Lymph node infarction: role of underlying malignancy, tumour proliferation fraction and vascular compromise--a study of 35 cases and a comprehensive review of the literature.

AIMS: To determine the roles of the presence of malignancy, tumour proliferation fraction, vascular compromise and therapeutic and diagnostic manipulations in lymph node infarction (LNI). METHODS AND RESULTS: Thirty-five cases of LNI were identified over a 20-year period. Of the 35 patients, 31 (89%) had an underlying malignancy: 27 of the 31 (87%) were haematologic malignancies, the rest being metastatic carcinoma (two), melanoma, and seminoma. Of the four patients without evidence of malignancy, two were diagnosed with viral infection, one had LNI adjacent to a thrombosed pancreas graft, and one was lost to follow-up. Ki67 immunostaining in viable tumour demonstrated a range (5-60%) of proliferation fractions. A history of fine needle aspiration alone was present in seven of the 35 patients (20%), a history of chemotherapy alone in 11 (31%), and a history of both in two (5.7%). Factor VIII immunostaining highlighted thrombosed and recanalized vessels next to the infarction. CONCLUSIONS: Infarction of lymph nodes is associated with previous, concurrent or subsequent diagnosis of malignancy in the vast majority of cases. Chemotherapy or previous fine needle aspiration can precipitate infarction in some cases, but infarction may occur without such intervention, possibly because of an underlying subacute or chronic vascular compromise produced by vascular thrombosis.

Lymph or Chyle Leak After Neck Dissection in Patients With Thyroid Carcinoma: Results of a Study on 1724 Patients.

BACKGROUND: To discuss the prevention and treatment of lymph or chyle leak following neck dissection in patients with thyroid carcinoma. METHODS: A total of 1724 patients with thyroid carcinoma received neck dissection in the Sun Yat-sen University Cancer Center between November 2009 and October 2014. The incidence and management of leak were analyzed. RESULTS: A total of 92 (5.34%) patients developed leak, 28 (1.62%) developed lymph leak, 59 (3.42%) developed chyle leak, and 5 (.29%) developed chylothorax. Medical management to stop postoperative lymph or chyle leak included pressure dressing, reoperation, fasting, or low-fat diet therapy. CONCLUSIONS: Lymph or chyle leak may occur in thyroid carcinoma patients who underwent neck dissection. Clinicians should alert to leak when there were IV + VI region lymph node metastasis and should become aware of chylothorax after pressure dressing. A careful identification and ligation of lymphatic duct may be an effective way to avoid lymph or chyle leak.

Serum thyroglobulin elevation after needle aspiration of the lymph nodes: the predictive value for detecting metastasis in papillary thyroid cancer patients - a pilot study.

Ultrasonography (USG)-guided fine needle aspiration (FNA) is widely used for diagnosis of lymph node (LN) metastasis in papillary thyroid cancer (PTC). However, FNA cytology sometimes shows inconclusive results. Recently, the measurement of thyroglobulin (Tg) in FNA washout fluid (aspirate-Tg) has been widely adopted, but there are some difficulties in the preparation of the sample and standardization of the procedure. Here, we examined serum Tg after FNA as a new predictive marker for LN metastasis of PTC. We performed USG-guided FNA cytology and examined aspirate-Tg in PTC patients showing suspicious metastatic LNs during follow-up. We measured baseline serum thyroid stimulating hormone (TSH), Tg, and Tg antibody levels before FNA, and serum Tg level within an hour after FNA. We defined aspirate-Tg level above 0.9 ng/mL as positive, and a 30% increase in serum Tg level after FNA compared to the baseline as elevation of serum Tg. Twenty-two patients were included in our study. Nine patients (40.9%) showed elevation of Tg level after FNA, and the mean value of Tg elevation was 24.8 ±â€Š48.0 ng/mL. Among these 9 patients, 8 were diagnosed with PTC and 1 patient showed cellular atypia on cytopathology. All these patients showed positive aspirate-Tg. Thirteen patients (59.1%) did not show elevation of Tg level after FNA. Among these patients, 2 had PTC, 2 had cellular atypia, and 9 yielded negative results for malignancy on cytopathology. Elevation of serum Tg level after FNA might have a diagnostic role for predicting LN metastasis of PTC.

Carbohydrate supplementation before operation retains intestinal barrier function and lowers bacterial translocation in a rat model of major abdominal surgery.

BACKGROUND: Overnight fasting of rats augments the susceptibility of the small intestine to ischemia-reperfusion damage. Feeding before surgery may improve injuries to distant organs that were induced by ischemia-reperfusion. The present study tested the hypothesis that one of the food constituents, namely carbohydrates, may be responsible for the protective effect of preoperative feeding on postoperative organ dysfunction. METHODS: Male Wistar rats were fed ad libitum for 5 d and had either free access to water or free access to a carbohydrate drink and water. Then they were fasted for 16 h and access remained to either water or a carbohydrate drink and water. Following this, the arteria mesenterica superior was clamped for 60 min followed by 180 min of reperfusion. Subsequently, the intestinal permeability of stripped ileum was determined by measuring the mucosal to serosal flux in Ussing chambers. For assessment of bacterial content, organs were aseptically removed and assessed for bacterial content by culture under anaerobic conditions. RESULTS: Preoperative supplementation with carbohydrates resulted in a better maintenance of intestinal barrier function when compared with water supplemented animals. Moreover, carbohydrate supplementation resulted in a reduction in the ischemiareperfusion-induced increase in bacterial content of the liver, kidney, and mesenteric lymph nodes. CONCLUSIONS: Preoperative intake of carbohydrates by rats retains both the intestinal barrier function and prevents translocation of bacteria to distant organs.

Regulatory T Cells Mediate Local Immunosuppression in Lymphedema.

Patients who suffer from lymphedema have impaired immunity and, as a result, are at an increased risk for infections. Furthermore, previous studies have shown that lymphadenectomy impairs acquisition of adaptive immune responses and antibody production in response to foreign antigens. Although it is clear that antigen presentation in lymph nodes plays a key role in adaptive immunity, the cellular mechanisms that regulate impaired immune responses in patients with lymphedema or following lymphatic injury remain unknown. We have previously found that axillary lymph node dissection, both clinically and in a mouse model, results in a marked increase in the number of regulatory T cells in the ipsilateral limb. In this study, we focus on the role of regulatory T cells in immunosuppression and show that regulatory T-cell proliferation in tissues distal to site of lymphatic injury contributes to impaired innate and adaptive immune responses. More importantly, using Foxp3-DTR transgenic mice, we show that depletion of regulatory T cells in the setting of lymphatic injury restores these critical immune-mediated responses. These findings provide additional evidence that immune responses following lymphatic injury play a key role in mediating the pathology of lymphedema.

CT diagnosis of chyluria after partial nephrectomy.

OBJECTIVE: The purpose of this study was to describe the CT diagnosis of chyluria after partial nephrectomy. CONCLUSION: Fat in the bladder can be identified on CT after partial nephrectomy. This finding is caused by chyluria secondary to lymphatic injury and should not be mistaken for other abnormalities. Our study population did not need treatment of chyluria.

Management of lymph fistula in the groin after arterial reconstruction.

Leakage of lymph from the inguinal incision is a rare but disturbing complication of arterial surgery. This article describes our experience in the management of 12 patients in whom lymphorrhea developed following arterial reconstruction. Seven patients were treated with pressure dressings, antibiotics, and immobilization. In this group, fistula healing was delayed up to four weeks, and wound infection occurred in three of seven patients. One patient eventually required removal of the prosthetic graft and below-knee amputation. Early groin reexploration and direct ligature of ruptured lymphatics was performed in the remaining five patients. Hospitalization was shortened and wound infection prevented in all patients in this group. We recommend prompt operative closure as the preferred approach in the management of lymph fistula following vascular reconstruction, especially when synthetic graft material is present.

Massive lymphatic fluid leakage during laparoscopic lymphnode biopsy for abdominal malignancy.

This report concerns massive lymphatic fluid leakage during laparoscopic abdominal lymphnode biopsy for mesenteric tumor of non-Hodgkin's disease. Laparoscopic lymphnode biopsy was performed on a 58-year-old man who presented with a huge abdominal mass. The initial diagnosis was based on abdominal computed tomography, which revealed a large mass. This was followed by laparoscopic abdominal lymphnode biopsy for a definitive diagnosis. During the operation, massive lymphatic leakage up to about 300 mL occurred, but was stopped completely by electric coagulation. Histological examination indicated the mass to be a B-cell type non-Hodgkin's lymphoma. Hospitalization was uneventful, and the patient was discharged 7 days postoperatively to the Department of Internal Medicine for chemotherapy. This new endoscopic approach offers a useful alternative to the traditional transabdominal excision of intra-abdominal lymphnodes, although attention must be paid to possible complications including massive intraoperative lymphatic leakage.

[Forensic medical implications of lymph node and lymphatic injuries]. / Implications médico-légales des traumatismes ganglionnaires et lymphatiques.

Three cases of injuries to lymph nodes are reported; the main sequela was lymphedema. One case occurred after node curettage and two after varicose vein surgery.

[Traumatic chylothorax (apropos of a case following a closed vertebral-thoracic injury)]. / Chilotorace traumatico (a proposito di un caso consecutivo a trauma chiuso vertebro-toracico).

The authors report a case of chylothorax due to blunt trauma with fracture of the spine in a man aged 60. After mentioning the possible pathogenesis and clinics of the case shown, the Authors explain the treatment successfully adopted, that is, the ligature of thorax duct at his inlet in the thorax through right thoracotomy on the 5th intercostal space.

EUS-FNA of enlarged necrotic lymph nodes may cause infectious mediastinitis.

Transesophageal endoscopic ultrasound with fine-needle aspiration (EUS-FNA) is a minimally invasive technique to investigate the mediastinum. Although EUS-FNA can be considered in general as a safe technique, complications do occur. We here report an infectious complication of EUS-FNA that occurred after puncture of a large malignant necrotic mediastinal lymph node.

Correlação entre as medidas antropométricas e o comprometimento linfonodal de pacientes pós-menopausadas com câncer de mama / Correlation between anthropometric measurements an lymph node metastases in postmenopausal women with breast cancer

Introdução: Diversos estudos epidemiológicos observaram que mulheres obesas na pós-menopausa apresentam aumento de risco e mortalidade do câncer de mama. Apesar de não haver consenso, alguns estudos demonstraram maior grau de comprometimento dos linfonodos axilares nessas pacientes, o que pode contribuir para o pior prognóstico da doença nesse grupo. Objetivo: Avaliar a correlação entre as medidas antropométricas e o grau de comprometimento linfonodal axilar em pacientes pós-menopausadas com câncer de mama hormônio-responsivo. Métodos: Estudo prospectivo analítico com 57 mulheres com carcinoma ductal invasivo no estágio II, na pós-menopausa, com receptores hormonais positivos (receptor estrogênico e/ou receptor de progesterona - RE/RP), tratadas nos hospitais São Paulo e Pérola Byington. Logo após o diagnóstico foram realizadas as medidas antropométricas (IMC, CA, CQ e RCQ) das pacientes e, após o tratamento cirúrgico e avaliação histopatológica dos linfonodos axilares, realizou-se o estudo estatístico. Resultados: Observou-se associação significativa entre o número de linfonodos acometidos e o sobrepeso (IMC> 25 kg/m2) (p = 0,0329). Cerca de 64% das pacientes com mais de três linfonodos acometidos apresentaram IMC> 25 kg/m2. Entretanto, não houve diferença estatística entre as medidas antropométricas e a positividade dos linfonodos axilares de forma global. Conclusão: O número de linfonodos axilares comprometidos foi maior em pacientes com índice de massa corpórea entre 25 e 30 kg/m2.

Introduction: Several epidemiological studies have shown an increased risk and mortality in breast cancer of obese postmenopausal women. The higher number of lymph node metastases in these patients could contribute to poor prognosis. Objective: To evaluate the correlation between the anthropometric measurements and lymph node metastases in postmenopausal women with breast cancer expressing hormone receptors (ER/PgR). Methods: Prospective study with 57 women with invasive ductal carcinoma, stage II and estrogen receptor and/or progesterone receptor (ER/PgR) positivity treated in São Paulo and Pérola Byington Hospital. Anthropometric datawere obtained after the diagnoses, and statistical analysis was done after surgery treatment and definitive pathology results of axillary lymph nodes dissection. Results: There was a significant association (p = 0.0329) between the number of axillary lymph node metastases and overweight (BMI > 25 kg/m2). Almost 64% of patients with more than three lymph node metastases had more than 25 kg/m2. However, there were no statistical significance between the correlation of anthropometric measurements and the global number of axillary lymph node metastases. Conclusion: The number of axillary lymph node metastases was higher in patients with body mass index between 25 and 30 kg/m2.

The lymphatics of the groin flap.

This communication briefly discusses lymph-draining potentials and problems of skin flaps; describes specifically the lymphatics of the groin flap, an axial pattern flap; gives examples of its clinical application as a lymphatic wick; and explains its partial success and failure. The concept of axial pattern flaps was developed when the groin flap was described in 1972 by McGregor and Jackson. Attempts were subsequently made to delineate the extent of the vascular territories of these axial vessels. Although the flap was initially used as a pedicle flap, transfer of its vascular territory based on the axial vessels was soon undertaken, producing the so-called free flap. One desirable characteristic of this axial pattern flap was the remarkable absence of edema following elevation and transfer or transplantation to the new site. This stimulated one of us (L.C.) to review the lymph-draining potential of this flap.

[Effect of trauma on space-time organization of B-dependent area of the regional lymph node cortex]. / Vliianie travmy na prostranstvenno-vremennuiu organizatsiiu B-zavisimoi zony kory regionarnogo limfaticheskogo uzla.

In the experiment performed on 238 non-inbred white mice it has been demonstrated that after trauma in the concha auricularis population density (PD) of immune-competent cells in the germinative center (GC) and in the crown of the regional lymph node (LN) changes. The PD of small lymphocytes increases, and the PD of mitotically dividing cells, immunoblasts, plasmoblasts, immature and mature plasmocytes decreases sharply in both zones. The increase of small lymphocytes PD in the regional LN after the trauma is obviously connected with intensification of their inflow from the lesion focus. Inhibition of proliferation and differentiation of the immune-competent cells in the GC of the crown is a response to the operation stress. During the posttraumatic period both spectral composition and parameters of the constituents of rhythmical alteration of the cells PD change both in the GC and in the crown. As a rule, displacement of acrophase and decrease in amplitude of the rhythm take place. Total power of the process for various types of immune-competent cells alters unequally. In the spectral composition of the rhythmicity amount of circadian components increases, their power increases, too. This demonstrates an increase of central hormonal effects during the posttraumatic period. After trauma fluctuations of the cells PD of the plasmacytic line, as well as in mitotically dividing cells with a 7-hour's period, which has been revealed in intact animals before the trauma, are preserved. This demonstrates a relative independence of the given synchronizer of rhythmicity at a tissue level from any influence of the higher regulatory center.