Anatomical Distribution Of Lymph Nodes Research Articles

Study protocol for an International Prospective Observational Cohort Study for Optimal Bowel Resection Extent and Central Radicality for Colon Cancer (T-REX study).

This is a prospective observational cohort study aiming to include 4000 patients with stages I to III colon cancer treated at 35 specialist institutions in Japan, South Korea, Germany, Russia, Lithuania and Taiwan. The anatomical distribution of lymph nodes and feeding arteries are investigated using surgical specimens according to pre-specified categorizing methods using intraoperative anatomical markings. Primary analyses are performed to identify the general principles of metastatic lymph node distribution in terms of its relation to the location of the primary tumor and feeding arteries. Secondary analyses will be used to estimate prognostic outcomes according to bowel resection length and central radicality and will be used to evaluate the quality of resected surgical specimens. Through in-depth lymph node mapping, standardized criteria for the definite area of ‘regional’ lymph node resection in routine surgical procedures can be identified, which is expected to contribute to international standardization in colon cancer surgery (ClinicalTrials.gov NCT02938481).

Prospective analysis of tumor spread to the small bowel mesentery in cases of right-sided colon cancer

Guidelines advocate minimal ileal resection when right hemicolectomy is performed for right-sided colon cancer. The practice, thought to prevent malabsorption syndrome, does not appear to foster local recurrence. Little evidence based on rigorous study exists, however. To understand the pattern of lymphatic spread of right-sided colon cancer toward the small bowel and thus determine the appropriate margin size, we prospectively investigated anatomical distribution of lymph nodes (LNs) in the small bowel mesentery and of metastasis to these nodes in patients with right-sided colon cancer treated by such surgery. In each case, the mesenteric specimen, which had been dissected along the ileocolic vessels and included intermediate LNs, was divided into 2 areas: that 0-3cm from the vessel pedicle (area 1) and that 3-5cm from the pedicle (area 2). The peri-intestinal mesentery was cut into 9 segments. Ninety-one patients were included in the study. Overall, 3366 LNs were dissected. Four hundred fifty-three of these LNs were located in area 1 (90 cases), and 15 (3.3%) were metastatic. Only 63 LNs were located in area 2 (34 cases; average of 0.69 per patient); none was metastatic. Overall, 269 LNs were found in the small bowel mesentery (in 56 of the 91 patients). Only 4 were positive (3 cases), and all were within 5cm of the ileocecal valve. Our data indicate that a surgical margin 3cm from the ileocecal pedicle and a short (5cm) ileal margin are oncologically reasonable for effective right hemicolectomy.

Leukemias involving abdominal and pelvic lymph nodes: evaluation with contrast-enhanced MDCT.

To clarify features of lymph nodes associated with leukemia purposing to offer help for imaging diagnosis and differential diagnosis of leukemia. We retrospectively analyzed 47 patients with clinically proven leukemia involving the abdominal and pelvic lymph nodes. Of these 47 patients, 10 had acute myeloid leukemia, 9 had acute lymphocytic leukemia, and 28 had chronic lymphocytic leukemia. MDCT was used to determine lymph node features such as morphology, growth patterns, size, enhancement patterns, anatomical distribution, and manifestations in extramedullary organs. Incidence of leukemia was higher in men than in women. Enlarged lymph nodes were more frequently conglomerated in chronic lymphocytic leukemia (96.4%) than in acute myeloid leukemia (50%) and acute lymphocytic leukemia (55.6%; P<0.05 for both). Lymph nodes associated with chronic lymphocytic leukemia were larger than those associated with acute myeloid and lymphocytic leukemias (P<0.05for both). The enlarged lymph nodes appeared homogeneous (80.9%) and homogeneous mixed with peripheral (19.1%). No statistically significant differences were observed between the three types of leukemias with respect to enhancement patterns (allP>0.05). The lymph nodes commonly associated with these three leukemias were located in the lesser omentum, upper and lower para-aortic regions, and groin region. Our study showed that contrast-enhanced MDCT could accurately determine the enhancement patterns and anatomical distribution of lymph nodes associated with leukemia. Therefore, it is helpful for imaging diagnosis and differential diagnosis of leukemia.

Tuberculosis vs. chronic lymphocytic leukaemia in mediastinal lymph nodes using computed tomography

The enlarged mediastinal lymph nodes caused by tuberculosis (TB) and chronic lymphocytic leukaemia (CLL) are similar, sometimes resulting in misdiagnosis of the two diseases. To determine the differential characteristics of enlarged mediastinal lymph nodes caused by TB and CLL using multidetector-row computed tomography (MDCT). We conducted a retrospective analysis for the anatomical distribution and enhancement patterns of mediastinal lymph nodes on MDCT in 67 consecutive patients with newly diagnosed untreated TB (58%) and CLL (42%). Concerning the main anatomic distribution of lymph nodes, TB involved the 4R (n = 32, 82%) and 10R (n = 27, 69%) regions more often than CLL (n = 16, 57%; n = 12, 43%, respectively). Contrast region 1 had a greater tendency to be affected in CLL (n = 16, 57%) than TB (n = 11, 28%). TB showed peripheral enhancement in 28 cases (72%), frequently with a multilocular appearance, compared to CLL, which showed no peripheral enhancement in these cases. Homogeneous enhancement was more commonly seen in CLL than in TB (82% vs. 10%, P < 0.01). The distribution and enhancement pattern of enlarged lymph nodes on MDCT was useful in differentiating TB and CLL.

Tuberculosis versus lymphoma in the abdominal lymph nodes: A comparative study using contrast-enhanced MRI

PurposeThe purpose of this study was to determine the differential characteristics on MRI between tuberculosis and lymphoma in abdominal lymph nodes. Materials and methodsWe conducted a retrospective analysis for the counter, size, signal intensity, enhancement patterns, and anatomic distribution of lymph nodes in 57 consecutive patients with documented tuberculosis (28 patients; 49.1%) and newly diagnosed, untreated lymphoma (29 patients; 50.9%). ResultsTwenty-four cases (85.7%) in the tuberculosis group were hyperintense on T2-weighted images and either hypointense or isointense on T1-weighted images with respect to the abdominal wall muscle. All cases in the lymphoma group were hyperintense on T2-weighted images and isointense on T1-weighted images with respect to the abdominal wall muscle. Concerning the main anatomic distribution of lymph nodes, the lymph nodes in the lower paraaortic region were more frequently involved in the lymphoma group (48.3%) than in tuberculosis (17.9%, p<0.05). Moreover, mesenteric lymph nodes were more often involved in tuberculosis (32.1%) than in lymphoma (6.9%, p<0.05). Tuberculous lymphadenopathy showed predominantly peripheral enhancement, frequently with a multilocular appearance; whereas lymphomatous adenopathy often demonstrated uniform homogeneous enhancement (all p<0.001). ConclusionContrast-enhanced MRI can be useful in differentiation between these two entities.

ULTRASONOGRAPHIC EXAMINATION OF ABDOMINAL LYMPH NODES IN THE DOG

Ultrasonography is a valuable diagnostic tool for examination of the abdomen. Normal lymph nodes are often indistinct during routine abdominal ultrasonographic examination. Lymph nodes altered by infiltrative or inflammatory processes may become sonographically visible due to enlargement and/or altered echogeńicity. A working knowledge of the anatomic distribution of lymph nodes and the scheme of lymphatic drainage is important for increasing the sensitivity and specificity of abdominal lymph node assessment during ultrasonographic examination.

A reevaluation of intrathoracic lymphadenopathy in sarcoidosis.

Chest radiographs of 62 patients with sarcoidosis and intrathoracic lymphadenopathy were evaluated retrospectively for anatomic distribution of lymph nodes. All but two cases had bilateral hilar lymphadenopathy. Approximately 75% of the patients had nodal enlargement in the right paratracheal or aortopulmonic window regions and about 20% in the subcarinal or anterior mediastinal areas. The most frequent combination of lymphadenopathy, found in 37% of cases, included the aortopulmonic window, bilateral hilar, and right paratracheal regions. Right paratracheal and bilateral hilar lymph node enlargement was seen in only three patients. Aortopulmonic window nodes were almost always found with hilar or hilar and mediastinal lymphadenopathy. Anterior mediastinal or subcarinal involvement was never found without some combination of right paratracheal, bilateral hillar, and aortopulmonic window lymphadenopathy. We therefore conclude that aortopulmonic window, anterior mediastinal, or subcarinal lymph node enlargement often accompany the characteristic lymphadenopathy of sarcoidosis.