Cystic Node Research Articles

Learning, techniques, and complications of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline

This article is the second of a two-part publication that expresses the current view of the European Society of Gastrointestinal Endoscopy (ESGE) about endoscopic ultrasound (EUS)-guided sampling, including EUS-guided fine needle aspiration (EUS-FNA) and EUS-guided Trucut biopsy. The first part (the Clinical Guideline) focused on the results obtained with EUS-guided sampling, and the role of this technique in patient management, and made recommendations on circumstances that warrant its use. The current Technical Guideline discusses issues related to learning, techniques, and complications of EUS-guided sampling, and to processing of specimens. Technical issues related to maximizing the diagnostic yield (e.g., rapid on-site cytopathological evaluation, needle diameter, microcore isolation for histopathological examination, and adequate number of needle passes) are discussed and recommendations are made for various settings, including solid and cystic pancreatic lesions, submucosal tumors, and lymph nodes. The target readership for the Clinical Guideline mostly includes gastroenterologists, oncologists, internists, and surgeons while the Technical Guideline should be most useful to endoscopists who perform EUS-guided sampling. A two-page executive summary of evidence statements and recommendations is provided.

Laparoscopic Cholecystectomy Without Handling the Cystic Artery: A New Approach to Minimize Complications

Although laparoscopy has now become the procedure of choice for removal of gallbladder, complications especially injury to cystic artery and ducts are thought to be higher. We describe a technique that avoids handling and injury of cystic artery and resultant duct injuries. The video length is 2 minutes 13 seconds. From October 7, 2005, to December 31, 2010, 17 patients were successfully operated by the cystic artery sparing technique. In this technique, dissection begins distal to cystic lymph node on the gallbladder wall using hook cautery, thereby clears the Calot's triangle without even touching the cystic artery. This maneuver eliminates the risk of injuring thus causing bleeding and any subsequent complications. Age, sex, and operative outcomes including follow-ups were evaluated. Age of the patients ranged from 3.4 years to 16 years with an average of 10.12 years. Males were predominant (10:7). Average operative time was 40 minutes. There were no intraoperative or immediate postoperative complications. Patients were allowed feeding 4-6 hours after operation and discharged the following morning. Patients were asked to come for follow-up at 1 week, 1 month, 3 months, 6 months, and 1 year and thereafter yearly. Follow-up period ranged from 6 months to 5 years. There were no operation-related complications other than minor abdominal pain in 3 patients and port-site pain in 2 patients which resolved on conservative treatments. During laparoscopic cholecystectomy, if handling of the main cystic artery is avoided then complications of hemorrhage and bile duct injuries can be minimized.

HPV and head and neck cancer

Head and neck cancer is frequent worldwide and oropharyngeal locations are presently sharply on the increase, in relation with an increasing incidence of oropharyngeal infection by oncogenic type-16 human papillomavirus (HPV). The clinical and biologic profile of these patients is distinct from that of other oropharyngeal carcinoma patients, with earlier onset, cystic cervical nodes and basaloid carcinoma histopathology. Detection of intratumoral viral DNA is essential to confirm the role of HPV, and E6/E7 mRNA expression is the most relevant indicator for stratification. Several methods can reveal intratumoral oncogenic HPV DNA, but PCR with hybridization is the most sensitive and most widely used. According to several reports, prognosis in terms of survival and locoregional control is better in HPV-positive oropharyngeal carcinoma than in oropharyngeal carcinoma associated with smoking and alcohol consumption. The future lies in vaccination, but further studies will determine whether the rate of oropharyngeal carcinoma falls in women vaccinated against cervical cancer.

Generalized lymphadenopathy with cystic spleen lesions: a rare presentation of tuberculosis

A 28-year-old HIV-negative black male from Ethiopia, with no significant medical history, presented for a lump on the left side of his neck since 5 months ago. Associated symptoms were fever, night sweats and a 4.5-kg weight loss (15% of weight). He had immigrated to the USA 5 years before presentation and had not left the country since he moved. He was not using any drugs and was in a monogamous relationship with his wife. Physical examination was unremarkable except for multiple large spongy and rubbery lymph nodes on the left side of the neck, bilateral axillaries and multiple insignificant inguinal lymph nodes bilaterally. Hepatosplenomegaly and tenderness in the left upper quadrant were appreciated. Computed tomography (CT) of the neck, thorax and abdomen with contrast revealed multiple cystic lymph nodes in the neck, chest and abdomen, and multiple cystic lesions in the spleen and liver. A left axillary lymph node excisional biopsy showed caseating granuloma. Acid-fast and fungal stains of the specimen were negative. Mycobacterium tuberculosis complex was isolated from a biopsied lymph node 2 months later. It was reported pan-susceptible to all four first-line anti-tuberculosis (TB) drugs. Following 6 months of treatment, the patient made a full recovery (Figures 1 and 2). Splenic involvement in TB is a rare clinical condition and is difficult to diagnose. Although the TB case rate has decreased

Cystic Lymph Nodes in the Lateral Neck As Indicators of Metastatic Papillary Thyroid Cancer

To determine whether radiographic findings portend to metastatic disease in patients with papillary thyroid carcinoma (PTC) and whether cystic lymph node metastasis can be recognized by preoperative, ultrasound-guided fine-needle aspiration (FNA). We performed a retrospective review of patients with cystic lymph nodes in the lateral neck identified on preoperative ultrasonography between March 1996 and December 2009. Factors examined included demographic information; stage; cytologic and final pathologic findings; and imaging characteristics including location, size, and presence of vascularity and calcifications. Time of cystic node identification in relationship to initial diagnosis was also recorded. Thirty patients had cystic lymph nodes in the lateral neck on cervical ultrasonography during the study period. Among this group, 28 (93%) had PTC, 1 (3%) had papillary serous carcinoma of the ovary, and 1 (3%) had poorly differentiated thyroid cancer. Median age at initial cancer diagnosis was 41 years (range, 16-64 years). Twenty-one patients (70%) were women, and median lymph node size was 1.8 cm (range, 0.6-4.8 cm). Twenty-three patients (77%) had a solitary cystic lymph node, and the remainder had more than 1 cystic lymph node. Cystic lymph nodes were identified at initial presentation in 11 patients (37%), while cystic lymph nodes were discovered in 19 patients (63%) after the initial operation. FNA was performed on the cystic lymph nodes of 23 patients (77%). Cytologic findings were positive for metastatic disease in 18 of 23 patients (78%). Among the 5 of 23 patients with negative cytologic findings, thyroglobulin aspirate was obtained in 1 patient, confirming metastatic PTC. Final pathologic review after surgical resection of cystic lymph nodes with negative cytologic findings from FNA was consistent with metastatic disease in 4 of 5 patients (80%). In patients with PTC, the presence of a cystic lymph node by ultrasonographic examination is highly suggestive of locally metastatic disease. Confirmation of metastatic PTC may sometimes be achieved with thyroglobulin aspirate from cystic lymph nodes when cytologic findings are negative. Clinicians should strongly consider surgical lymph node resection of cystic lymph nodes regardless of the preoperative cytologic findings by FNA.

Tiroid Papiller Mikrokarsinomun Soliter Kistik Metastazi: 2 Olgunun Sunumu

The appearance of a solitary lateral cervical cystic mass as the only initial presenting symptom of occult thyroid carcinoma is uncommon. Its presence is often related with the more frequently branchial cyst in young adults, but also rarely related with thyroid carcinomas. In most of these cases all such lesions may initially be considered as metastatic foci from a primary thyroid lesion. However, an alternative explanation by means of which ectopic thyroid tissue is associated with a branchial cyst has to be considered, especially if no primary tumour is observed in the histological examination of the thyroid gland. We present two case of solitary cystic lymph node metastasis of occult papillary carcinoma of the thyroid.

Contrast‐enhanced 18F‐FDG‐PET/CT for the assessment of necrotic lymph node metastases

Cystic lymph node metastasis (CLNM) is commonly found in human papillomavirus (HPV)-associated tonsillar squamous cell carcinoma (SCC). The aim of this study was to compare the accuracy in detecting cystic lymph node metastasis from tonsillar SCC between contrast-enhanced CT, ¹⁸F- fluorodeoxyglucose-positron emission tomography (FDG-PET), non-enhanced ¹⁸F-FDG-PET/CT, and contrast-enhanced ¹⁸F-FDG-PET/CT. Thirty-four patients with a tonsillar SCC undergoing a pretreatment contrast-enhanced ¹⁸F-FDG-PET/CT followed by a neck dissection as a standard of reference were included. The contrast-enhanced CT part, the ¹⁸F-FDG-PET part, the non-enhanced ¹⁸F-FDG-PET/CT part, and the contrast-enhanced ¹⁸F-FDG-PET/CT were assessed separately for correct N classification and the differentiation of N0 versus N+. RESULTS.: Contrast-enhanced ¹⁸F-FDG-PET/CT, non-enhanced ¹⁸F-FDG-PET/CT, and contrast-enhanced CT are equally accurate for correct neck staging. Regarding pN0 versus pN+, contrast-enhanced CT and contrast-enhanced ¹⁸F-FDG-PET/CT are superior to non-enhanced ¹⁸F-FDG-PET/CT (p = .017). Contrast-enhanced CT and contrast-enhanced ¹⁸F-FDG-PET/CT perform equally and better than non-enhanced ¹⁸F-FDG-PET/CT in detecting CLNM in tonsillar SCC. Therefore, in patients scheduled for ¹⁸F-FDG-PET/CT, we strongly suggest performing a contrast-enhanced ¹⁸F-FDG-PET/CT, which is not routine in most centers.

甲状腺乳頭癌嚢胞性頸部リンパ節転移の鑑別診断―穿刺液中サイログロブリン測定の有用性―

Combining ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI) and fine-needle aspiration cytology (FNAC) usually results in the best preoperative diagnosis of cervical masses, including neoplasms. This may not be true, however, especially in occult papillary thyroid carcinoma (PTC) associated with single cystic cervical lymph node metastasis. We assessed the role of thyroglobulin measurement in FNA fluid (FNATg) in differentially diagnosing cystic cervical mass lesions, including PTC cystic lymph node metastasis. We reviewed the records of 17 subjects with cervical cystic masses undergoing both FNATg measurement and surgery. FNA was done under ultrasonographic guidance. We also measured FNATg concentrations from extrathyroid lesions, consisting of cystic cervical lymph node metastases and benign cystic lesions. Pathological diagnosis involved 5 PTC lymph node metastases, 3 lateral cervical cysts, 7 thyroglossal duct cysts, and 2 squamous cell carcinoma (lung and oropharynx) lymph node metastases. FNATg of PTC lymph node metastasis was much higher than the reference range of blood serum thyroglobulin, although much lower for the lateral cervical cyst detection threshold. FNAC and FNATg measurement are thought to be mutually complementary in the differential diagnosis of PTC cystic lymph node metastasis. High concentrations of FNATg in a cystic cervical mass is considered specific to PTC lymph node metastasis, indicating its usefulness in distinguish PTC cystic metastasis from other cystic lesions. Including FNATg measurement with FNAC may thus improve preoperative diagnosis accuracy without additionally stressing subjects with PTC cystic lymph node metastasis.

Sudden death due to a cystic atrio-ventricular node tumour

Sudden cardiac deaths constitute a major health problem. Most cases are attributed to cardiomyopathies, coronary artery diseases and functional dysregulations. Sudden death in an adult due to a primitive cardiac tumor is a rare occurrence. In the following, we present a case of an adult male who died from an undiagnosed cystic atrio-ventricular node tumour six years after having a pace maker fitted. We focus on the postmortem diagnosis to underline the importance of a systematic histological examination of the cardiac conduction tissue in forensic pathology.

The role of human papillomavirus in head and neck cancer

Over the last 20 years, there has been increasing awareness of a subset of squamous cell carcinomas of the head and neck (HNSCC), i.e. HPV-positive HNSCC. These cancers seem to differ somewhat from HPV-negative HNSCC. Patients with HPV-positive HNSCC tend to be younger and have a lower intake of tobacco and alcohol. Distinct molecular profiles separate them from HPV-negative cancers and show similarities with HPV-positive cervical SCC. There is evidence that HPV-positive HNSCC is a sexually transmitted disease. Patients with HPV-positive HNSCC are often diagnosed at a late stage with large cystic lymph nodes in the neck. HPV-positive HNSCC show an affinity for the oropharynx, especially the tonsils and the base of the tongue, and tend to show low differentiation histopathologically. There is a better prognosis regardless of the treatment regimen for HPV-positive HNSCC compared with HPV-negative HNSCC, and this seems to be related to the immune system. Whether the new vaccines for HPV will protect not only against cervical cancer but also against HPV-positive HNSCC remains unknown.

Tuberculosis of the Spleen as a Cause of Fever of Unknown Origin and Splenomegaly

Splenic involvement of tuberculosis, which is rare, warrants better definition in the current era of resurgence of tuberculosis. Out of 339 splenectomies performed between January 1989 and December 2008 for indications other than trauma, histopathologic analysis of the spleen revealed tuberculosis in 8 patients. All eight patients were referred for splenectomy due to fever of unknown origin (FUO). No patient was infected with HIV, and all had at least moderate splenomegaly and hepatomegaly. Three patients had hypersplenism with bleeding manifestations. Radiologic evaluations demonstrated that splenic lesions were present in five patients. Five patients had evidence of tuberculosis manifested as enlarged splenic hilar lymph nodes, cystic lymph nodes, or liver. Two patients exhibited tubercle bacilli in their sputum during the postoperative period. In areas where tuberculosis is prevalent, tuberculosis should be considered in the differential diagnosis of patients presenting with FUO and splenomegaly. Extrasplenic involvement is usually seen in splenic tuberculosis, although it may not be apparent at presentation. Splenic tuberculosis can present in isolation without extrasplenic involvement, and even in immunocompetent individuals.

Case 154: Pharyngeal and Retropharyngeal Tuberculosis with Nodal Disease

HomeRadiologyVol. 254, No. 2 PreviousNext DIAGNOSIS PLEASECASE 154Case 154: Pharyngeal and Retropharyngeal Tuberculosis with Nodal DiseaseAditya Bharatha, Eric S. Bartlett, Eugene Yu Aditya Bharatha, Eric S. Bartlett, Eugene Yu Author Affiliations1From the Division of Neuroradiology, Department of Medical Imaging, Princess Margaret Hospital, 610 University Ave, 3rd Floor, Room 3–959, Toronto, ON, Canada M5G 2M9.Address correspondence to E.Y. (e-mail: [email protected]).Aditya BharathaEric S. BartlettEugene Yu Published Online:Jan 7 2010https://doi.org/10.1148/radiol.2542081660MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In References1 Rangheard AS, Vanel D, Viala J, Schwaab G, Casiraghi O, Sigal R. Synovial sarcomas of the head and neck: CT and MR imaging findings of eight patients. AJNR Am J Neuroradiol 2001;22(5):851–857. Medline, Google Scholar2 Moon WK, Han MH, Chang KHet al.. CT and MR imaging of head and neck tuberculosis. RadioGraphics 1997;17(2):391–402. Link, Google Scholar3 Prasad KC, Sreedharan S, Chakravarthy Y, Prasad SC. Tuberculosis in the head and neck: experience in India. J Laryngol Otol 2007;121(10):979–985. Crossref, Medline, Google Scholar4 Lee Y, Park KS, Chung SY. Cervical tuberculous lymphadenitis: CT findings. J Comput Assist Tomogr 1994;18(3):370–375. Crossref, Medline, Google Scholar5 Burrill J, Williams CJ, Bain G, Conder G, Hine AL, Misra RR. Tuberculosis: a radiologic review. RadioGraphics 2007;27(5):1255–1273. Link, Google Scholar6 Choudhury N, Bruch G, Kothari P, Rao G, Simo R. 4 years’ experience of head and neck tuberculosis in a south London hospital. J R Soc Med 2005;98(6):267–269. Crossref, Medline, Google Scholar7 Erasmus JJ, Connolly JE, McAdams HP, Roggli VL. Solitary pulmonary nodules. I. Morphologic evaluation for differentiation of benign and malignant lesions. RadioGraphics 2000;20(1):43–58. Link, Google Scholar8 Nalini B, Vinayak S. Tuberculosis in ear, nose, and throat practice: its presentation and diagnosis. Am J Otolaryngol 2006;27(1):39–45. Crossref, Medline, Google ScholarArticle HistoryReceived September 17, 2008; revision requested October 15; revision received November 5; accepted November 19; final version accepted December 10.Published online: Jan 7 2010Published in print: Feb 2010 FiguresReferencesRelatedDetailsCited ByMedical RadiologyPailinKongmebhol, Jose FlorencioLapeña2022Some Manifestations of Tuberculosis in Otorhinolaryngology – Case Series and a Short Review of Related Data from South-Eastern EuropeAdela-IoanaMocanu, HoriaMocanu, CosminMoldovan, IoanaSoare, ElenaNiculet, Alin LaurentiuTatu, Claudiu IonutVasile, DanielaDiculencu, Paraschiva APostolache, AlexandruNechifor2022 | Infection and Drug Resistance, Vol. Volume 15Primary sinonasal tuberculosis: Our experiences in a tertiary care hospital of eastern IndiaSantosh KumarSwain, Ishwar ChandraBehera, Mahesh ChandraSahu2017 | Egyptian Journal of Ear, Nose, Throat and Allied Sciences, Vol. 18, No. 3Extra nodal ENT tuberculosisWafaAbid, Olfa BenGamra, HanenGhorbal, IbtissamBeji, SarraZribi, InesHriga, ChirazMbarek2014Nov1 | Egyptian Journal of Ear, Nose, Throat and Allied Sciences, Vol. 15, No. 3Primary pharyngeal tuberculosis presenting as a submucosal tumourJ.W.Lee, K.-A.Ryu, K.R.Kwon, B.S.Koo2014 | International Journal of Oral and Maxillofacial Surgery, Vol. 43, No. 8Tuberculous retropharyngeal abscess presenting with symptoms of obstructive sleep apneaAlpen B.Patel, Michael L.Hinni17 October 2012 | European Archives of Oto-Rhino-Laryngology, Vol. 270, No. 1Recommended Articles Imaging Findings in Tuberculous Heart DiseaseRadioGraphics2020Volume: 40Issue: 2pp. 607Extrapulmonary Tuberculosis: Pathophysiology and Imaging FindingsRadioGraphics2019Volume: 39Issue: 7pp. 2023-2037Deep Learning at Chest Radiography: Automated Classification of Pulmonary Tuberculosis by Using Convolutional Neural NetworksRadiology2017Volume: 284Issue: 2pp. 574-582Pulmonary Tuberculosis: Role of Radiology in Diagnosis and ManagementRadioGraphics2017Volume: 37Issue: 1pp. 52-72CT of the Neck: Image Analysis and Reporting in the Emergency SettingRadioGraphics2019Volume: 39Issue: 6pp. 1760-1781See More RSNA Education Exhibits Cystic Cervical Lymph Nodes: A Systematic Approach and Useful Imaging Features for their DifferentiationDigital Posters2020Above and Beyond Hypopharynx Imaging - Understanding Anatomy, Lesions, and StagingDigital Posters2018The Resurgence of Tuberculosis: The Spectrum of TB Pathologies Through the AgesDigital Posters2018 RSNA Case Collection Synovial sarcoma of neckRSNA Case Collection2020Pulmonary Tuberculosis RSNA Case Collection2021Tuberculous spondylitisRSNA Case Collection2020 Vol. 254, No. 2 Metrics Altmetric Score PDF download

Does gallbladder cancer divide India?

(47%) GBs showed macroscopic abnormalities consisting of “thickening, mucosal ulcerations and polypoidal lesions”. Gallbladder cancer (GBC) was found in 13 of these GBs, including nine that were “thick-walled”, two with “mucosal ulcerations” and two with “nodularity of mucosa with polypoid projections”. Presumably these macroscopic changes were no different from those seen in 597 GBs with macroscopic abnormalities but no GBC. None of the GBs without macroscopic abnormalities was found to have GBC. The GBC was stage Tis in one patient, T2 in nine and T3 in three patients. No information has been provided on whether the specimens contained cystic lymph nodes, and whether these were examined histologically. In patients with GBC, status of resection margin, and treatment and follow up details are not provided. However, it is evident that as many as nine patients who had T2 lesions could have benefitted from a re-resection. Based on their findings, the authors recommend a policy of selective histological examination of only those GBs which show macroscopic abnormalities, to save costs and reduce workloads. We would like to introduce a strong note of caution in accepting this recommendation across all geographical areas. GBC is the most common cancer of the biliary tract worldwide. 2 The overall prognosis remains grim with 5-year survival of less than 5-10%. 3 Potentially curative resection of the tumor and its loco-regional spread provides the only hope of long-term cure and survival. The extent of such resection may range from a simple cholecystectomy, through an extended cholecystectomy with a 2-cm nonanatomic wedge of liver in the GB bed in segments IVb+V and lymphadenectomy, to an extended right hepatectomy and pancreatico-duodenectomy, depending upon the location and spread of the tumor. Curative resection is possible in only those few patients who have a tumor that is limited to the GB wall without involvement of the lymph nodes or adjacent structures in the hepato-duodenal ligament. 4 A highly select sub-group of patients with locally advanced, but non-metastatic, disease may benefit from extensive resections including hepatopancreatico-duodenectomy. 5,6 However, in most patients, the disease is diagnosed at an advanced stage when curative resection is not possible; in these cases, radiotherapy, with or without chemotherapy, has little impact on survival. 7 GBC diagnosed for the first time on histology of GB removed with a presumed diagnosis of gallstone disease is known as incidental GBC (IGBC). The term IGBC should not be used when GBC is suspected either on pre-operative

Cavitatory mesenteric lymph node syndrome: A rare entity

Celiac disease is a gluten sensitive enteropathy that involves an abnormal immunological response to glutens in wheat, rye etc. It predominantly involves the small intestinal mucosa, though, extra luminal manifestations can also occur. One rare extraluminal manifestation is cavitatory mesenteric lymph node syndrome. It occurs in refractory celiac disease and is associated with poor prognosis due to various complications. The diagnosis is often made on imaging when cystic mesenteric lymph nodes with fat-fluid levels are seen and this can then be confirmed by histopathological examination. We recently had a typical case where we were able to make this diagnosis.

Place du curage ganglionnaire après chimioradiothérapie dans les carcinomes épidermoïdes des voies aérodigestives supérieures avec atteinte ganglionnaire initiale (nasopharynx exclu)

The optimal timing and extent of neck dissection in the context of chemoradiation for head and neck cancer remains controversial. For some institutions, it is uncertain whether neck dissection should still be performed upfront especially for cystic nodes. For others, neck dissection can be performed after chemoradiation and can be omitted for N1 disease as long as a complete response to chemoradiation is obtained. The question is debated for N2 and N3 disease even after a complete response as the correlation between radiological and clinical assessment and pathology may not be reliable. Response rates are greater than or equal to 60% and isolated neck failures are less than or equal to 10% with current chemoradiation protocols. Some therefore consider that systematic upfront or planned neck dissection would lead to greater than or equal to 50% unnecessary neck dissections for N2-N3 disease. Positron-emission tomography (PET) scanning to assess treatment response and have shown a very high negative predictive value of greater than or equal to 95% when using a standard uptake value of 3 for patients with a negative PET at four months after the completion of therapy. These data may support the practice of observing PET-negative necks. More evidence-based data are awaited to assess the need for neck dissection on PET. Selective neck dissection based on radiological assessment and peroperative findings and not exclusively on initial nodal stage may help to limit morbidity and to improve the quality of life without increasing the risk of neck failure. Adjuvant regional radiation boosts might be discussed on an individual basis for aggressive residual nodal disease with extracapsular spread and uncertain margins but evidence is missing. Medical treatments aiming at reducing the metastatic risk especially for N3 disease are to be evaluated.

Value of identification of cystic duct, common bile duct, and common hepatic duct in prevention of bile duct injury during laparoscopic cholecystectomy

To explore effective method to avoid iatrogenic bile duct injury during laparoscopic cholecystectomy (LC). 10 492 patients underwent LC from May 1996 to May 2006, 8566 of them were treated by the method to identify the cystic duct, common hepatic duct, and common bile duct during LC (tri-duct method group), and the left 1926 cases whose cystic duct failed to be exposed easily were treated with the method to identify at least two of the 4 structures (cystic lymph node, Hartmann's pouch, cystic artery, and emptiness of cystic triangle) so as to help identify the cystic duct (tri-duct plus tri-structure group). The operating time, amount of blood loss, open conversion rate, and morbidity were compared between these 2 groups. No cases of bile leakage or jaundice because of accidental injury of bile duct were found. The operating time of the tri-duct plus tri-structure group was (28 +/- 12) (15 - 52) min, significantly shorter than that of the tri-duct group [(38 +/- 16) (15 - 92) min, P < 0.05]. The open conversion rate of the tri-duct plus tri-structure group was 1.8%, significantly lower than that of the tri-duct group (8.7%, P < 0.05). There were no significant difference in the amount of blood loss and morbidity between the two groups (both P > 0.05). The tri-structure method can not only confirm the cystic duct correctly, thus preventing iatrogenic bile duct injury, but also shorten the operating time and reduce the open conversion ratio during LC.

The Role of MR Imaging in Detecting Nodal Disease in Thyroidectomy Patients with Rising Thyroglobulin Levels

One of the dilemmas facing clinicians treating patients with thyroid cancer is the evaluation of postthyroidectomy patients with rising serum thyroglobulin levels and indeterminate or normal findings on neck sonography. In this study, we examine the role of MR imaging in this subgroup of patients. We retrospectively reviewed MR images of patients with thyroid cancer with abnormal lymph nodes in the retropharyngeal and parapharyngeal spaces and determined the size and signal-intensity characteristics of these nodes. We reviewed patient charts for the following history: 1) thyroidectomy, 2) rising thyroglobulin levels, 3) iodine-131 radiation therapy, 4) neck dissection, and 5) pathology on neck sonography and chest CT. We reviewed pathology findings to determine if thyroid cancer metastases were present in these lymph nodes. Eight patients had abnormal retropharyngeal space nodes, and 1 patient had a parapharyngeal space mass. Lymph nodes ranged from 7 to 25 mm. On MR imaging, 1 patient had a cystic node, 2 had complex nodes, and 6 had solid nodes. Eight patients had rising serum thyroglobulin levels and a history of thyroidectomy, radioiodine therapy, and neck dissection. Two of these patients had no pathologic nodes on sonography and normal findings on chest CT. Six patients had tissue sampling of their skull base node, and metastatic thyroid cancer was present in 5. MR imaging of the neck should be considered in thyroidectomy patients with rising serum thyroglobulin levels and a history of radioiodine therapy and neck dissection. Radiologists should carefully examine the retropharyngeal and parapharyngeal spaces in these patients because nodal metastases may occur there more commonly than realized.

The presence of two cystic nodes

The presence of two cystic nodes

Cystic lymph node metastasis in papillary thyroid carcinoma

Thyroid cancer, especially papillary carcinoma, metastasizes most often into cervical lymph nodes. Cervical ultrasound and ultrasound-guided fine-needle aspiration biopsy are the most sensitive modalities in detecting locoregional neck recurrence. The aim of this study was to illustrate the ultrasound spectrum of lymph node metastases from papillary thyroid carcinoma. During 1998-2002 years due to suspicion of recurrence of thyroid cancer, 75 ultrasound-guided fine-needle aspiration biopsies of regional lymph nodes were performed. Ultrasound examination of 75 patients with thyroid cancer (56 women and 19 men; mean age of patients was 54.67+/-12.89 years) was performed. All biopsies were performed on nonpalpable lesions (lymph node short axis < or =1.5 cm). A total of 75 ultrasound-guided fine-needle aspiration biopsies of regional lymph nodes under suspicion of malignancy were performed. Only 5 (6.7%) of the 75 lymph nodes were cystic with internal septation. Other 70 (93.3%) lymph nodes were solid. Cytopathological results of 75 ultrasound-guided fine-needle aspiration biopsies from regional cervical lymph nodes were noninformative in 4 (5.3%) cases, benign - 40 (53.4%), suspicion - 4 (5.3%), and malignant - 27 (36.0%) cases. Eighteen patients underwent surgery for regional lymph nodes. All cystic metastases were confirmed to be papillary thyroid carcinoma on pathologic examination. Ultrasound cannot exactly distinguish benign from malign lesions, but sonographic appearance can suggest malignancy and help in selection of the correct lymph nodes to aspirate with ultrasound-guided fine-needle aspiration biopsy. Cystic lymph node metastases may occur in papillary thyroid carcinoma. Cystic neck lesion patients with thyroid papillary carcinoma should always be verified with fine-needle aspiration biopsy.

Cystic lymph node metastasis in patients with head and neck cancer: An HPV‐associated phenomenon

: Cystic lymph node metastases have been associated with tonsil cancer. A subset of oropharyngeal cancers contain human papillomavirus (HPV) DNA. The clinical and virologic associations of cystic nodal metastasis in head and neck cancer (HNSCC) were investigated. : A retrospective review of patients undergoing neck dissection between 2002 and 2004 identified patients with cystic lymph node metastases. Clinical and pathologic information was recorded. The presence of HPV DNA was analyzed using in situ hybridization in a subset of patients. : One hundred neck dissections were reviewed and 20 had cystic nodes. Seventeen of these patients had primary tumors arising in the palatine or lingual tonsil. Three were "unknown primary." HPV DNA was present in 11 of 13 patients with cystic metastases with tissue available for analysis (87%). No HPV DNA was identified in tumor from 21 patients with solid nodal metastasis (p <.0001). : Cystic cervical lymph node metastasis is strongly associated with HPV-related tonsillar HNSCC: (c) 2008 Wiley Periodicals, Inc. Head Neck 2008.