Abdominopelvic Nodes Research Articles

Evaluation of adjuvant therapy in women with uterine papillary serous cancer

BACKGROUND AND OBJECTIVEUterine papillary serous cancer (UPSC) represents only 10% of all uterine cancers and is associated with a significantly worse prognosis compared with other histological types of endometrial cancers. It closely resembles the behavior of ovarian carcinoma.DESIGN AND SETTINGRetrospective study in a referral center covering period from February 1989 to January 2009.PATIENTS AND METHODSEighteen patients who underwent definitive surgery followed by adjuvant therapy—platinum-based chemotherapy, radiotherapy, or both—were reviewed. Median age was 62 years (range, 52–76 years). All patients underwent total abdominal hysterectomy and salpingo-oophorectomy. Positive lymph nodes were found in 4 of 7 patients who underwent lymph node sampling/dissection. Seven patients had stage I/II disease, whereas 11 patients had stage III disease. Six patients received chemotherapy, 5 patients received radiation therapy, while 7 patients received both chemotherapy and radiation therapy.RESULTMedian follow-up was 27 months. The median survival and relapse-free survival were 33 and 23 months, respectively. Eight patients were alive and free of disease, of whom 5 patients were stage I/II and 4 patients were stage III. Distant metastasis was the most common site of relapse. Early stage (I/II) was associated with significant improvement in relapse-free survival (RFS) and overall survival (OS) (P=.004 and P=.05, respectively). The combined-modality treatment including chemotherapy-radiotherapy showed statistically significant improvement in RFS (P=.012), while the improvement in OS did not reach statistical significance (P=.12).CONCLUSIONThis study indicates that postoperative combined treatment with chemotherapy and radiation therapy plays a role in the management of UPSC by improving RFS. Distant metastasis remains the major site of relapse. Future studies using combined-modality therapy are needed to improve the outcome in patients with UPSC.

Unusual Presentations of Metastatic Prostate Carcinoma as Detected by anti-3 F-18 FACBC PET/CT

Prostate carcinoma is the second most common cause of cancer-related mortality in males in the United States. The pattern of metastatic disease of prostate cancer is well recognized, frequently involving sclerotic bone lesions and abdominopelvic lymph nodes. Anti-3 F-18 FACBC acid is a synthetic amino acid analog positron emission tomography radiotracer with reported utility in the detection of prostate carcinoma. We present 2 cases of unusual presentations of prostate carcinoma, one with malignant ascites and omental implants and the other with lytic bone lesions detected with anti-3 F-18 FACBC acid.

Is Radiotherapy a Good Adjuvant Strategy for Men With a History of Cryptorchism and Stage I Seminoma?

Men with cryptorchism can have aberrant abdominopelvic lymph node (LN) drainage or a different natural history if they develop Stage I seminoma. If so, the nodal echelons for metastases will not be reliable, and adjuvant radiotherapy (RT) would not be an ideal strategy. Two prospectively maintained oncology databases were reviewed for men with a history of testicular seminoma and cryptorchidism. The primary endpoint was the 5-year relapse-free rate. A total of 23 men were identified, most (n = 13) had had a tumor in a scrotal location after orchiopexy. After orchiectomy, 5 men were managed with surveillance, and 18 underwent RT to a median dose of 25 Gy (range, 20-30 Gy). All the radiation fields included the para-aortic LNs, and 13 included the ipsilateral pelvic LNs. After a median follow-up of 64 months (range, 2-148), 2 patients developed a relapse. One did so 4 months into a surveillance program in the para-aortic and ipsilateral pelvic LNs, sites that would have been treated had he undergone RT. The other patient developed a relapse in the contralateral testis 46 months after having undergone RT. It is likely that the latter patient had a metachronous primary rather than a relapse; hence, the 5-year relapse-free rate was 80% for surveillance and 100% for RT. Both patients underwent successful salvage treatment, and all patients were disease free and alive at the last follow-up visit. A history of cryptorchism does not appear to confer a greater risk of relapse for men with Stage I seminoma managed with radiotherapy. RT, surveillance, and adjuvant carboplatin chemotherapy are treatment options for these patients.

Unusual 2-[18F]-fluoro-2-deoxy-d-glucose accumulation induced by postoperative intestinocutaneous fistula in the patient with uterine cervical cancer and SLE

A 47-year-old woman with systemic lupus erythematosus presented with a history of radical hysterectomy and pelvic lymph node dissection for cervical cancer Ia and brachytherapy for vaginal recurrence. Four years later, abnormal hypermetabolic lesion at vaginal vault on FDG-PET/CT was found and confirmed as vaginal recurrence by punch biopsy. So, she underwent anterior pelvic exenteration with urostomy. She underwent colostomy because of colonic fistula 1 week after anterior pelvic exenteration. She had wound problem near the colostomy site. The wound waxed and waned, however, no definite discharge was identified from wound. Three months later after anterior pelvic exenteration, FDG-PET/CT revealed multiple hypermetabolic lesions along the incision line, colostomy site and abdominopelvic lymph nodes. Biopsies of the skin and lymph nodes with FDG accumulation revealed an inflammatory granulation tissue and reactive lymphadenopathy. Definite symptom such as leakage of stool was not identified. One year later, there was no interval change of multiple hypermetabolic lesions on follow-up FDG-PET/CT. There was still wound problem. So, revision of colostomy was done with impression of subtle fistula between skin and colostomy. Multiple hypermetabolic lesions on FDG-PET/CT disappeared after 3 months of repair of colostomy. We reported a case showing high FDG accumulation at wound and paraaortic lymph node on PET/CT because of intestinocutaneous fistula around colostomy. These malignant mimicking FDG accumulations were disappeared after colostomy reversion.

Should Men with Stage One Testicular Seminoma and a History of Cryptorchism be Offered Adjuvant Radiotherapy?

In men with cryptorchism (CO) and testicular malignancy, there is potentially either aberrant development of abdominopelvic (AP) lymph node (LN) drainage or a different natural history. If so, the normally predictable nodal echelons for metastases would not be reliable, and hence adjuvant radiotherapy (RT) would not be an ideal first-line strategy.

Distinctive Cytogenetic Profile in Benign Metastasizing Leiomyoma: Pathogenetic Implications

"Benign metastasizing leiomyoma" is the terminology used to describe a controversial entity characterized by a proliferation of bland-appearing smooth muscle in lung or abdominopelvic lymph nodes. In this report, we describe 5 cases of pulmonary-based smooth muscle tumors that are clinically and histologically consistent with this entity, and in which we identified consistent chromosomal aberrations (19q and 22q terminal deletion in all cases). This cytogenetic profile is found in approximately 3% of uterine leiomyoma, but has not been described in other types of benign or malignant neoplasia. These findings suggest that the nodular pulmonary smooth muscle proliferations termed "benign metastasizing leiomyoma," are a genetically distinct entity, which likely originate from a biologically distinctive subset of uterine leiomyoma.

LYMPHANGIOSIS TYPE OF PRIMARY DIFFUSELY INFILTRATING CARCINOMA OF THE COLON -A CASE REPORT-

This paper presents a patient who was operated on for preoperative diagnosis of lymphangiosis type of primary diffusely infiltrating carcinoma of hte colon and rectum but experienced metastasis to the brain one month after the operation, with a fatal course. A 47-year-old man complaining of severe diarrhea was suspected of having inflammatory intestinal disease such as idiopathic ulcerative colitis, but was demonstrated having an denocarcinoma on biopsy at another hospital. The patient was referred to the center with a probable diagnosis of metastatic colorectal cancer. Barium enema examination demonstrated an irregularity of the intestinal wall, and difficulties of extension almost 30cm in length at the signoid portion and the rectum level. But no stenosis was found. Endoscopically, the mucosa was intact but edematous and rough. There was no luminal mass and only the small, shallow ulcerlation was observed. The patient underwent abdominoperineal resection of the tumor at the sigmoid colon and rectum, resulting in non-curative resection because of extensive abdominopelvic lymph nodes metastasis including involvement of the para-aortic lymph nodes. No evidence of tumor involvement in any other abdominal or pelvic organs was evident at the time of surgery. The surgical specimen revealed a diffusely thickened and irregular wall with a 2cm shallow mucosal ulcer. Histologically, the tumor was poorly differentiated adenocarcinoma except the small area of moderately differentiated adenocarcinoma under the ulcer. The patient received a course of chemotherapy (CPT-11) postoperatively, but after a week, the brain metastasis caused brain edema and his consciousness was getting down. The patient's clinical course continued to deteriorate due to the progression of the cancer, a nd he died two months after the operation. Primary diffusely inflitrating carcinoma of the colon is a relatively rare primary colorectal malignancy. But the prognosis is poor and its clinical significance is large. The poor prognosis is likely related to the initial delay in its diagnosis especially in the lymphangiosis type, because its symptom is sometimes unclear and the lesion is often similar to inflammatory colonic lesions radiographically and microscopically.

CT Appearance of Right Gonadal Vein

The CT appearance of the right gonadal vein was studied. It is usually first seen 1 cm below the bifurcation of the inferior vena cava (IVC) and empties into the IVC laterally or anterolaterally 4 cm below the union of the right renal vein and IVC. Occasionally, it empties into an accessory right renal vein rather than the IVC. The right gonadal vein was visualized partially or completely in 80% of patients, and generally measured less than or equal to 4 mm in maximum diameter. It was enlarged in a patient with portal hypertension and in a post-partum woman. Knowledge of its typical CT appearance should prevent confusion with abdominopelvic lymph nodes.

III. Lymph Node Metastasis and other Pathological Parameters in Carcinoma of the Rectum

Of 123 patients with rectal carcinoma who underwent radical surgery combined with abdominopelvic lymph node dissection, lymph node metastasis was present in 67 cases (54.7%) ; the upward metastasis in 65 cases (97.0%) and the lateral metastasis in 20 cases (29.9%). Lymph node metastasis was recognized in less than 10% in carcinomas associated with one or more of following characteristics : 1 carcinoma less than 3 cm in diameter in the upper rectum, 2 Borrmann I carcinoma in any part of the rectum, 3 carcinoma limited to the muscle coat in the upper rectum. Such cases were 23 cases (18.7%).Lymph node metastasis was recognized approximately in 80% in carcinomas asscociated with one or more of following characteristics : 1 Borrmann III carcinoma in the lower rectum, 2 mucinous adenocarcinoma in the lower rectum, 3 carcinoma showing lymphatic permeation in the lower rectum, 4 carcinoma showing venous permeation in any part of the rectum, 5 carcinoma infiltrating diffusely into the stroma in the lower rectum, 6 carcinoma spreading through the proximal rectal wall more than 1 cm in length in any part of the rectum. Such cases were 54 cases (43.9%).In remaining 46 cases (37.4%), such characteristics above-mentioned were not recognizable.

Internal at large medicine

<h3>Extended field irradiation</h3> The survival rate in patients with prostatic cancer appears to be much better following extended field irradiation, report investigators from the University of Southern California School of Medicine, Los Angeles. In the past, radiotherapy for prostate cancer generally has been limited to the prostatic field, although extended field irradiation has been used for other types of malignancies, said James P. Fitzgerald, MD. The 30 patients he discussed at the 56th scientific assembly of the Radiological Society of North America, Inc., received a total of 7,200 rads in 11 weeks to the primary tumor plus 4,800 rads in 6 weeks to potential sites of abdominopelvic lymph node metastasis. Three patients with massive para-aortic node involvement received an additional 4,000 rads to the mediastinal and supraclavicular nodes. The five-year survival rate—not necessarily disease-free—has been about 54% for patients undergoing local irradiation of only the prostatic field. In the series

Medical News

<h3>Extended field irradiation aids men with prostate cancer</h3> Irradiation of abdominopelvic lymph nodes in addition to the prostate gland and adjacent structures apparently leads to a significant increase in the survival rate of patients with prostatic cancer. The regimen may even offer hope for a "cure" of the disease. In what is believed to be the first clinical trial of extended field irradiation for prostatic cancer, the projected<i>tumor-free</i>, three-year survival rate in 30 men was 93%. The predicted disease-free, five-year survival rate is 85%. In contrast, the present five-year survival rate—not necessarily disease-free—for patients undergoing local irradiation of only the prostatic field is about 54%. James P. Fitzgerald, MD, radiation therapist at the University of Southern California School of Medicine, Los Angeles, reported these preliminary results at the 56th scientific assembly of the Radiological Society of North America, Inc. His coauthors are Frederick W.

Five-year results of abdominopelvic lymph node dissection for carcinoma of the rectum.

A series of 122 patients with adenocarcinoma of the rectum who had abdominopelvic lymph node dissection five or more years ago is presented.