infrequent presentation of breast cancer with metastasis to the contralateral neck lymph node can be challenged for standard therapies.

A Case of Nasopharyngeal Tuberculosis with Cervical Lymph Node Tuberculosis Suspected of Cervical Malignant Disease at the First Examination

A case of nasopharyngeal tuberculosis with cervical lymph node tuberculosis is reported. The patient was a 20-year-old female immigrant from Vietnam and cook apprentice. Her chief complaint was left neck swelling with pain for three months. She was diagnosed with left neck lymphadenitis at a previous hospital, which suspected malignant lymphoma and referred her to our hospital. At the time of the first visit, she had left lymph swelling with tenderness and granuloma-like masses in the nasopharynx. PET-CT showed accumulations in both the swollen left neck lymph and nasopharynx. The diagnosis of this case would appear to be nasopharyngeal cancer with left and neck lymph node metastasis or nasopharyngeal tuberculosis with cervical lymph node tuberculosis in addition to malignant lymphoma. Based on some examinations (biopsy, bacteria culture, and imaging), it was diagnosed as nasopharyngeal tuberculosis with cervical lymph node tuberculosis. Therefore, she was treated with anti-tuberculosis agent in respiratory medicine.

Results of definitive radiotherapy with concurrent chemotherapy for maxillary sinus carcinomas with neck lymph node metastasis

The purpose of this study was to describe the results of definitive radiotherapy (RT) with concurrent chemotherapy for maxillary sinus carcinomas (MSCs) with neck lymph node metastasis to clarify its limitation. Local control (LC), progression-free survival (PFS) and overall survival (OS) rates were calculated using the Kaplan–Meier method and were compared between subgroups using the log rank test. Toxicity was classified using common terminology criteria of adverse events version 5.0. Eighteen patients with inoperable MSC with neck lymph node metastasis including 12 men and 6 women with a median age of 67 years were analyzed. The histologic diagnoses were as follows: 16 patients had squamous cell carcinomas and 2 had other histology. Four patients had stage T3 MSC, 6 had T4a and 8 had T4b. Among 18 patients, 7 received concurrent systemic chemotherapy and 11 received selective arterial chemo-infusion. The median follow-up period was 17 months. The 2-year LC, PFS and OS rates for the entire cohort were 34, 31 and 46%, respectively. No significant differences were observed for LC, PFS and OS rates between systemic chemotherapy and selective arterial chemo-infusion cohorts. Grade 3 or higher acute toxicity, including both non-hematological and hematological, was observed in nine patients (50%), while no grade 3 or higher late toxicity was observed. In conclusion, we described the results of definitive RT for MSCs with neck lymph node metastasis. Local recurrence of primary tumor was a frequent pattern of failure and it should be addressed in future study.

Peri-tumoral Lymphovascular density by antipodoplanin antibody D2-40, as a predictor of nodal metastasis in oral squamous cell carcinoma

BACKGROUND: The involvement of regional lymph nodes by cancer is a major determinant of prognosis in oral squamous cell carcinoma (OSCC) and is a significant predictor of patient survival. Peri-tumoral lymphangiogenesis is being studied as an important tool in predicting neck lymph node metastasis. Podoplanin, a transmembrane glycoprotein is expressed on lymphatic vessel endothelium and considered as a marker of lymphangiogenesis. The high podoplanin expression has been associated with invasion, progression, and metastasis of oral cancer. D2-40, an anti-podoplanin monoclonal antibody, is a specific marker of lymphatic endothelial cells. The present study was designed to investigate the peritumoral lymphovascular density (PT-LVD) by evaluating D2-40 expression and its potential utility in predicting lymph node metastasis in OSCC. METHODS: Seventy-two patients with OSCC were enrolled (36 with early and 36 with advanced-stage tumors). Differential expression of peritumoral lymphovascular density (PT-LVD) was evaluated using D2-40 expression by immunohistochemistry (IHC). Expression was categorized as low and high, derived from the mean of a number of vessels per 10 high power fields in hot-spots. Statistical methods were employed to correlate expression with age, gender, tumor site, stage, and neck lymph node involvement. RESULTS: We observed a significant association between peritumoral lymphovascular density (PT-LVD) with clinical neck lymph node status (p=0.001) and tumor stage (p=0.033). There was no significant correlation of D2-40 expression with age, gender, tumor site, T stage, and tumor differentiation. CONCLUSION: PT-LVD is a positive predictor of neck lymph node metastasis. It has translational potential, along with other clinical parameters for decision making in the treatment of the neck in oral cancer.

TRIM29 inhibits miR-873-5P biogenesis via CYTOR to upregulate fibronectin 1 and promotes invasion of papillary thyroid cancer cells

Papillary thyroid cancer (PTC) is the most common endocrine tumor with an increasing incidence, has a strong propensity for neck lymph node metastasis. Limited treatment options are available for patients with advanced or recurrent metastatic disease, resulting in a poor prognosis. Tripartite motif protein 29 (TRIM29) is dysregulated in various cancer and functions as oncogene or tumor suppressor in discrete cancers. In this study, we found that both TRIM29 and fibronectin 1 (FN1) were upregulated with positive correlation in PTC tissues. Neither overexpression nor downregulation of TRIM29 altered the proliferation of PTC cells significantly. Overexpression of TRIM29 significantly promotes, while knockdown of TRIM29 significantly decreases migration and invasion by regulating FN1 expression in PTC cells. In terms of mechanism, we found that TRIM29 altered the stability of FN1 mRNA via regulation of miR-873-5p expression. The current study also demonstrated that long non-coding RNA (LncRNA) CYTOR suppressed maturation of miR-873-5p via interaction with premiR-873, and TRIM29 decreased miR-873-5p via upregulation of CYTOR. This study suggests that involvement of TRIM29 in migration and invasion in PTC cells may reveal potential metastatic mechanism of PTC and represent a novel therapeutic target and strategy.

The Number of Central Lymph Nodes on Preoperative Ultrasound Predicts Central Neck Lymph Node Metastasis in Papillary Thyroid Carcinoma: A Prospective Cohort Study

To evaluate the effectiveness of the number of central compartment lymph nodes (CLNs) on ultrasound (US) in predicting CLN metastasis (CLNM). We prospectively studied 309 papillary thyroid cancer (PTC) patients who underwent thyroidectomy with CLN dissection at our center from May 2017 to July 2017. The number and features of CLNs were evaluated preoperatively via US. All US examinations were performed using a Philips iU 22 or a GE Logiq 9 machine. Correlations between CLNs observed via preoperative US and amount of CLNM were evaluated. We found that ≥2 CLNs on the preoperative US was associated with CLNM (P<0.01). For this feature, the sensitivity, specificity, and area under the curve (AUC) were 54.3%, 66.1%, and 0.61, respectively. The presence of both suspected metastasis and ≥2 CLNs on US had a specificity of 86.5%. In addition, ≥3 CLNs on preoperative US was associated with large-volume CLNM (>5 metastatic CLNs) (P<0.01). For this feature, the sensitivity, specificity and AUC were 54.8%, 74.5% and 0.65, respectively. The presence of both suspected metastasis and ≥3 CLNs on US had a specificity of 84.9%. The presence of suspected metastasis and/or ≥3 CLNs had a sensitivity of 80.6%. Our results suggest that ≥2 and ≥ 3 CLNs on preoperative US may serve as ancillary preoperative markers for predicting CLNM.