Evidence Of Regional Metastasis Research Articles

Sentinel lymph node biopsy experience in squamous cell carcinoma of the oral mucosa сT1–2N0M0

Introduction. Head and neck cancer is the 7th most common malignancy worldwide; squamous cell carcinoma of the oral mucosa are almost a third of tumors of that localization. Metastatic lesions of the neck lymph nodes are an unfavorable prognostic factor for malignant tumors of that location since it is associated with a 50 % decrease in overall survival. In this regard, the detection of metastases to the neck lymph nodes is an important component of high-quality oncological care for patients with that pathology.Aim. To evaluate the efficiency of sentinel lymph node biopsy in squamous cell carcinoma of cavity of mouth mucosa cT1–2N0М0.Materials and methods. 72 patients were included in trial at the age from 21 to 74 (mean 57.3) with confirmed squamous cell carcinoma of cavity of mouth mucosa cT1–2N0М0. No evidence of regional metastasis, by preoperative examination, including ultrasound, computed tomography with intravenous contrast was observed. All patients received radioisotope research to determine localization of sentinel lymph nodes, and then biopsy of that nodes was performed. Before obtaining information about the status of the sentinel lymph node, radical neck dissection was not performed. Pathology report with immunohistochemical investigation was performed by pathologist of A. F. Tsyb Medical Radiological Research Center – branch of the National Medical Research Radiological Center, Ministry of Health of Russia.Results. When assessing efficiency of sentinel lymph node method, true positives results (detection of metastasis in sentinel lymph node) were achieved in 3 (4.17 %) out of 72 cases. Follow up time was from 1 to 69 months. Among those cases, where metastasis in sentinel lymph nodes were not detected, relapse in regional lymph nodes was developed in 3 (4.35 %) out of 69 cases. Radical neck dissection was performed in cases with metastasis in sentinel lymph nodes. The specificity of method was 95 %, the predictive value of a negative result was 0.04.Conclusion. Sentinel lymph neck node biopsy is an effective method of subclinical locoregional metastases detection in cancer of oral mucosa cT1–2N0M0. In our study of sentinel lymph neck node biopsy, oncological outcomes were comparable to radical neck dissection, with fewer postoperative complications.

Occult Metastases During Salvage Oral Cavity and Oropharyngeal Free Flaps: Oncologic Outcomes.

To define rates of occult metastases in salvage oral cavity and oropharyngeal cancer resection requiring free flap, to examine the location of occult metastases, and to determine associations between occult metastasis and survival. Retrospective cohort study. Two tertiary care referral centers. We identified previous cases of irradiation with recurrent or second primary oral cavity or oropharyngeal squamous cell carcinoma that had no evidence of regional metastasis and required free tissue transfer reconstruction of the primary site. Patients who underwent elective neck dissection or exploration were reviewed. The main outcome measures were the presence and location of occult nodal metastasis. Disease-free survival and overall survival were measured. Odds ratios and hazard ratios were used for analysis. A total of 83 patients were included: 52 with oral cavity primary tumors and 31 with oropharynx. An overall 78 (94%) underwent elective salvage neck dissection. Occult metastases were found in 9 (11.5%) patients. The most common nodal station for occult metastasis was level 2. Neither elective neck dissection nor the presence of occult metastasis was significantly associated with regional disease-free or overall survival. Oropharyngeal primary tumors were associated with higher risk of occult metastasis (odds ratio, 1.38; P < .01) and worse overall survival (hazard ratio, 2.09; P = .01). There is a low incidence of occult metastasis in postradiated recurrent or second primary oral cavity and oropharyngeal tumors. Elective neck dissection and occult nodal metastases were not associated with regional or overall survival. This series may help surgeons make decisions regarding the extent of neck surgery after prior radiation, especially when free flap reconstruction is required.

Elective neck dissection versus observation in patients with head and neck cutaneous squamous cell carcinoma.

The survival benefit of elective neck dissection (END) for patients with cutaneous squamous cell carcinoma (cSCC) of the head and neck and no evidence of regional metastasis (cN0) has never been reported. The aim of this study was to determine the effect of END on patient survival. The authors included patients with head and neck cSCC who had undergone primary surgery from 1995 to 2017. The primary end point was survival, and the secondary end points were the incidence of occult regional disease and regional disease control. To assess the impact of END on survival, the authors used multivariable Cox proportional hazards models with propensity score and matching techniques for internal validation. A total of 1111 patients presented with no evidence of nodal disease; 173 had END, and 938 were observed. Adjuvant radiotherapy to the neck was administered to 101 patients (9%). END resulted in a 5-year overall survival rate of 52%, whereas the rate was 63% in the observation group (P=.003 [log-rank]). The 5-year disease-free survival rate for patients undergoing END was similar to that for the observation group (73% vs 75%; P=.429). A multivariate regression model showed that the performance of END was not associated with improved rates of overall, disease-specific, or disease-free survival; similarly, among patients with advanced disease (T3-4), those who underwent END did not have improved survival rates. Among patients with cSCC of the head and neck, observation of the neck nodes resulted in noninferior survival rates in comparison with END at the time of primary surgery. Further studies are required to elucidate the role of END in patients with advanced disease.

LOW-GRADE PAPILLARY ADENOCARCINOMA: A RARE ENTITY

Introduction Low-grade papillary adenocarcinoma (LGPA) of the minor salivary glands is uncommon, which is noted to occur after 40 years of age with a male/female ratio of 2:1. Adenocarcinoma in this site includes salivary and nonsalivary types pathologically. The prevalence of LGPA is 17%, which is often poorly recognized and misdiagnosed, as it has a greater potential for local recurrence with evidence of regional metastasis, and only a few cases are reported in the literature. LGPA represents a relatively rare histologic variant of polymorphous low-grade adenocarcinoma. Case Presentation A 50-year-old female patient reported a complaint of a swelling in the posterior part of the hard palate that was associated with pain of 1-year duration. On examination, a mobile submucosal swelling of 1-cm size was noted in the posterior part of the hard palate laterally on the left side, and wide excision of the lesion was performed. On histologic examination, the lesional tissue exhibited extensive well-defined papillary arrangement of tumor cells that had a columnar appearance. The lesion was interpreted as LGPA on histologic examination, which was followed by immunohistochemistry to confirm the diagnosis. She is disease-free over a period of 2 years, and follow-up is being continued to monitor for development of recurrence. Conclusion A rare case of LGPA is reported for its diagnostic challenge; the lesion has a biological tendency to develop local recurrence and regional metastasis. Low-grade papillary adenocarcinoma (LGPA) of the minor salivary glands is uncommon, which is noted to occur after 40 years of age with a male/female ratio of 2:1. Adenocarcinoma in this site includes salivary and nonsalivary types pathologically. The prevalence of LGPA is 17%, which is often poorly recognized and misdiagnosed, as it has a greater potential for local recurrence with evidence of regional metastasis, and only a few cases are reported in the literature. LGPA represents a relatively rare histologic variant of polymorphous low-grade adenocarcinoma. A 50-year-old female patient reported a complaint of a swelling in the posterior part of the hard palate that was associated with pain of 1-year duration. On examination, a mobile submucosal swelling of 1-cm size was noted in the posterior part of the hard palate laterally on the left side, and wide excision of the lesion was performed. On histologic examination, the lesional tissue exhibited extensive well-defined papillary arrangement of tumor cells that had a columnar appearance. The lesion was interpreted as LGPA on histologic examination, which was followed by immunohistochemistry to confirm the diagnosis. She is disease-free over a period of 2 years, and follow-up is being continued to monitor for development of recurrence. A rare case of LGPA is reported for its diagnostic challenge; the lesion has a biological tendency to develop local recurrence and regional metastasis.

English

Ridolfi et al. in 1977 defined medullary breast carcinoma (MBC) as one of the invasive and malignant subtypes of breast cancer.1 It is a rare breast malignancy accounting for 5 % of breast carcinomas.2 Although MBC is considered as having good prognosis, patients reported as triple-negative breast cancers are associated with aggressive clinical behaviour and poor prognosis.3 Also factors like local invasion, evidence of regional metastasis, etc. will determine the progress of this type of cancer.

Non-Muscle Invasive Papillary Urothelial Carcinoma Metastatic to the Mandible.

Urothelial carcinoma, the most common histologic subtype of bladder cancer in the United States, most frequently presents as non–muscle invasive disease. Initially, therapy involves transurethral endoscopic resection and subsequent intravesical therapies with extended surveillance for high-risk disease. Even with the best treatments, recurrence and progression can occur. However, metastasis of non–muscle invasive bladder cancer to distant sites without evidence of progression or regional metastasis is rare. In this article, we present the case of a patient with high-grade papillary urothelial carcinoma who developed an unusual metastasis to the mandible, confirmed by GATA-3 immunostaining, over 4 years after initial transurethral resection. Prior to the development of metastatic disease, this patient had no evidence of local recurrence during maintenance Bacillus Calmette-Guerin intravesical therapy and concurrent surveillance. Positron emission tomography-computed tomography taken after presentation with mandibular metastasis did not show any evidence of regional metastasis. This case highlights an unusual location for distant metastasis of urothelial carcinoma occurring in a patient without evidence of muscle invasive disease or regional metastasis. We additionally highlight the utility of GATA-3 immunostaining in identifying urothelial carcinoma histologically.

Recent trends in the management of minor salivary gland carcinoma

The current management of minor salivary gland cancer is reviewed. These malignancies often present as a submucosal swelling and have been reported at all anatomic subsites of the head and neck. Modern imaging is essential in evaluating the location and the anatomic extent of disease. An incisional or punch biopsy determines the histologic type and grade. Recent advances in molecular biology have yielded diagnostic and potential therapeutic targets that may change our treatment in the future. Complete resection is the treatment of choice. Unfortunately, given the proximity of essential structures, the need to balance functional and cosmetic with oncologic consequences can interfere with an adequate "clear margin." The neck should be treated when there is evidence of regional metastasis or when subclinical metastatic risk exceeds 15%. Surgery alone cures most low-stage, low-grade tumors, all other stages and grades require postoperative radiotherapy. Systemic treatment for locoregional and distant failure remains disappointing.

T2 N0 Esophageal Squamous Cell Carcinoma on EUS with Metastasis to a Supraclavicular Lymph Node

Purpose: Case Report: A 64 year old female with a past medical history of hypertension presented to our clinic for follow-up evaluation of a proximal esophageal ulcer. The patient had missed her last scheduled appointment and had been off of acid-suppressive medication for approximately nine months. She had been feeling well and had no gastrointestinal complaint and no weight loss. The patient had a history of alcoholic liver disease but reported abstaining from alcohol for the past eight years. She had been a smoker until her late 40s. The patient was scheduled for an upper endoscopy which revealed a 1 cm mass with central depression in the proximal esophagus. Biopsies indicated poorly differentiated squamous cell carcinoma. CT scan of the chest appeared negative for metastatic disease and did not reveal mediastinal, hilar, or celiac adenopathy. Transesophageal ultrasound confirmed a friable irregular mass measuring 1.5 cm at 26 cm from the incisors. Invasion into the muscularis propia was noted but there was no evidence of regional metastasis. A PET/CT was then performed which did show a single hypermetabolic lymph node in the right supraclavicular area measuring 1.6 cm with a maximum SUV of 9.4. Biopsy of the node indicated squamous cell carcinoma, consistent with metastatic esophageal squamous cell carcinoma. The patient's treatment plan was amended accordingly and after two cycles of cisplatin and 5-fluorouracil a PET/CT revealed complete resolution of the mid-esophageal lesion as well as resolution of the solitary supraclavicular lymph node. Conclusion: The main factors to consider when recommending primary therapy for esophageal carcinoma are tumor stage/ metastasis, location, histologic type, and the general medical condition of the patient. Surgery, often with adjunctive therapy, is typically considered for cases of limited disease, however, surgery alone is not a standard treatment for extensive disease. While earlier studies have demonstrated the value of transesophageal ultrasound as an important diagnostic modality for mediastinal lymph node metastasis, supraclavicular lymph node metastasis can be missed. For patients with metastatic disease therapy options will vary. Due to these differences in therapy consideration, all methods to accurately establish extent of disease should be pursued, including early PET/CT imaging.

Assessment of lymphatic drainage patterns and implications for the extent of neck dissection in head and neck melanoma patients

The aim of this study is to evaluate lymphatic drainage with sentinel node location data in patients with head and neck cutaneous melanoma, and to determine the implications for the extent of therapeutic neck dissections. Sixty-five patients with head and neck cutaneous melanoma without evidence of regional metastases at ultrasound guided fine needle aspiration cytology examination were included. Lymphatic drainage patterns were investigated using planar and dynamic lymphoscintigraphy, and SPECT/CT. Biopsy of sentinel nodes was guided by images and gamma probe. The incidence of discordant sentinel nodes was determined by comparing actual drainage patterns to "O'Briens map" and to the treatment guidelines of The Netherlands Cancer Institute. Sentinel node identification was successful in 98% of the patients. Fifteen patients (23%) were diagnosed with a tumor-positive sentinel node. Two sentinel node-negative patients (3%) developed a regional lymph node metastasis (false-negative ratio: 12%). Twenty-three percent of the harvested sentinel nodes were discordant according to "O'Brien's map," while 14% were discordant according to the treatment guidelines of The Netherlands Cancer Institute (P < 0.001). Almost a quarter of head and neck melanomas metastasize outside clinically predicted neck levels. Neck surgery guidelines of The Netherlands Cancer Institute provide for a smaller number of discordant sentinel nodes.