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1.
BMC Surg ; 21(1): 280, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34082744

RESUMO

BACKGROUND: This study aimed to explore potential risk factors for 253 lymph node metastasis, and to identify the prognostic impact of 253 lymph node metastasis in colorectal cancer patients. METHODS: A retrospective study was conducted of 391 colorectal cancer patients who underwent surgical treatments that included 253 lymph node dissection. Clinicopathological features, molecular indexes and 1-year overall survival rates were analyzed. RESULTS: Univariate analyses revealed the following risk factors for 253 lymph node metastasis: high preoperative levels of CEA, large tumour max diameters, and numbers of harvested lymph nodes, presence of vessel carcinoma emboli, low level of MSH6 and MLH1 immunohistochemical staining intensity. Multivariate analysis showed that elevated MLH1 immunohistochemical staining intensity was an independent protective factor for 253 lymph node metastasis (OR: 0.969, 95% CI 0.945, 0.994, P = 0.015). A significant difference was found in 1-year overall survival rate between 253 lymph node-positive and lymph node-negative colorectal cancer patients (88.9% vs.75.0%, P < 0.001). CONCLUSIONS: 253 lymph node-positive colorectal cancer patients had a worse prognosis than the 253 lymph node-negative patients. 253 lymph node dissection may improve the prognosis of colorectal cancer patients with high risk factors for 253 lymph node metastasis.


Assuntos
Neoplasias Colorretais , Excisão de Linfonodo , Neoplasias Colorretais/cirurgia , Humanos , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Fatores de Risco
2.
Nihon Shokakibyo Gakkai Zasshi ; 118(6): 549-554, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-34108354

RESUMO

The Japanese guidelines for the treatment of gastric cancer recommend nivolumab as third-line chemotherapy for metastatic gastric adenocarcinoma. We report a case in which long-term control of metastatic gastric adenocarcinoma was achieved with nivolumab after pseudoprogression. A man in his late 70s with advanced HER2-negative gastric cancer and liver metastasis underwent total gastrectomy to control tumor bleeding. He then underwent chemotherapy with S-1 plus oxaliplatin, followed by S-1 alone. After metastases in the liver and para-aortic and hilar lymph nodes regrew, the patient received ramucirumab plus paclitaxel as second-line chemotherapy, followed by third-line therapy with nivolumab. After four cycles of nivolumab, these metastases showed progression;however, the treatment was continued because levels of CA19-9 were decreased, and performance status was good. After five more cycles of nivolumab, the liver metastasis shrank, and CA19-9 levels decreased;therefore, we confirmed pseudoprogression. The patient suffered no immune-related adverse events and survived for 50 months after gastrectomy with 34 cycles of nivolumab treatment. Thus, at the beginning of treatment with an immune checkpoint inhibitor, oncologists must consider the possibility of pseudoprogression in cases of tumor growth associated with decreasing tumor marker levels and good performance status.


Assuntos
Nivolumabe , Neoplasias Gástricas , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Gastrectomia , Humanos , Linfonodos , Masculino , Nivolumabe/uso terapêutico , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/cirurgia
3.
Zhonghua Wai Ke Za Zhi ; 59(6): 502-506, 2021 Jun 01.
Artigo em Chinês | MEDLINE | ID: mdl-34102735

RESUMO

Objective: To examine the correlation factors of contralateral central lymph node metastasis in unilateral papillary thyroid carcinoma with lateral cervical lymph node metastasis. Methods: The clinical data of patients with unilateral papillary thyroid carcinoma who underwent total thyroidectomy and bilateral central lymph node dissection and ipsilateral cervical lymph node dissection from June 2016 to June 2018 at Department of Thyroid Surgery, West China Hospital, Sichuan University were analyzed retrospectively. A total of 317 patients, including 87 males and 230 females, aged (41.4±12.1) years (range: 16 to 75 years), were enrolled in this study. The risk factors of contralateral central lymph node metastasis were analyzed by χ2 test and Spearman correlation analysis. Results: There were 116, 69, 269, and 181 cases of pretracheal lymph node, prelaryngeal lymph node, ipsilateral central lymph node and contralateral central lymph node metastasis, respectively, and 16 cases of skipping metastasis. Univariate analysis showed that contralateral central lymph node metastasis was associated with gender, maximum tumor diameter, capsule invasion, pretracheal lymph node metastasis, prelaryngeal lymph node metastasis, and ipsilateral central lymph node metastasis (all P<0.05). Spearman correlation analysis showed that male (rs=0.162, P=0.004), maximum tumor diameter>10 mm (rs=0.184, P=0.001), capsule invasion (rs=0.135, P=0.016), pretracheal lymph node metastasis (rs=0.394, P<0.01), prelaryngeal lymph node metastasis (rs=0.272, P<0.01) and ipsilateral central lymph node metastasis (rs=0.203, P<0.01) were independent correlation factors for contralateral central lymph node metastasis. Conclusion: For patients with unilateral papillary thyroid carcinoma with ipsilateral cervical lymph node metastasis, bilateral central lymph node dissection should be considered if male, tumor diameter>10 mm, capsule invasion, pretracheal lymph node metastasis, prelaryngeal lymph node metastasis, or ipsilateral central lymph node metastasis.


Assuntos
Carcinoma Papilar , Carcinoma , Neoplasias da Glândula Tireoide , Carcinoma/cirurgia , Carcinoma Papilar/cirurgia , China , Feminino , Humanos , Linfonodos , Metástase Linfática , Masculino , Esvaziamento Cervical , Estudos Retrospectivos , Câncer Papilífero da Tireoide , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia
4.
Zhonghua Er Ke Za Zhi ; 59(6): 511-515, 2021 Jun 02.
Artigo em Chinês | MEDLINE | ID: mdl-34102827

RESUMO

Objective: To investigate the feasibility, clinical efficacy and safety of endobronchial ultasound (EBUS) in children. Methods: The radiological features, EBUS images, pathological results and intraoperative and postoperative complications of 3 cases who underwent EBUS examination and 1 case who underwent EBUS guided transbronchial needle aspiration (EBUS-TBNA) were retrospectively analyzed. Results: Among the 4 cases, 2 were males and 2 were females, with the onset age of 7.4-9.2 years. The child who underwent successful EBUS-TBNA was presented with fever and diagnosed with mediastinal lymphadenopathy before the operation, and the postoperative pathology indicated histiocytic necrotic lymphadenitis (HNL). The other 3 children diagnosed with primary airway tumors, whose pre-operative CT imaging found no infiltration in extra-bronchial structures, had the masses resected through EBUS. According to postoperative pathological findings, two were diagnosed with mucoepidermoid carcinoma and one with bronchial leiomyoma. The lesions were located at the opening of the right main bronchus in 1 case and at the main airway in 2 cases. EBUS showed abnormal echogenicity of the tracheal wall in the 3 cases, including hyperechoic area in the water capsule and mucous layer, relatively hypoechoic area in the submucosal smooth muscle layer, hyperechoic area in the inner cartilage layer, hypoechoic in the cartilage layer and hyperechoic in the outer cartilage layer. In one case, structural disorder of the submucosal smooth muscle layer and partial disruption of the cartilage layer of the tracheal wall were found at the lesion site, while the other 2 cases had intact tracheal wall structure. There were no postoperative complications such as pneumothorax or hemoptysis in the 4 children. Conclusion: EBUS is a safe and feasible technique for evaluating mediastinal lymph node enlargement and the degree of airway wall infiltration in primary airway tumor.


Assuntos
Neoplasias Pulmonares , Linfadenopatia , Broncoscopia , Criança , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Feminino , Humanos , Linfonodos/diagnóstico por imagem , Masculino , Estudos Retrospectivos
5.
J Int Med Res ; 49(6): 3000605211012209, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34098769

RESUMO

BACKGROUND: Although the National Comprehensive Cancer Network guidelines recommend routine lymph node dissection (LND) in intrahepatic cholangiocarcinoma (ICC), the role of LND remains controversial, and the node (N) stage is oversimplified. METHODS: Patients were identified from the Surveillance, Epidemiology, and End Results research data 18 (SEER 18). Propensity score matching (PSM) was used to reduce bias, and Kaplan-Meier curves and Cox proportional hazards models were used to compare overall survival (OS). The best cutoff values were found using X-tile software. RESULTS: Of 2037 patients included in SEER 18, 1147 underwent LND (56.3%); 389 (34.3%) had pathologically confirmed lymph node metastasis (LNM), and 316 (27.6%) had at least 6 LNDs. The median OS was worse for LND patients (34 months vs. 40 months, respectively), and this result remained after PSM. Male sex, age ≥60 years, tumor size > 5 cm, and LNM were independent prognostic risk factors for ICC. LNM ≥3 was associated with worse OS. CONCLUSIONS: Only a few LNDs met the requirements per the guidelines. LND does not improve OS in ICC, and the best approach to LND and a better N staging method should be explored further.


Assuntos
Neoplasias dos Ductos Biliares , Colangiocarcinoma , Neoplasias dos Ductos Biliares/patologia , Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares Intra-Hepáticos/patologia , Colangiocarcinoma/patologia , Colangiocarcinoma/cirurgia , Humanos , Excisão de Linfonodo , Linfonodos/patologia , Linfonodos/cirurgia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias
6.
Pan Afr Med J ; 38: 245, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34104293

RESUMO

Pulmonary lesions on imaging are presumed to be metastatic lesions in patients with breast cancer. Here, we report an interesting case of a 63-year-old lady with breast carcinoma showing pulmonary lesions on imaging suggestive of pulmonary metastases. Detailed evaluation of pulmonary lesions confirmed the presence of co-existing pulmonary sarcoidosis. Modern diagnostic methods like 18-flurodeoxyglucose positron emission tomography (18-FDG PET) are unable to clearly differentiate metastatic disease from granulomatous diseases like sarcoidosis. Thus, histological confirmation is needed for accurate staging and determining response to treatment and rarely, in non-responders, detecting any co-existing disease. This case emphasizes the need for detailed histopathological examination of lymph nodes in patients with non-responsive disease or recurrent disease despite adequate chemotherapy.


Assuntos
Neoplasias da Mama/diagnóstico , Neoplasias Pulmonares/diagnóstico , Sarcoidose Pulmonar/diagnóstico , Neoplasias da Mama/patologia , Feminino , Fluordesoxiglucose F18 , Humanos , Neoplasias Pulmonares/patologia , Linfonodos/patologia , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons , Sarcoidose Pulmonar/patologia
7.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 50(1): 81-89, 2021 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-34117856

RESUMO

:To establish and verify a risk prediction nomogram for ipsilateral axillary lymph node metastasis in breast cancer stage T1 (mass ≤ 2 cm). :The clinicopathological data of 907 patients with T1 breast cancer who underwent surgical treatment from January 2010 to June 2015 were collected,including 573 cases from the Second Affiliated Hospital of Zhejiang University School of Medicine (modeling group) and 334 cases from Zhejiang University Lishui Hospital (verification group). The risk factors of ipsilateral axillary lymph node metastasis were analyzed by univariate and multivariate logistic regression. The influencing factors were used to establish a nomogram for predicting ipsilateral axillary lymph nodes metastasis in T1 breast cancer. The model calibration,predictive ability and clinical benefit in the modeling group and the verification group were analyzed by C index,receiver operating characteristic curve,calibration curve and decision curve analysis (DCA) curve,respectively. :Univariate analysis showed that lymph node metastasis was related with primary tumor size,vascular tumor thrombus,Ki-67,histopathological grade,and molecular type (<0.05 or <0.01). Multivariate logistic regression analysis showed that the primary tumor > vascular tumor thrombus,Ki-67 positive,estrogen receptor (ER) positive,and histopathological grade 2-3 were independent risk factors of axillary lymph node metastasis (<0.05 or <0.01). Based on the independent risk factors,a nomogram prediction model was established. The C indexes of the model group and the validation group were 0.739 (95%:0.693-0.785) and 0.736 (95%:0.678-0.793),respectively. The calibration curve and DCA curve of the modeling group and the verification group indicated that the model was consistent and had good clinical benefit. :Primary tumor size,histopathological grade,vascular tumor thrombus,Ki-67,and ER status are predictors of ipsilateral axillary lymph node metastasis in T1 breast cancer. The established prediction nomogram can effectively predict the risk of ipsilateral axillary lymph node metastasis in T1 breast cancer,which can be used as a reference for individualized axillary management.


Assuntos
Neoplasias da Mama , Nomogramas , Axila , Feminino , Humanos , Linfonodos , Metástase Linfática , Estudos Retrospectivos
8.
J Med Microbiol ; 70(6)2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34115583

RESUMO

Introduction. Leishmaniasis is a neglected tropical and subtropical disease caused by over 20 protozoan species.Hypothesis. Treatment of this complex disease with traditional synthetic drugs is a major challenge worldwide. Natural constituents are unique candidates for future therapeutic development.Aim. This study aimed to assess the in vivo anti-leishmanial effect of the Gossypium hirsutum extract, and its fractions compared to the standard drug (Glucantime, MA) in a murine model and explore the mechanism of action.Methodology. Footpads of BALB/c mice were infected with stationary phase promastigotes and treated topically and intraperitoneally with G. hirsutum extract, its fractions, or Glucantime, 4 weeks post-infection. The extract and fractions were prepared using the Soxhlet apparatus with chloroform followed by the column procedure.Results. The crude extract significantly decreased the footpad parasite load and lesion size compared to the untreated control group (P<0.05), as revealed by dilution assay, quantitative real-time PCR, and histopathological analyses. The primary mode of action involved an immunomodulatory role towards the Th1 response in the up-regulation of IFN-γ and IL-12 and the suppression of IL-10 gene expression profiling against cutaneous leishmaniasis caused by Leishmania major.Conclusion. This finding suggests that the extract possesses multiple combinatory effects of diverse bioactive phytochemical compositions that exert its mechanisms of action through agonistic-synergistic interactions. The topical extract formulation could be a suitable and unique candidate for future investigation and pharmacological development. Further studies are crucial to evaluate the therapeutic potentials of the extract alone and in combination with conventional drugs using clinical settings.


Assuntos
Antiprotozoários/uso terapêutico , Gossypium , Leishmania major/efeitos dos fármacos , Leishmaniose Cutânea/tratamento farmacológico , Fitoterapia , Extratos Vegetais/uso terapêutico , Administração Tópica , Animais , Antiprotozoários/farmacologia , Feminino , Injeções Intraperitoneais , Interferon gama/genética , Interferon gama/metabolismo , Interleucina-10/genética , Subunidade p40 da Interleucina-12/genética , Subunidade p40 da Interleucina-12/metabolismo , Leishmania major/fisiologia , Leishmaniose Cutânea/parasitologia , Leishmaniose Cutânea/patologia , Leishmaniose Cutânea/fisiopatologia , Linfonodos/patologia , Antimoniato de Meglumina/administração & dosagem , Antimoniato de Meglumina/uso terapêutico , Camundongos , Camundongos Endogâmicos BALB C , Carga Parasitária , Extratos Vegetais/administração & dosagem , Extratos Vegetais/farmacologia , Baço/parasitologia , Baço/patologia , Células Th1/imunologia , Transcriptoma
9.
World J Surg Oncol ; 19(1): 179, 2021 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-34134714

RESUMO

BACKGROUND: Lymph node metastasis (LNM) is a risk factor for poor long-term outcomes and a prognostic factor for disease-free survival in colon cancer. Preoperative lymph node status evaluation remains a challenge. The purpose of this study is to determine whether tumor size measured by multidetector computed tomography (MDCT) could be used to predict LNM and N stage in colon cancer. MATERIAL AND METHODS: One hundred six patients with colon cancer who underwent radical surgery within 1 week of MDCT scan were enrolled. Tumor size including tumor length (Tlen), tumor maximum diameter (Tdia), tumor maximum cross-sectional area (Tare), and tumor volume (Tvol) were measured to be correlated with pathologic LNM and N stage using univariate logistic regression analysis, multivariate logistic analysis, and receiver operating characteristic (ROC) curve analysis. RESULTS: The inter- and intraobserver reproducibility of Tlen (intraclass correlation coefficient [ICC] = 0.94, 0.95, respectively), Tdia (ICC = 0.81, 0.93, respectively), Tare (ICC = 0.97, 0.91, respectively), and Tvol (ICC = 0.99, 0.99, respectively) parameters measurement are excellent. Univariate logistic regression analysis showed that there were significant differences in Tlen, Tdia, Tare, and Tvol between positive and negative LNM (p < 0.001, 0.001, < 0.001, < 0.001, respectively). Multivariate logistic regression analysis revealed that Tvol was independent risk factor for predicting LNM (odds ratio, 1.082; 95% confidence interval for odds ratio, 1.039, 1.127, p<0.001). Tlen, Tdia, Tare, and Tvol could distinguish N0 from N1 stage (p < 0.001, 0.041, < 0.001, < 0.001, respectively), N0 from N2 (all p < 0.001), N0 from N1-2 (p < 0.001, 0.001, < 0.001, < 0.001, respectively), and N0-1 from N2 (p < 0.001, 0.001, < 0.001, < 0.001, respectively). The area under the ROC curve (AUC) was higher for Tvol than that of Tlen, Tdia, and Tare in identifying LNM (AUC = 0.83, 0.82, 0.69, 0.79), and distinguishing N0 from N1 stage (AUC = 0.79, 0.78, 0.63, 0.74), N0 from N2 stage (AUC = 0.92, 0.89, 0.80, 0.89, respectively), and N0-1 from N2 stage (AUC = 0.84, 0.79, 0.76, 0.83, respectively). CONCLUSION: Tumor size was correlated with regional LNM in resectable colon cancer. In particularly, Tvol showed the most potential for noninvasive preoperative prediction of regional LNM and N stage.


Assuntos
Neoplasias do Colo , Tomografia Computadorizada Multidetectores , Neoplasias do Colo/diagnóstico por imagem , Neoplasias do Colo/cirurgia , Humanos , Linfonodos/diagnóstico por imagem , Linfonodos/cirurgia , Metástase Linfática/diagnóstico por imagem , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos
10.
Int. braz. j. urol ; 47(3): 484-494, May-June 2021. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1154488

RESUMO

ABSTRACT Prostate cancer is the most common invasive cancer in men. Radical prostatectomy (RP) is a definitive treatment option, but biochemical recurrence can reach 40%. Salvage lymphadenectomy is a relatively recent approach to oligometasis and has been rapidly diffused primarily due to improvement in imaging diagnosis and results showing possibly promising therapy. A systematic literature review was performed in March 2020, according to the PRISMA statement. We excluded studies with patients with suspicion or confirmation of visceral and / or bone metastases. A total of 27 articles were included in the study. All studies evaluated were single arm, and there were no randomized studies in the literature. A total of 1,714 patients received salvage lymphadenectomy after previous treatment for localized prostate cancer. RP was the most used initial therapeutic approach, and relapses were based on PET / CT diagnosis, with Coline-11C being the most widely used radiopharmaceutical. Biochemical response rates ranged from 0% to 80%. The 5 years - Free Survival Biochemical recurrence was analyzed in 16 studies with rates of 0% up to 56.1%. The articles do not present high levels of evidence to draw strong conclusions. However, even if significant rates of biochemical recurrence are not evident in all studies, therapy directed to lymph node metastases may present good oncological results and postpone the onset of systemic therapy. The long-term impact in overall survival and quality of life, as well as the best strategies for case selection remains to be determined.


Assuntos
Humanos , Masculino , Neoplasias da Próstata/cirurgia , Qualidade de Vida , Prostatectomia , Terapia de Salvação , Excisão de Linfonodo , Linfonodos , Recidiva Local de Neoplasia/cirurgia
11.
Adv Exp Med Biol ; 1187: 591-599, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33983601

RESUMO

The status of the axillary lymph nodes is one of the most important prognostic factors for patients with breast cancer. For over 100 years, axillary lymph node dissection was the standard approach to obtain and manage axillar lymph node, but now, sentinel lymph node biopsy has become a standard approach with less morbidity and equal accuracy in clinical node-negative patients. In addition, numerous studies are on the way to omit axillary lymph node dissection in specific patient subgroups. The recent trials like the ACOSOG Z0011 showed the evidence that omitting an ALND in patients with low burden nodal disease is safe in patients receiving whole-breast radiation. To reduce the use of ALND is the goal to consider when selecting an axillary management strategy.


Assuntos
Neoplasias da Mama , Linfonodos , Axila , Neoplasias da Mama/cirurgia , Humanos , Excisão de Linfonodo , Linfonodos/cirurgia , Biópsia de Linfonodo Sentinela
12.
J Med Case Rep ; 15(1): 309, 2021 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-34051835

RESUMO

BACKGROUND: Clear cell renal carcinoma is known for its propensity for metastatic spread. Common sites of metastasis are the lungs, bones, lymph nodes, liver, adrenals and brain, but all organs can be affected. Contralateral ureteral metastasis is a rare phenomenon, and only a few cases have been reported in the literature. CASE PRESENTATION: We present the case of a 58-year-old Caucasian patient with a single contralateral ureteral metastasis of a clear cell renal carcinoma. CONCLUSION: Ureteral metastasis of clear cell renal carcinoma is very rare, and there is no well-established treatment. For patients with low metastatic spread/volume, the aim should be to preserve kidney function, and thus metastasectomy should be considered.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Metastasectomia , Ureter , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/cirurgia , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia , Linfonodos , Pessoa de Meia-Idade , Ureter/diagnóstico por imagem , Ureter/cirurgia
13.
Hinyokika Kiyo ; 67(3): 83-90, 2021 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-33957027

RESUMO

From April 2007 to April 2018, we performed lymph node dissection in 305 cases of laparoscopic radical prostatectomy and 202 cases of robot-assisted radical prostatectomy at our hospital, and there were 68 cases with positive lymph node metastasis (pN1). Of these 68 cases, we examined retrospectively 62 cases in which extended lymph node dissection (ELND) was performed. The median number of removed lymph nodes was 25 (interquartile range [IQR] ; 18-34) and the median number of metastatic lymph nodes was 1 (IQR ; 1-3). Postoperative prostate-specific antigen (PSA) recurrence was observed in 40 of the 62 patients. The median time to PSA recurrence was 24 months. After univariate analysis, PSA at initial diagnosis (iPSA) of 10 ng/ml or more, pathological Gleason score (pGS) of 8 or more, total number of lymph node metastases of 2 or more, and positive surgical margin (RM+) were found to be riskfactors of PSA recurrence. In multivariate analysis, iPSA of 10 ng/ml or more, pGS of 8 or more and RM+ were independent riskfactors of PSA recurrence (p<0.05). In the cases without riskfactors such as iPSA≥10, pGS≥8, and RM+, immediate postoperative adjuvant therapy may be avoided even with pN1.


Assuntos
Laparoscopia , Neoplasias da Próstata , Procedimentos Cirúrgicos Robóticos , Humanos , Excisão de Linfonodo , Linfonodos/cirurgia , Masculino , Recidiva Local de Neoplasia/epidemiologia , Antígeno Prostático Específico , Prostatectomia , Neoplasias da Próstata/cirurgia , Estudos Retrospectivos , Fatores de Risco
14.
BMC Gastroenterol ; 21(1): 240, 2021 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-34034653

RESUMO

BACKGROUND: While double primary cancers are common in breast cancer patients, co-existence of primary gastric cancer and gastric metastases of breast cancer is exceedingly rare. CASE PRESENTATION: A 51-year-old woman receiving chemotherapy for breast cancer presented with melena and presyncope. A circumferential thickening of the pylorus and small submucosal tumor-like lesions in the gastric fundus and corpus were confirmed on endoscopy. Immunohistochemistry of biopsies revealed that the former was composed of poorly differentiated gastric cancer cells, while the latter were breast cancer metastases. Distal gastrectomy was performed. Pathological evaluation of the resected specimen revealed gastric adenocarcinoma in the pyloric lesion and breast countless cancer metastases throughout the remainder of the stomach, with positive margins. One lymph node had evidence of both stomach cancer and breast cancer metastases, forming a collision tumor. Despite a successful surgery, the patient died 6 months later due to progression of breast cancer. CONCLUSION: We report a case of synchronous primary gastric adenocarcinoma and gastric metastases of breast cancer. Inter-disciplinary collaboration is crucial in determining the optimal treatment in double cancers.


Assuntos
Neoplasias da Mama , Neoplasias Gástricas , Feminino , Gastrectomia , Humanos , Linfonodos , Pessoa de Meia-Idade , Neoplasias Gástricas/cirurgia
15.
BMC Surg ; 21(1): 261, 2021 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-34039328

RESUMO

BACKGROUND: The effectiveness of prophylactic lateral lymph node dissection (LLND) in treating patients with lower rectal cancer remains controversial and has not been clearly established. Therefore, we aimed to retrospectively analyze the survival impact of prophylactic LLND in patients with lower rectal cancer. METHODS: Data of 301 patients with lower rectal cancer (tumor's lower edge on the anal side of the peritoneal reflexion) with clinical T3 disease and negative preoperative lateral lymph node metastasis, who underwent radical resection (R0) at our hospital between April 2007 and March 2017, were included in this study. Patients who received preoperative chemotherapy or radiotherapy were excluded. The relapse-free survival (RFS) and overall survival (OS) rates were compared between the dissection (prophylactic LLND, n = 37) and non-dissection (no prophylactic LLND, n = 264) groups. RESULTS: Significantly fewer men and younger patients were noted in the dissection group than in the non-dissection group. Post-surgery 3- and 5-year RFS rates were 69.6% and 66.8% in the dissection group and 75.1% and 72.5% in the non-dissection group, respectively (5-year post-surgery RFS, p = 0.58). In the dissection and non-dissection groups, the 5-year OS rates were 86.5% and 79.7%, respectively (p = 0.29), and the 5-year cancer-specific survival rates were 88.9% and 86.0%, respectively (p = 0.29), with no significant differences. Lateral lymph node recurrence was observed in one (2.7%) and 10 patients (3.8%) in the dissection and non-dissection groups, respectively, and there was no significant difference between the groups. CONCLUSIONS: In this study, the effectiveness of prophylactic LLND was limited in patients with > T3 lower rectal cancer with no evidence of preoperative lymph node metastasis. Prophylactic LLND may not be necessary if there is no preoperative lymph node metastasis, even if the invasion depth is T3 or higher.


Assuntos
Recidiva Local de Neoplasia , Neoplasias Retais , Dissecação , Humanos , Excisão de Linfonodo , Linfonodos/patologia , Masculino , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/prevenção & controle , Estadiamento de Neoplasias , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Estudos Retrospectivos
16.
Front Immunol ; 12: 661052, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33995382

RESUMO

While lymphocytopenia is a common characteristic of coronavirus disease 2019 (COVID-19), the mechanisms responsible for this lymphocyte depletion are unclear. Here, we retrospectively reviewed the clinical and immunological data from 18 fatal COVID-19 cases, results showed that these patients had severe lymphocytopenia, together with high serum levels of inflammatory cytokines (IL-6, IL-8 and IL-10), and elevation of many other mediators in routine laboratory tests, including C-reactive protein, lactate dehydrogenase, α-hydroxybutyrate dehydrogenase and natriuretic peptide type B. The spleens and hilar lymph nodes (LNs) from six additional COVID-19 patients with post-mortem examinations were also collected, histopathologic detection showed that both organs manifested severe tissue damage and lymphocyte apoptosis in these six cases. In situ hybridization assays illustrated that SARS-CoV-2 viral RNA accumulates in these tissues, and transmission electronic microscopy confirmed that coronavirus-like particles were visible in the LNs. SARS-CoV-2 Spike and Nucleocapsid protein (NP) accumulated in the spleens and LNs, and the NP antigen restricted in angiotensin-converting enzyme 2 (ACE2) positive macrophages and dendritic cells (DCs). Furthermore, SARS-CoV-2 triggered the transcription of Il6, Il8 and Il1b genes in infected primary macrophages and DCs in vitro, and SARS-CoV-2-NP+ macrophages and DCs also manifested high levels of IL-6 and IL-1ß, which might directly decimate human spleens and LNs and subsequently lead to lymphocytopenia in vivo. Collectively, these results demonstrated that SARS-CoV-2 induced lymphocytopenia by promoting systemic inflammation and direct neutralization in human spleen and LNs.


Assuntos
COVID-19/imunologia , Linfonodos/imunologia , Linfopenia/imunologia , SARS-CoV-2/imunologia , Baço/imunologia , Enzima de Conversão de Angiotensina 2/imunologia , COVID-19/complicações , COVID-19/patologia , Proteínas do Nucleocapsídeo de Coronavírus/imunologia , Citocinas/imunologia , Feminino , Humanos , Inflamação/imunologia , Inflamação/patologia , Linfonodos/ultraestrutura , Linfopenia/etiologia , Linfopenia/patologia , Pessoa de Meia-Idade , Fosfoproteínas/imunologia , RNA Mensageiro/imunologia , Estudos Retrospectivos , SARS-CoV-2/patogenicidade , SARS-CoV-2/ultraestrutura , Baço/ultraestrutura
17.
J Int Med Res ; 49(5): 3000605211016138, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34038217

RESUMO

Acute myeloid leukemia (AML) with T lymphoblastic lymphoma (T-LBL) is a hematologic tumor of two origins, myeloid and lymphoblastic, and is relatively rare in the same patient. We report a rare case of AML with T-LBL. After the patient was diagnosed, he received standard chemotherapy, which decreased the primitive bone marrow cell percentage from 84% to 5%; however, the enlarged superficial lymph nodes showed no obvious change in size. Immunohistochemistry revealed the following: cluster of differentiation (CD)3 (+), CD5 (+), CD7 (+), transmission disequilibrium test (TDT) (+), myeloperoxidase (MPO) (-), and lysozyme (Lys) (-). The lymph node morphology and immunohistochemical results indicated T-LBL. Therefore, the final diagnosis was AML with T-LBL, with both diseases occurring independently and concurrently.


Assuntos
Leucemia Mieloide Aguda , Linfoma não Hodgkin , Leucemia-Linfoma Linfoblástico de Células Precursoras , Humanos , Imuno-Histoquímica , Leucemia Mieloide Aguda/tratamento farmacológico , Linfonodos/diagnóstico por imagem , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico
18.
Khirurgiia (Mosk) ; (6. Vyp. 2): 95-100, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34032795

RESUMO

Metastases of the right colon cancer to extra-regional lymph nodes are rarely observed. Available literature data cannot be a reliable guide to choose the optimal treatment strategy. Indeed, excision of extra-regional lymph nodes is a rare experience and its results are poorly represented. According to our clinical experience, surgical intervention following comprehensive examination may be radical in patients with right colon cancer if distant metastases are absent. Resection of extra-regional lymph nodes can be safely performed in these cases. We report a patient with the right colon cancer and lesion of extra-regional lymph nodes behind the pancreatic head, paracaval and paraaortic space, hepatoduodenal ligament. Standard laparoscopic right-sided hemicolectomy with D-3 lymph node dissection was accompanied by resection of a conglomerate of nodal metastases behind the pancreatic head and superficial resection of the pancreas. Extra-regional lymph node excision is a reasonable option for colon mucinous adenocarcinoma stage I-III. However, comprehensive preoperative examination is required. Technical difficulty of extra-regional lymph node excision it is not the reason for limitation of surgical intervention. However, safe and total resection requires an adequate surgical approach.


Assuntos
Adenocarcinoma Mucinoso , Neoplasias do Colo , Adenocarcinoma Mucinoso/diagnóstico , Adenocarcinoma Mucinoso/cirurgia , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/cirurgia , Humanos , Excisão de Linfonodo , Linfonodos/cirurgia , Metástase Linfática
19.
Zhonghua Zhong Liu Za Zhi ; 43(5): 563-568, 2021 May 23.
Artigo em Chinês | MEDLINE | ID: mdl-34034476

RESUMO

Objective: To explore the method of predicting high lymph node load in patients with early breast cancer to avoid unnecessary sentinel lymph node biopsy. Methods: The clinicopathological and thoracic multi-slice spiral CT (MSCT) data of 2620 patients with early (cT1~2N0M0) breast cancer treated in the Affiliated Cancer Hospital of Zhengzhou University from January 1, 2014 to August 1, 2018 were collected. According to the postoperative pathological results, the patients were divided into the group with axillaryhigh lymph node burden (HNB) and the non-HNB group. The influencing factors of axillary lymph node burden in patients with early breast cancer were determined by univariate and multivariate analysis, and the diagnostic model of MSCT to HNB was established. The best cutoff value for the diagnosis of HNB was determined through analyzing the receiver operative characteristic (ROC) curve, and the consistency between MSCT diagnosis and pathological diagnosis was evaluated by Kappa test. Results: Among the 2 620 patients, 168 were diagnosed of HNB. Univariate analysis showed that the tumor size, the status of human epidermal growth factor receptor 2 (HER-2), the number of abnormal lymph nodes showed in MSCT, the ratio of the length to the diameter of the maximum abnormal lymph node as shown in MSCT, the condition of the maximum abnormal lymph node door, and the parenchyma of the maximum abnormal lymph node were related to axillary lymph node burden in patients with early breast cancer (P<0.05). Multivariate analysis showed that the number of abnormal lymph nodes showed in MSCT was an independent influencing factor of axillary HNB in patients with early breast cancer. Compared with patients without abnormal lymph nodes, the OR values of patients with 1, 2, 3 or more abnormal lymph nodes displayed by MSCT and in axillary HNB status were 3.305, 9.379, 126.163 and 780.953, respectively. Using 3 or more abnormal lymph nodes detected by MSCT to predict the area under the ROC curve of axillary HNB in patients with early breast cancer, the area was 0.928, the sensitivity was 82.1%, the specificity was 95.4%, and the accuracy was 94.5%. Kappa test showed that the consistency between MSCT diagnosis and pathological diagnosis was relatively high (Kappa=0.629, P<0.001). Conclusions: The number of abnormal lymph nodes showed in MSCT is an independent influencing factor of axillary HNB in patients with early breast cancer. Taking 3 or more abnormal lymph nodes showed in MSCT as the threshold can help to predict the axillary HNB status of early breast cancer patients and exempt some of them from unnecessary sentinel lymph node biopsy.


Assuntos
Neoplasias da Mama , Axila , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Humanos , Excisão de Linfonodo , Linfonodos/diagnóstico por imagem , Metástase Linfática , Biópsia de Linfonodo Sentinela
20.
World J Surg Oncol ; 19(1): 150, 2021 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-33985521

RESUMO

BACKGROUND: Approximately 20% of patients with colorectal cancer are initially diagnosed with stage IV disease. This study aims to examine the role of regional lymph node (LN) status in metastatic colorectal cancer (mCRC) with respect to clinicopathologic features and survival outcomes. METHODS: We investigated 1147 patients diagnosed with mCRC and had undergone surgical resection of the primary CRC. A total of 167 patients were placed in the LN-negative (LN-) group and another 980 in the LN-positive (LN+) group. RESULTS: LN+ patients exhibited a significantly higher rate of T4 tumors (p = 0.008), poorly differentiated adenocarcinoma (p < 0.001), lymphovascular invasion (p < 0.001), and perineural invasion (p < 0.001) than those in the LN- group. LN- patients had a significantly higher rate of lung metastasis (p < 0.001), whereas the rate of peritoneal seeding (p < 0.001) and systemic node metastasis (p < 0.001) was both significantly higher in the LN+ group. The 5-year overall survival (OS) in the LN+ group was significantly poorer than that in the LN- group (LN- vs. LN+ 23.2% vs. 18.1%; p = 0.040). In patients with curative resection, the 5-year OS rate has no significant difference between the two groups (LN- vs. LN+ 19.5% vs. 24.3%; p = 0.890). CONCLUSIONS: Metastatic CRC patients with LN+ who underwent primary tumor resection may present with more high-risk pathological features, more peritoneal seeding, and systemic node metastasis, but less lung metastasis than LN- patients. LN+ patients had poorer long-term outcomes compared with that in LN- patients. Nevertheless, with curative resection, LN+ patients could have similar survival outcomes as LN- patients.


Assuntos
Neoplasias Colorretais , Excisão de Linfonodo , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Humanos , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos
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