Lymphadenectomy for oncogynecological pathology: evaluation of lymph cyst formation and detection of metastases depending on the number of lymph nodes removed

Introduction. Lymphadenectomy in gynecological oncology allows performing adequate surgical staging, determining the need for adjuvant therapy, and reducing the risk of disease recurrence. An increase in the volume of lymphadenectomy leads to an increase in the incidence of postoperative complications — the formation of lymphatic cysts. There are no clear recommendations on the required number of removed lymph nodes in order to identify their metastatic lesions. The aim of the study was to study the possible dependence of the number of removed lymph nodes and the formation of lymphatic cysts. Materials and methods. A retrospective study of 219 patients after surgical treatment from 2020 to 2021 was carried out on the basis of GBUZ Chelyabinsk Regional Center of Oncology and Nuclear Medicine. The study included cases of stage I-IV uterine cancer of all histological types, which underwent radical hysterectomy with bilateral pelvic or bilateral pelvic and paraaortic lymphadenectomy; cases of cervical cancer stage IA1-IIA disease after radical hysterectomy II-III type according to the classification of M.S. Piver, F. Rutledge (1974) with performing bilateral pelvic lymphadectomy. Statistical processing of the results was carried out. Results. The percentage of complications (lymphatic cysts) in the cervical cancer group was 2.06% (N = 2), in the uterine body cancer group 1.72 (N = 2). There was no statistically significant relationship between the removed lymph nodes and their metastatic lesions. Removing more than 27 lymph nodes is a risk factor for developing lymphatic cysts. Discussion. Lymphadenectomy allows for adequate surgical staging and reduces the risk of disease recurrence. Complicated lymphatic cysts occur in 0.9-34% of cases, which was reflected in our study, but the percentage of these complications is quite low. Conclusion. The increase in the volume of lymphadenectomy (removal of more lymph nodes) is justified by the desire for accuracy in the surgical staging of the tumor process. Despite this, there is a risk of complications after lymphadenectomy — the formation of lymphatic cysts that occurs when 27 or more lymph nodes are removed.

Symptomatic lymphatic cysts after oncourological operations on the pelvic organs and influence of their anatomical localization on the clinical appearance

Introduction. Lymphatic cysts (LC) are the accumulation of free lymphatic fluid in a limited space (between tissues and organs), in the place where the lymphadenectomy was performed. They are the most frequent complications in pelvic oncourology. LC are divided into symptomatic and asymptomatic.Purpose of the study. To assess the influence of the anatomical localization of symptomatic lymphatic cysts (sLC) on the clinical appearance.Materials and methods. 203 radical prostatectomies (RPE) and 42 radical cystectomies (RC) were performed with pelvic lymph node dissection (PLND) in the N.I. Pirogov City Clinical Hospital № 1 from January 2017 to March 2020. Of 203 patients, 13 (6.4%) developed SLC, and of 42 patients, 6 (14.3%). All patients who developed complications underwent complex ultrasound studies and multispiral computed tomography (MSCT) of the retroperitoneal space, abdomen, and pelvic area to assess the localization and volume of the sLC.Results. Four anatomical localizations of the sLC can be distinguished after analyzing the clinical picture of 19 patients with sLC and comparing the obtained data with MSCT: paravasal-iliac, paravesical, prevesical, and pelvic-retroperitoneal. The frequency of paravasaliliac sLC was higher, they developed in 13 (68.5%) patients. The clinical picture included: pain in the pelvic area, lymphedema of the lower limb, body temperature ≥ 39.0 °C, due to LC infection and compression of the iliac vessels. Paravesical sLC were found in 2 (10.5%) patients. There was a failure of the urethrovesical anastomosis, according to retrograde cystography, due to displacement of the bladder. Prevesical sLC were found in 2 (10.5%) patients. Patients noted progressive urinary incontinence and pain above the pubic symphysis. Pelvic-retroperitoneal sLC was observed in 2 (10.5%) patients, with the clinical appearance of nagging pain in the lumbar region, body temperature ≥ 38.0 °C, due to ureteral compression and the development of obstructive pyelonephritis, as well as compression of the inferior vena cava by a lymphatic cyst. The repeated intervention was performed in 18 cases: percutaneous drainage of the LC under ultrasound guidance in 12 (63.2%) patients, laparoscopic marsupialization of the LC in 3 (15.7%) patients, an open technique in 3 (15.7%). In 1 patient (5.4%) the treatment was conservative.Conclusion. Symptomatic LC can be classified according to 4 anatomical locations, which define their clinical symptoms. Most sLC require reoperation.

Lymphatic cysts after gynecological cancer surgery: risk factors, diagnosis and treatment

Lymphatic cysts, also known as lymphocele, are one of the most common complications after pelvic and paraaortic lymph node dissection in patients with gynecological cancers. Despite the high incidence of this complication, no specific guidelines on the diagnosis and treatment of lymphocele have been developed so far. This article analyzes the incidence of lymphatic cysts, risk factors, and currently available options for their diagnosis and treatment.

Laparoscopy as a Diagnostic and Definitive Therapeutic Tool in Cases of Inflamed Simple Lymphatic Cysts of the Mesentery

Mesenteric cysts are rare benign abdominal tumors. These cysts, especially those of lymphatic origin, very rarely become inflamed. The diagnosis of inflamed lymphatic cysts of the mesentery may be difficult. We herein report two cases of inflamed simple lymphatic cysts of the mesentery definitively diagnosed and excised by laparoscopy.

Histopathology of the lymphatic system in ascitic broilers

Histomorphologic changes of the lymphatic system of the liver and thoracic duct were examined. The diameters of lymphatic segments isolated from the thoracic ducts of ascitic and normal broilers at 32 to 37 days of age were measured using an optical micrometer measurement system. e histopathological picture of the segments of lymphatic tissue showed lymphatic cysts bilaterally along the posterior vena cava. The hepatic capsule manifested edema, thickening, and cellular proliferation. Microscopic changes in lymphatic vessels of the hepatic capsule include lymph embolism, and lymphatic plasma retention in lymphatic cysts. In some cases, distended lymphatic vessels exhibited protuberances, and lymph leaked from the lymphatic cysts into the surrounding swollen and degenerated endothelial cells of the thoracic duct. Sometimes, extensive endothelial cell loss was observed, and their exfoliated fragments were also seen. Marked dilatation of thoracic duct and lymph embolism, leaking of lymph, edema in some fibers and the enlargement of spaces between fibers, swollen intimas, and rupture and bleeding of the thoracic duct were also visible. The thoracic duct’s long and short semi-axis, and the cross sectional area of the thoracic duct differed significantly between normal and ascitic broilers.

Sclerotherapy of lymphatic cysts of the leg with OK-432

Lymphatic cysts can either represent lymphatic malformations (LMs) or may occur after trauma or operation. Independent of their etiology lymphatic cysts can cause functional impairment and recurrent skin infections. We report the successful use of OK-432 injected transcutanously to treat lymphatic macrocysts. Treatment of LMs with OK-432 has been reported to be a safe and minimally invasive procedure. The underlying mechanism is still unclear but injection leads to an inflammation of the wall resulting in occlusion or shrinkage of the cyst.

Comparison of endoscopic, ultrasound and microbiological examinations in diagnosis of reproductive disorders in mares

Endoscopyc examinations were performed on 37 mares of different breeds. All examined mares had reproductive problems. During the examination, the following pathological changes were found: inflammation of endometrium in 19 cases (64.9%), uterus adhesions in 4 cases (10.8%), exudate in uterus lumen in 13 cases (32.4%), thin fibrin exudate in 8 cases (21.6%) and lymphatic cysts in 12 cases (32.4%). In one case adhesions in the cervical wall were found, and in one case there was hair encapsulated in the cervical mucus as a consequence of fetotomy. These changes were found in 2.7% of cases.