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1.
Eur. j. anat ; 24(1): 63-68, ene. 2020. ilus
Artigo em Inglês | IBECS | ID: ibc-186066

RESUMO

During a routine female cadaveric dissection, we found an unusual bilateral pelvic branching pattern of the internal and external iliac arteries. The vaginal and middle rectal arteries had a common origin from the right internal pudendal artery. An aberrant obturator artery arises from both external iliac arteries. A right aberrant obturator artery gives a small branch to the back of the pubic bone. The left inferior epigastric artery arises from the common trunk of the external iliac artery with the aberrant obturator artery. Knowledge of arterial variations helps to reduce the internal hemorrhage during abdominal and pelvic surgeries


No disponible


Assuntos
Humanos , Feminino , Artéria Ilíaca/anatomia & histologia , Cadáver , Dissecação/métodos , Variação Anatômica , Artérias/anatomia & histologia , Músculos Psoas/anatomia & histologia , Linfonodos/anatomia & histologia , Nervo Pudendo/anatomia & histologia , Hemorragia
2.
J Surg Oncol ; 121(1): 144-152, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31638275

RESUMO

BACKGROUND AND OBJECTIVES: Development of vascularized submental lymph node (VSLN) flap has encountered dilemmas; (a) whether to include skin paddle, (b) how to reduce the harvest area while gaining most lymph nodes. To answer, these structures were studied; submental perforator, lymph nodes in neck-level I and anterior belly of digastric muscle (ABDM). METHODS: Forty VSLN flaps were harvested from 23 cadavers. The lymph nodes and arterial supply were studied macro- and microscopically. The nodes were classified by arterial supplies, location along the longitudinal axis and relationship with ABDM. RESULTS: VSLN flap had 4.4 lymph nodes by average (range 1-8) predominantly located in the posterior three-quarter of the flap. Half of the submental perforators were originated deep to ABDM. they circumvent the muscle, supplied much of the nodes in neck sublevel Ia before reaching the skin. While sublevel Ib located the most surgically accessible submental nodes. Most of their arterial supply was branched from submental perforator lateral to ABDM, not directly from the submental artery. CONCLUSION: The flap could be reduced to the posterior three-quarter of the original area. Skin paddle should be included to serve as an indirect lymph node monitor. If Ia lymph nodes are to be included, ABDM should be sacrified.


Assuntos
Linfonodos/anatomia & histologia , Linfonodos/irrigação sanguínea , Músculos do Pescoço/anatomia & histologia , Pele/irrigação sanguínea , Retalhos Cirúrgicos/irrigação sanguínea , Idoso , Artérias/anatomia & histologia , Cadáver , Dissecação , Feminino , Humanos , Linfonodos/cirurgia , Masculino , Pessoa de Meia-Idade , Músculos do Pescoço/irrigação sanguínea
3.
Chirurg ; 90(12): 957-965, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31691141

RESUMO

The lymphatic system of the lungs is complex. To maintain an effective gas exchange there is a need for a dense lymphatic network. The alveolae have no lymphatic vessels. There is no segment-specific lymph drainage. For both lungs there are fixed bronchopulmonary lymph nodes but the number and size of the lymph nodes are variable. There are seven mediastinal lymph node chains that vary in extent, each of which acts as an independent functional unit. The accurate assessment of the nodal status needs a simple reproducible nodal map. The division into compartments or zones makes this easier. Mediastinal lymph node metastases without involvement of bronchopulmonary lymph nodes are possible. The development mechanism of this skip metastasizing is multifactorial.


Assuntos
Neoplasias Pulmonares , Linfonodos/anatomia & histologia , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Excisão de Linfonodo , Linfonodos/fisiologia , Metástase Linfática , Sistema Linfático/anatomia & histologia , Mediastino/anatomia & histologia , Estadiamento de Neoplasias
4.
Nat Commun ; 10(1): 4594, 2019 10 09.
Artigo em Inglês | MEDLINE | ID: mdl-31597914

RESUMO

Cranial lymphatic vessels (LVs) are involved in the transport of fluids, macromolecules and central nervous system (CNS) immune responses. Little information about spinal LVs is available, because these delicate structures are embedded within vertebral tissues and difficult to visualize using traditional histology. Here we show an extended vertebral column LV network using three-dimensional imaging of decalcified iDISCO+-clarified spine segments. Vertebral LVs connect to peripheral sensory and sympathetic ganglia and form metameric vertebral circuits connecting to lymph nodes and the thoracic duct. They drain the epidural space and the dura mater around the spinal cord and associate with leukocytes. Vertebral LVs remodel extensively after spinal cord injury and VEGF-C-induced vertebral lymphangiogenesis exacerbates the inflammatory responses, T cell infiltration and demyelination following focal spinal cord lesion. Therefore, vertebral LVs add to skull meningeal LVs as gatekeepers of CNS immunity and may be potential targets to improve the maintenance and repair of spinal tissues.


Assuntos
Linfonodos/fisiologia , Vasos Linfáticos/fisiologia , Traumatismos da Medula Espinal/fisiopatologia , Coluna Vertebral/fisiologia , Ducto Torácico/fisiologia , Animais , Processamento de Imagem Assistida por Computador/métodos , Linfonodos/anatomia & histologia , Vasos Linfáticos/anatomia & histologia , Masculino , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Microscopia Confocal , Microscopia de Fluorescência , Traumatismos da Medula Espinal/patologia , Coluna Vertebral/anatomia & histologia , Ducto Torácico/anatomia & histologia
5.
Chirurg ; 90(12): 966-973, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31549196

RESUMO

Systematic mediastinal, hilar and interlobar lymph node dissection is required in the S3 guidelines for the treatment of operable lung cancer. The lymph node involvement is considered one of the key prognostic factors. The type of lymph node resection is repeatedly the subject of controversially discussion. Lymph node dissection is essential for staging, prognosis, survival and recurrence rate. It should be standardized as a compartmental dissection with en bloc resection of lymph nodes including surrounding fat and connective tissue. Thus, exact knowledge of the anatomy of the thoracic organs with their peculiarities and high anatomical variability is necessary.


Assuntos
Neoplasias Pulmonares , Excisão de Linfonodo , Linfonodos/anatomia & histologia , Humanos , Neoplasias Pulmonares/cirurgia , Excisão de Linfonodo/métodos , Metástase Linfática , Recidiva Local de Neoplasia/prevenção & controle , Estadiamento de Neoplasias , Prognóstico
6.
Cancer Radiother ; 23(6-7): 682-687, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31492540

RESUMO

Despite representing a 1% of diagnosed cancer cases in the USA and up to 5% in eastern Asia and Africa, oesophageal cancer still holds numerous questions concerning the best therapeutic management. For squamous cell carcinoma, while radiochemotherapy has proven itself to be the gold standard as part of the trimodality or alone as a definitive treatment, radiotherapy modalities are still debated especially regarding lymph node irradiation. Involved nodes irradiation was developed with the aim of maintaining clinical outcomes and enhancing quality of life but lacks grade 1 evidence. In this article, we aim to summarize the state of art regarding lymph node irradiation, discuss the impact of target definition, delivery techniques, concomitant treatment and the perspectives. Being highly connected to the lymph vessels, lymphatic metastases are frequent and can locate from the neck to the coeliac area with each node having a different prognostic significance. Regarding the comparison between elective nodal irradiation and involved nodes irradiation, evidence-based medicine mostly relies on retrospective studies. Pooled, it suggests similar clinical outcomes with lower acute toxicities in favour of involved nodes irradiation. However, delivery techniques, doses and concomitant treatment were not consensual. Studies are ongoing evaluating the impact of radiation delivery techniques and the choice of concomitant treatment, i.e. immunotherapy. Modern techniques of imaging, radiation therapy progressing each day and alternative treatment modalities being tested, the need of randomized controlled trials has never been so high. Elective nodal irradiation should remain the standard of care while phase 3 trials explore the safety of involved nodal irradiation.


Assuntos
Adenocarcinoma/terapia , Carcinoma de Células Escamosas/terapia , Quimiorradioterapia/métodos , Neoplasias Esofágicas/terapia , Linfonodos/efeitos da radiação , Irradiação Linfática/métodos , Adenocarcinoma/secundário , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma de Células Escamosas/secundário , Neoplasias Esofágicas/patologia , Esôfago/anatomia & histologia , Humanos , Linfonodos/anatomia & histologia , Linfonodos/patologia , Metástase Linfática , Terapia Neoadjuvante/métodos , Radioterapia Conformacional/métodos
7.
Ann Anat ; 226: 73-83, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31279869

RESUMO

A meshwork of intraluminal processes in lymph node (LN) sinuses originates during LN development. Lymph flows through the meshwork, which has an important role in immunology and pathology. However, the formation mechanism of intraluminal processes has not been sufficiently studied. Our objective is to assess whether this mechanism is by intussusception, as occurs in transcapillary pillar formation in blood vessel intussusceptive angiogenesis. For this purpose, LNs with developing intrasinusal processes were used (human foetuses, 13-18GW) for serial histologic sections and immunohistochemical procedures. The studies showed (a) sinuses originating from lymphatic sacs around expanded LN anlagen, (b) intra-sinus structures (lined by anti-podoplanin+, VEGFR3+, Prox-1+, CD31+ lymphatic endothelial cells) with characteristics (in serial sections and 3D images) similar to those considered the hallmarks of intussusceptive angiogenesis, including pillars (≤2.5µm, with a collagen core), interstitial tissue structures (ITSs) or larger pillars (>2.5µm, with a more cellular core) and folds (that form pillars when spanning), and (c) remodelled and fused pillars, ITSs and folds, which formed meshworks, compartmentalizing the sinuses into small intercommunicating spaces (segmentation). In conclusion, intussusception participates in the formation of the meshwork of processes in LN sinuses during LN development. This mechanism is also of interest because it contributes to the general knowledge of intussusceptive lymphangiogenesis (which has received less attention than intussusception in blood vessels), provides a basis for further studies and supports a new role for vessel intussusception (formation of an intraluminal meshwork with known action in fluid filtering, cell interactions and immunology).


Assuntos
Feto/anatomia & histologia , Linfonodos/anatomia & histologia , Linfonodos/embriologia , Linfangiogênese/fisiologia , Adulto , Capilares/crescimento & desenvolvimento , Capilares/ultraestrutura , Feminino , Desenvolvimento Fetal , Humanos , Imuno-Histoquímica , Linfa/fisiologia , Linfonodos/ultraestrutura , Microscopia Confocal , Organogênese , Gravidez
8.
Medicine (Baltimore) ; 98(14): e14963, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30946321

RESUMO

The present study is to evaluate the significance in prognosis of relative tumor volume (RTV) in patients with non-resectable esophageal squamous cell carcinoma (ESCC) treated by definitive radiotherapy alone or in combination with chemotherapy.Fifty-eight consecutive patients with ESCC in UICC stage I to IV were retrospectively analyzed. Relative primary gross volume (RGTVp) was defined as primary gross volume (GTVp) divided by body volume. Relative primary gross volume for lymph nodes (RGTVnd) was defined as primary gross volume for lymph nodes (GTVnd) divided by body volume. The relationships were analyzed between overall survival (OS), disease free survival (DFS), local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and RGTVp (RGTVnd) in univariate and multivariate analyses.The cut-off values of 0.947 and 0.007 were determined for RGTVp and RGTVnd, respectively. The 3-year OS, DFS, and LRFS for patients with RGTVp ≤ 0.947 vs RGTVp > 0.947 was 65.4% vs 25.0% (P = .001), 46.2% vs 12.5% (P = .002), and 90.1% vs 42.0% (P < .001). RGTVp was an independent risk factor for OS (P = .046), DFS (P = .015) and LRFS (P = .032), but showed no association with DMFS in univariate and multivariate analyses. The 3-year DFS and DMFS for patients with RGTVnd ≤ 0.007 vs RGTVnd > 0.007 was 44.4% vs 20.0% (P = .023), and 62.9% vs 24.6% (P < .004). RGTVnd was associated with DMFS (P = .012) in multivariate, but showed no associated with DFS.The present study demonstrates that RTV was an independent factor relevant to prognosis for ESCC. It provides new clinical basis for personalized therapeutic regimens and might be included in the staging system.


Assuntos
Neoplasias Esofágicas/mortalidade , Carcinoma de Células Escamosas do Esôfago/mortalidade , Carga Tumoral , Adulto , Idoso , Intervalo Livre de Doença , Quimioterapia Combinada , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/radioterapia , Carcinoma de Células Escamosas do Esôfago/tratamento farmacológico , Carcinoma de Células Escamosas do Esôfago/patologia , Carcinoma de Células Escamosas do Esôfago/radioterapia , Feminino , Seguimentos , Humanos , Linfonodos/anatomia & histologia , Linfonodos/patologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Radioterapia de Intensidade Modulada/métodos , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida
9.
Medicine (Baltimore) ; 98(1): e14028, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30608456

RESUMO

The benefits of prophylactic central neck dissection (pCND) for treating patients with clinical node-negative (cN0) papillary thyroid carcinoma (PTC) remain controversial. Lymph node metastases have been strongly associated with local recurrence and low survival, especially in PTC patients with 5 or more or ≥2 mm metastatic lymph nodes. The following study investigates the incidence and risk factors of more than 5 or ≥2 mm metastatic lymph nodes in the central compartment.A total of 611 patients with cN0 PTC were retrospectively analyzed. Cervical lymph nodes were harvested, and the size of metastatic lymph nodes was consequently analyzed.Non-small-volume central lymph node metastases (NSVCLNM), defined as more than 5 or ≥2 mm metastatic lymph nodes) were detected in 67 (11.0%) patients. Male gender, age ≤36 years, multifocal lesions, extrathyroidal extension, and tumor size > 0.85 cm were independent risk factors for NSVCLNM in cN0 PTC. The sensitivity and specificity of having ≥3 risk factors for predicting NSVCLNM was 46.3% and 86.8%, respectively.These findings suggest that pCND is a suitable treatment strategy for cN0 PTC patients with 3 or more risk factors for NSVCLNM.


Assuntos
Linfonodos/patologia , Metástase Linfática/patologia , Esvaziamento Cervical/métodos , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Adulto , Biópsia por Agulha Fina/métodos , Feminino , Humanos , Linfonodos/anatomia & histologia , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical/efeitos adversos , Recidiva Local de Neoplasia/patologia , Valor Preditivo dos Testes , Estudos Prospectivos , Melhoria de Qualidade , Estudos Retrospectivos , Câncer Papilífero da Tireoide/mortalidade
10.
Clin Anat ; 32(1): 9-12, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30178488

RESUMO

Lymphadenectomy is a crucial part of the surgical therapy for gastric cancer. The number of normal lymph nodes could indicate the number of nodes that need to be retrieved during the procedure. The aim of this study is to analyze the number of lymph nodes in cadavers without gastric cancer according to the Japanese Gastric Cancer Association guidelines. Twenty fresh adult cadavers (14 males, mean age 55, range 24-93 years) were used. Abdominal lymph nodes were dissected and classified according to the Japanese Gastric Cancer Association. For total gastrectomy, the median number of lymph nodes that comprised D1 + dissection was 27 (range 15-42). The median and mean number of lymph nodes that comprised D2 dissection was 33, ranging from 18 to 50. For distal gastrectomy, the D1 + level comprised a median of 21 lymph nodes (range 11-38), and the D2 level 22 lymph nodes (range 11-39). In conclusion, considering gastrectomy + D2 lymphadenectomy as the standard treatment for gastric cancer, our results show that adequate lymphadenectomy must encompass around 30 lymph nodes. Clin. Anat., 2018. © 2018 Wiley Periodicals, Inc.


Assuntos
Linfonodos/anatomia & histologia , Estômago/anatomia & histologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
11.
Toxicol Pathol ; 47(1): 53-72, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30563426

RESUMO

We assessed the variability of spleen and mesenteric lymph node (MLN) microscopic observations and the correlations of these observations with other study data from 478 control cynomolgus monkeys from 53 routine nonclinical safety studies. Spleen weight parameters (absolute and relative to body or brain weights) were highly variable both within a control group on an individual study (up to 5.11-fold) and among animals with the same light microscopic observation. Grades for microscopic observations were also highly variable. The most frequent microscopic observations for spleen were changes in the size and number of germinal centers (58%), acidophilic (hyaline) material in lymphoid follicles (52%), and compound lymphoid follicles (20%). The most frequent microscopic observations in the MLN were eosinophil infiltrates (90%), changes in size and number of germinal centers (42%), and brown pigment (21%). The only meaningful relationships ( r2 > 0.3) were positive correlations between reticuloendothelial hyperplasia and malarial pigment in the spleen and between each of these observations and spleen weight parameters. We conclude that determination of test article-related effects on the immune system in routine monkey toxicology studies requires careful consideration and a weight-of-evidence approach due to the low numbers of animals/group, the inherent variability in spleen and MLN parameters, and the infrequent correlation among immune system-related end points.


Assuntos
Linfonodos/anatomia & histologia , Macaca fascicularis/imunologia , Baço/anatomia & histologia , Testes de Toxicidade/normas , Envelhecimento , Animais , Grupos Controle , Centro Germinativo , Linfonodos/crescimento & desenvolvimento , Linfonodos/imunologia , Macaca fascicularis/anatomia & histologia , Macaca fascicularis/crescimento & desenvolvimento , Tamanho do Órgão , Baço/crescimento & desenvolvimento , Baço/imunologia
12.
Microsurgery ; 39(3): 247-254, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30508286

RESUMO

PURPOSE: Vascularized lymph node transfer is becoming more common in the treatment of lymphedema, but suitable small animal models for research are lacking. Here, we evaluated the feasibility of pedicled vascularized inguinal lymph node transfer in mice. METHODS: Twenty-five mice were used in the study. An inguinal lymph node-bearing flap with a vascular pedicle containing the superficial caudal epigastric vessels was transferred into the ipsilateral popliteal fossa after excision of the popliteal lymph node. Indocyanine green (ICG) angiography was used to confirm vascularity of the flap. ICG lymphography was performed to evaluate lymphatic flow at 3 and 4 weeks postoperatively. Patent blue dye was injected into the ipsilateral hind paw to observe staining of the transferred lymph node at 4 weeks postoperatively. All transferred lymph nodes were then harvested and histologically evaluated by hematoxylin and eosin staining. RESULTS: In 16 of the 25 mice, ICG lymphography showed reconnection between the transferred lymph node and the afferent lymphatic vessels, as confirmed by patent blue staining. Histologically, these transferred lymph nodes with afferent lymphatic reconnection significantly regressed in size (0.37 ± 0.24 mm2 ) and showed clear follicle formation, whereas those without afferent lymphatic reconnection showed less size regression (1.31 ± 1.17 mm2 ); the cell population was too dense to allow identification of follicles. CONCLUSIONS: We established a mouse model of vascularized lymph node transfer with predictable afferent lymphatic reconnection. Both the vascularization and reconnection might be necessary for functional regeneration of the transferred lymph node.


Assuntos
Aloenxertos Compostos/transplante , Linfonodos/irrigação sanguínea , Linfonodos/fisiologia , Linfedema/cirurgia , Regeneração , Retalhos Cirúrgicos/irrigação sanguínea , Angiografia , Animais , Modelos Animais de Doenças , Dissecação , Artérias Epigástricas , Estudos de Viabilidade , Membro Posterior/diagnóstico por imagem , Canal Inguinal , Linfonodos/anatomia & histologia , Linfonodos/diagnóstico por imagem , Vasos Linfáticos/diagnóstico por imagem , Vasos Linfáticos/fisiologia , Linfografia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Artéria Poplítea , Dados Preliminares
13.
Jpn J Radiol ; 36(11): 629-640, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30194586

RESUMO

The internal mammary lymph node (IMLN) chain is a pathway through which breast lymphatic drainage flows. The internal mammary lymphatic vessel runs around the internal mammary artery and veins with IMLN in the parasternal intercostal spaces. IMLN metastasis, which forms a part of clinical TNM staging, may negatively affect the prognosis of primary breast cancer patients. IMLN metastasis is clinically detected using ultrasound, computed tomography, magnetic resonance imaging, and 18F-deoxyglucose positron emission tomography computed tomography. The uptake of radioactive tracers in IMLN with clinically negative axillary lymph nodes is often identified using sentinel lymph node mapping (SLNM) in primary breast cancer patients. The indication for IMLN biopsy or resection that is clinically detected or visualized using SLNM is controversial. The clinically suspicious IMLN may be considered for ultrasound-guided fine-needle aspiration. First IMLN recurrence needs to be biopsied. Irradiation of the breast, chest wall, and/or regional nodal irradiation, including IMLN, following lumpectomy or postmastectomy is recommended. Although radiation therapy for IMLN recurrence may improve clinical outcomes, it is also associated with pulmonary and cardiac toxicities. This review covers the local anatomy of IMLN, lymph drainage and image findings of IMLN with a discussion.


Assuntos
Neoplasias da Mama/patologia , Diagnóstico por Imagem/métodos , Linfonodos/diagnóstico por imagem , Metástase Linfática/diagnóstico por imagem , Adulto , Mama/diagnóstico por imagem , Mama/patologia , Feminino , Humanos , Linfonodos/anatomia & histologia , Linfonodos/patologia , Artéria Torácica Interna/diagnóstico por imagem , Pessoa de Meia-Idade , Biópsia de Linfonodo Sentinela
14.
J Surg Res ; 230: 143-147, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30100031

RESUMO

BACKGROUND: The standard of care for treatment of lymphedema is manual lymphatic drainage and compression therapy, which is time intensive and requires a life-long commitment. Autologous lymph node transfer is a microsurgical treatment in which a vascularized lymph node flap is harvested with its blood supply and transferred to the lymphedematous region to assist with lymph fluid clearance. An ideal donor lymph node site minimizes the risk of iatrogenic lymphedema and other donor site morbidity. To address this, we have used jejunal mesentery lymph nodes and omental flaps and hypothesize that the mesoappendix, as a "spare part," may be an ideal autologous lymph node transfer donor site. METHODS: In this Institutional Review Board-approved study, 25 mesoappendix pathology specimens resected for benign disease underwent gross pathologic examination for the presence of lymph nodes and measurement of the appendicular artery and vein caliber and length. RESULTS: A single lymph node was present in two of 25 specimens (8%). Mean arterial and vein calibers at the point of ligation were 0.87 ± 0.44 mm and 0.86 ± 0.48 mm (range 0.30-2.2 mm and 0.25-2.2 mm), respectively. Mean arterial and vein length was 1.70 ± 1.06 cm and 1.84 ± 1.09 cm (range 0.8-4.5 cm for each), respectively. CONCLUSIONS: The mesoappendix rarely contains a lymph node. The artery and vein calibers of 46% of the specimens were greater than 0.8 mm, the minimum caliber preferred for microsurgical anastomosis. If transplantation of a vascularized lymph node for the treatment of lymphedema is desired, the mesoappendix is inconsistent in providing adequate lymph nodes.


Assuntos
Apêndice/anatomia & histologia , Retalhos de Tecido Biológico/transplante , Linfonodos/transplante , Linfedema/cirurgia , Mesentério/anatomia & histologia , Adulto , Idoso , Apêndice/transplante , Feminino , Retalhos de Tecido Biológico/efeitos adversos , Humanos , Linfonodos/anatomia & histologia , Masculino , Mesentério/transplante , Microcirurgia/efeitos adversos , Microcirurgia/métodos , Pessoa de Meia-Idade , Sítio Doador de Transplante/patologia , Sítio Doador de Transplante/cirurgia , Transplante Autólogo/efeitos adversos , Transplante Autólogo/métodos , Adulto Jovem
15.
Esophagus ; 15(4): 272-280, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29948479

RESUMO

BACKGROUND: The structure of the fascia in upper mediastinum has already been reported from gross anatomical viewpoints by Sarrazin. But it is necessary to understand meticulous anatomy for thoracoscopic or mediastinoscopic surgery. So herein, we investigate histologically the thin membranous structure made of dense connective tissues. METHODS: Semi-sequential transverse sections of the mediastinum were obtained from three cadavers. Hematoxylin and eosin staining, Elastica van Gieson staining, and Masson trichrome staining were performed to identify the presence and location of the thin membranous structure made of dense connective tissues. RESULTS: The "visceral sheath" and "vascular sheath," as previously described by Sarrazin, were observed histologically. These two thin membranous structures do not surround the esophagus and trachea cylindrically. In addition, the "visceral sheath" on the right side of the upper mediastinum was unclear in comparison to the left side. The "visceral sheath" (on the left side) gradually became unclear, and seemed to almost disappear; the esophagus was found to be very close to the thoracic duct on the caudal side of the bifurcation of the trachea. Although the left recurrent nerve was located inside the "visceral sheath" in all cadavers, the left recurrent nerve lymph nodes were located inside the "visceral sheath" in cadaver 1 and between the "visceral sheath" and "vascular sheath" in cadaver 3. CONCLUSION: The "visceral sheath" around the esophagus in the upper mediastinum was histologically demonstrated; however, the findings were not constant.


Assuntos
Tecido Conjuntivo/anatomia & histologia , Esôfago/anatomia & histologia , Mediastino/anatomia & histologia , Cadáver , Tecido Conjuntivo/patologia , Esôfago/patologia , Técnicas Histológicas/métodos , Humanos , Linfonodos/anatomia & histologia , Linfonodos/patologia , Mediastinoscopia/métodos , Mediastino/patologia , Ducto Torácico/anatomia & histologia , Ducto Torácico/patologia , Toracoscopia/métodos , Traqueia/anatomia & histologia , Traqueia/patologia
16.
Surg Today ; 48(10): 916-920, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29869067

RESUMO

PURPOSE: The lymphatic flow along the posterior gastric artery (PGA) is considered of possible clinical importance in terms of lymphatic metastasis; however, little is known about the lymph nodes (LNs) around this artery. The purpose of this study was to establish if LNs exist around the PGA and to evaluate their clinical implications. METHODS: We examined the tissues surrounding the PGA from 21 cadavers to search for LNs. We also investigated the patterns of lymphatic metastases in patients who underwent surgery for gastric neoplasms at our institute to detect their presence along the PGA. RESULTS: The PGA was identified in 11 cadavers, and LNs around the PGA were detected microscopically in 2 of these. Lymphatic metastasis directly to the LNs at the splenic artery without any metastases was regarded as skip metastasis along the PGA. Skip metastasis was found in two of ten patients who underwent surgery for remnant gastric cancer. CONCLUSIONS: The existence of LNs around the PGA was confirmed, and based on our findings, lymphatic metastasis through the PGA is possible in patients with remnant gastric cancer.


Assuntos
Artérias Epigástricas/anatomia & histologia , Linfonodos/anatomia & histologia , Linfonodos/patologia , Neoplasias Gástricas/irrigação sanguínea , Neoplasias Gástricas/patologia , Humanos , Linfonodos/ultraestrutura , Metástase Linfática , Neoplasias Gástricas/ultraestrutura
17.
Artigo em Chinês | MEDLINE | ID: mdl-29747261

RESUMO

The cervical lymph node metastasis is a risk factor for the high recurrence rate and low survival rate in patients with thyroid carcinoma (especially for age ≥45 years old), which is the most common head and neck carcinoma. The neck lymphatic metastasis, mostly occurring in the central neck compare, is diagnosed among 20%-90% of patients with differentiated thyroid carcinoma. To definite the anatomic boundaries of the central lymph nodes and their subgroups is significantly important for thyroid carcinoma, such as the determination of surgical extent, the evaluation of prognosis and the choice of different treatment strategies. This paper aims to describe the anatomic boundaries and the components of the central neck compartment and the role of individual subgroups in thyroid carcinoma. We think that the central neck compartment is bounded superiorly by the hyoid bone, inferiorly by the innominate artery on the right and the corresponding axial plane on the left, laterally by the carotid arteries. The superior mediastinal lymph nodes should be the important subgroups of the central neck compartment in thyroid carcinoma. When the prophylactic central lymph node dissection for involved lymph nodes is performed in thyroid carcinoma, we should pay more attention to the superior mediastinal lymph nodes.


Assuntos
Pontos de Referência Anatômicos/anatomia & histologia , Carcinoma/cirurgia , Linfonodos/anatomia & histologia , Neoplasias da Glândula Tireoide/cirurgia , Tronco Braquiocefálico/anatomia & histologia , Artérias Carótidas/anatomia & histologia , Feminino , Humanos , Osso Hioide/anatomia & histologia , Metástase Linfática , Masculino , Mediastino/anatomia & histologia , Pescoço/anatomia & histologia , Esvaziamento Cervical , Gravidez , Prognóstico , Fatores de Risco , Taxa de Sobrevida
18.
Clin Anat ; 31(5): 684-687, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29664130

RESUMO

The lymphatic drainage for the majority of primary breast tumors is to the axillary lymph nodes (ALNs). Some, however, drain to the so-called extra-axillary basins, namely the internal mammary, supra- and infraclavicular regions. Another potential drainage route includes the intramammary lymph nodes (IMLNs). Current guidance suggests IMLNs should be considered as part of the axillary group, potentially affecting axillary management. However, due to evolution in imaging and advancement in technology, IMLNs may now be distinguished more accurately pre-operatively. There are currently no published guidelines for the management of IMLNs in the United Kingdom. The authors suggest that it is time to reclassify IMLNs as a separate focus of cancer and treat it as a separate entity. Clin. Anat. 31:684-687, 2018. © 2018 Wiley Periodicals, Inc.


Assuntos
Linfonodos/anatomia & histologia , Glândulas Mamárias Humanas/anatomia & histologia , Neoplasias da Mama/cirurgia , Feminino , Humanos , Excisão de Linfonodo , Linfonodos/diagnóstico por imagem , Glândulas Mamárias Humanas/diagnóstico por imagem , Sobremedicalização
19.
J Reconstr Microsurg ; 34(7): 472-477, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29660745

RESUMO

BACKGROUND: Vascularized lymph node transfer is an increasingly popular option for the treatment of lymphedema. The omental donor site is advantageous for its copious soft tissue, well-defined collateral circulation, and large number of available nodes, without the risk of iatrogenic lymphedema. The purpose of this study is to define the anatomy of the omental flap in the context of vascularized lymph node harvest. METHODS: Consecutive abdominal computed tomography angiography (CTA) images performed at a single institution over a 1-year period were reviewed. Right gastroepiploic artery (RGEA) length, artery caliber, lymph node size, and lymph node location in relation to the artery were recorded. A two-tailed Z-test was used to compare means. A Gaussian Mixture Model confirmed by normalized entropy criterion was used to calculate three-dimensional lymph node cluster locations along the RGEA. RESULTS: In total, 156 CTA images met inclusion criteria. The RGEA caliber at its origin was significantly larger in males compared with females (p < 0.001). An average of 3.1 (1.7) lymph nodes were present per patient. There was no significant gender difference in the number of lymph nodes identified. Average lymph node size was significantly larger in males (4.9 [1.9] × 3.3 [0.6] mm in males vs. 4.5 [1.5] × 3.1 [0.5] mm in females; p < 0.001). Three distinct anatomical variations of the RGEA course were noted, each with a distinct lymph node clustering pattern. Total lymph node number and size did not differ among anatomical subgroups. CONCLUSION: The omentum is a reliable lymph node donor site with consistent anatomy. This study serves as an aid in preoperative planning for vascularized lymph node transfer using the omental flap.


Assuntos
Linfonodos/irrigação sanguínea , Linfonodos/transplante , Linfedema/cirurgia , Omento/irrigação sanguínea , Omento/cirurgia , Retalhos Cirúrgicos , Adulto , Idoso , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Linfonodos/anatomia & histologia , Linfonodos/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Omento/anatomia & histologia , Omento/diagnóstico por imagem , Coleta de Tecidos e Órgãos
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