Lymph Node Groups Research Articles

ITRAQ proteomics of sentinel lymph nodes for the identification of extra cellular matrix protein signatures that can flag metastasis in early breast cancer

BackgroundBreast cancer patients who present in the early stage of disease are affected by metastasis to the axillary group of lymph nodes. The first among this group that is affected is called as sentinel lymph node, and metastasis to this lymph node is crucial for the staging of cancer and the quality of surgical intervention. Sentinel Lymph Node Biopsy (SLNB) that is currently used to assess lymph node metastasis is neither sensitive, nor specific, is time‐consuming, thereby necessitating the identification of novel biomarkers that can flag sentinel lymph node metastasis.MethodsThis study was conducted after approval was obtained from the Institute Ethics Committee (Ref. No. IECPG‐ 27/23.01.2019, RT‐03/28.02.2019). Breast cancer patients were screened, and those with early stage were recruited in the study. Surgical resection of the breast was followed by identification of sentinel lymph nodes by methylene fluorescent technique. Histo‐pathology of fresh frozen section biopsy was used as the gold standard to assign the clinical phenotypes of metastatic (SLNM+) and non‐metastatic sentinel lymph nodes (SLNM‐). Discovery phase of the experiment included isobaric Tags for Relative and Absolute Quantitation (iTRAQ) technique comprising of six comparative experiments coupled with mass spectrometric analysis to identify differentially expressed proteins. The mass spectrometry proteomics data have been deposited to the ProteomeXchange Consortium via the PRIDE partner repository with the dataset identifier PXD027668. Validation was done by ELISA and protein concentrations were used to estimate the ROC for computing diagnostic parameters. Pathway analysis and gene ontology analysis was done to understand the relevance of the differentially expressed proteins in this study.ResultsBased on MS/MS spectra there were 7510 differentially expressed proteins comparing SLNB + and SLNB ‐. Nineteen proteins up‐regulated, and eight proteins that were down regulated in SLNB+ as compared to SLNB‐. ELISA confirmed the up‐regulation of caveolin 1, collagen α‐1, desmin, fibrillin‐1, and microfibrillar associated glycoprotein 4 in metastatic, as compared to non‐metastatic lymph nodes. These proteins are known to be integral in tumorogenesis, cell proliferation, invasion, cell survival and anti‐apoptosis. These proteins have 80%‐100%, of sensitivity and specificity to differentiate the two clinical phenotypes.ConclusionIdentified protein biomarkers have requisite diagnostic parameters to be developed as a translational tool to assess the status of sentinel lymph nodes during mastectomy procedure to guide surgical therapy of axillary lymph nodes in early breast oncology.

Comparative Analysis and Options to Improve the Immediate and Long-Term Effects of Gastric Cancer Surgical Treatment

Introduction. Currently, there are absolute and relative indications for splenectomy in the surgical treatment of gastric cancer.The aim of the study was to improve clinical outcomes of treatment in patients with gastric cancer identifying risks associated with splenectomy, and developing options to correct them. Methods. The study included clinical findings and parameters of the quality of life of 380 patients with gastric cancer who were treated at the Voronezh Regional Clinical Oncological Hospital in 2013-2019. All patients were conventionally divided into 2 groups. The patients of the first group (study group, 172 people) underwent gastrectomy with D2 lymphadenectomy, including splenectomy. The patients of the second group (comparison group, 208 people) underwent spleen-preserving gastrectomy with dissection of lymph node groups 10 and 11. The average follow-up was 39.6 months. In the postoperative period, all patients were examined according to the Clinical Recommendations of the Russian Federation. The SF-36, GSRS questionnaires were used to assess quality of life.Results. Splenectomy increased the incidence of early postoperative complications, including severe complications grades 3 - 5 according to the Clavien-Dindo classification, contributed to the development of reflux esophagitis and, in general, a worsen quality of life in the late postoperative period, but did not affect the patients survival.Conclusion. The data obtained evidence a significantly worse and generally unfavorable safety profile of patients undergoing splenectomy compared to patients who underwent spleen-preserving gastrectomy. Reduced indications for splenectomy appear to be the option to solve this problem. Measures for correction of postoperative complications have been developed for patients with absolute indications for splenectomy.

Comprehensive Risk System Based on Shear Wave Elastography and BI-RADS Categories in Assessing Axillary Lymph Node Metastasis of Invasive Breast Cancer-A Multicenter Study.

PurposeTo develop a risk stratification system that can predict axillary lymph node (LN) metastasis in invasive breast cancer based on the combination of shear wave elastography (SWE) and conventional ultrasound.Materials and MethodsA total of 619 participants pathologically diagnosed with invasive breast cancer underwent breast ultrasound examinations were recruited from a multicenter of 17 hospitals in China from August 2016 to August 2017. Conventional ultrasound and SWE features were compared between positive and negative LN metastasis groups. The regression equation, the weighting, and the counting methods were used to predict axillary LN metastasis. The sensitivity, specificity, and the areas under the receiver operating characteristic curve (AUC) were calculated.ResultsA significant difference was found in the Breast Imaging Reporting and Data System (BI-RADS) category, the “stiff rim” sign, minimum elastic modulus of the internal tumor and peritumor region of 3 mm between positive and negative LN groups (p < 0.05 for all). There was no significant difference in the diagnostic performance of the regression equation, the weighting, and the counting methods (p > 0.05 for all). Using the counting method, a 0–4 grade risk stratification system based on the four characteristics was established, which yielded an AUC of 0.656 (95% CI, 0.617–0.693, p < 0.001), a sensitivity of 54.60% (95% CI, 46.9%–62.1%), and a specificity of 68.99% (95% CI, 64.5%–73.3%) in predicting axillary LN metastasis.ConclusionA 0–4 grade risk stratification system was developed based on SWE characteristics and BI-RADS categories, and this system has the potential to predict axillary LN metastases in invasive breast cancer.

Postoperative lymphatic recurrence distribution and delineation of the radiation field in lower thoracic squamous cell esophageal carcinomas: a real-world study

BackgroundTo study lymphatic recurrence distribution after radical surgery in the real world and guide clinical tumor volume delineation for regional lymph nodes during postoperative radiotherapy for lower thoracic squamous cell esophageal carcinomas.MethodsWe enrolled patients who underwent radical esophagectomy, without radiation before or after surgery, at 3 cancer hospitals. Patients were classified into groups according to tumor locations. We included patients with tumors in the lower thoracic segment and analyzed the postoperative lymph node recurrence mode. A cutoff value of 10% was used to differentiate high-risk lymph node drainage areas from others.ResultsWe enrolled 1905 patients in the whole study series, including 652 thoracic esophageal carcinomas that met our inclusion criteria; there were 241 cases of lower thoracic esophageal carcinomas. 1st, 2nd, 4th, 7th, 8th groups of lymph nodes, according to the 8th edition of the AJCC classification, displayed as high-risk recurrence areas, representing 17.8%, 23.9%, 11.7%, 10.9% and 12.2% of lymph node recurrence. Stage III-IV tumors located in the lower segment of the thoracic esophagus showed a tendency to recur in the left gastric nodes (7.9%) and celiac nodes (10.6%).ConclusionsAccording to our results, we recommended including the 4th, 7th and 8th groups of lymph nodes in the radiation field, and for patients with stage III-IV disease, the 17th and 20th groups of nodes should be irradiated during postoperative treatment. Whether including 1st/2nd groups in preventive irradiation needed more proofs.

Impact of Regional Lymph Node Irradiation on Reducing Lymph Node Recurrence in Esophageal Cancer Patients.

To evaluate the preventive effects of regional lymph node irradiation on lymph node recurrence in esophageal cancer (EC). The study included 289 patients who received definitive radiotherapy for EC. The regional lymph node area of group 1 was determined as the area with the highest probability of lymph node metastasis and group 2 was determined as the area with the next highest probability of lymph node metastasis depending on the primary site of EC. The patients in whom group 2 was completely included in the irradiated field had a significantly lower rate of recurrence of regional lymph node metastasis than those in whom group 2 was not or insufficiently included (p=0.0337). There was no significant difference in overall survival (p=0.4627) or disease-specific survival (p=0.6174) between the two groups. Regional lymph node irradiation did not have survival-prolonging effects but significantly reduced regional lymph node recurrence.

Chinese experts consensus on standardized surgical management of specimens from radical gastrectomy (2022 edition)

In the standardized diagnosis and treatment process of advanced gastric cancer, there is a unappreciated key link between standard radical surgery and accurate pathological reports. That is, the process of dissection, fixation, sampling and recording of the specimen by the surgeons, starting from specimen isolation to the management of the pathologist. Standardizing this process can not only accurately reflect the detailed distribution and exact number of lymph nodes, but also clarify the pathological stage of gastric cancer, so as to make adjuvant treatment plans. Moreover, it can also reflect the scope of intraoperative lymph node dissection to ensure the standardized implementation of surgery, including the overall dissection principle (en bloc resection), and therefore can provide a solid foundation for later related researches. So far, there is still a lack of complete and unified standard for the surgical management of specimens after radical gastrectomy in China. On the basis of the relevant researches and clinical practice about specimen management at home and abroad, the Chinese Journal of Gastrointestinal Surgery, in the name of the Gastric Cancer Professional Committee, Chinese Anticancer Association, as well as the Oncogastroenterology Professional Committee, Chinese Anticancer Association, organized dozens of experts to formulate a consensus on the standardized surgical management of specimens after repeated discussions and revisions for two years. This consensus is aimed to standardize the preparations, basic requirements and sample processing procedures before the surgical treatment of postoperative specimens after a radical surgery for gastric cancer patients, including the processing time of specimens, the processing and data archiving of gastric specimens, and lymph node grouping, sorting and fine sorting records, etc and with the purpose of standardizing the surgical treatment of postoperative specimens on the basis of standardized diagnosis and treatment of gastric cancer, in order to further promote the high-quality development of gastric cancer surgery in China.

A comparative study of the role of cytopathology, staining for acid-fast bacilli and genexpert MTB/RIF assay in the diagnosis of tubercular lymphadenopathy

The diagnosis of tubercular lymphadenopathy can be made by FNAC combined with staining for AFB along with newer methods like GeneXpert assay. India carries one of the largest burdens of TB accounting for twenty-seven per cent of worldwide cases. To evaluate the role of cytopathology, AFB staining and GeneXpert assay in the rapid diagnosis of tubercular lymphadenopathy along with the usefulness of GeneXpert assay in the diagnosis of indeterminate aspirates. A total of 372 patients presenting with lymphadenopathy and clinical suspicion of a tubercular aetiology were included in the analysis.183 patients (56%) were adults (20-59 years) followed by 66 patients (20%)in the paediatric age group. 189 were females(57.3%) and 141 were males (42.7%). The cervical group of lymph nodes were most commonly involved (66%).69.1% were AFB positive in 201 smears with features favouring tubercular infection (positive cytology) which increased to 183 (91%) when GeneXpert Analysis was done, while 72 cases (55.8%) were AFB positive on cases with indeterminate cytology which showed an increment to 108 cases (83.7%) on the application of GeneXpert. FNAC combined with ZN staining and GeneXpert has a much higher diagnostic accuracy, GeneXpert further prevents underdiagnosis and enables rapid and accurate diagnosis in cases with indeterminate/inconclusive FNAC and ZN staining.

Breast cancer recurrence 27 years after full recovery; A case report with literature review.

IntroductionBreast cancer can recur after a decade of healthy life. The purpose of this study is to describe a rare case of breast cancer recurrence after 27 years of full recovery.Case reportA 67-year-old married nulliparous (G1P0A1) female presented with a few weeks of left axillary swelling. She is a known case of left breast cancer that was identified and treated in 1994 with a standard mastectomy without axillary intervention. An ultrasound and mammography imaging revealed a normal right breast and a clear left breast bed. Fine needle aspiration cytology (FNAC) revealed metastasized ductal carcinoma of the breast. The patient underwent general anesthesia and axillary dissection for level I and II axillary lymph node groups.DiscussionThe incidence of recurrence in axillary lymph nodes following excision of the original tumor in breast cancer patients varies according to the surgical approach, ranging from 0.8% to 8.6%. Patients with breast cancer who have a positive estrogen receptor are at a higher risk of delayed recurrence.ConclusionBreast cancer can recur even 27 years after being diagnosed and treated. This demonstrates the significance of continuing follow-up in patients diagnosed with breast cancer throughout their lives.

Estimation of pelvic lymph node dose contribution from HDR ICBT in cervical cancer

Context: Dose received to each pelvic group of lymph nodes, namely obturator (OB), internal iliac (II), and external iliac (EI), is less certain. This study is conducted to evaluate the dose delivered to these nodal groups so that this can be considered while planning external beam radiotherapy external beam radiation therapy (EBRT) boost in patients with gross pelvic lymph nodes. Aims: This study aimed to estimate the dose contribution to pelvic lymph nodes in three-dimensional high-dose-rate intracavitary radiotherapy (HDR-ICRT) of cervical cancer patients. Settings and Design: This was a single-arm retrospective observational study among 25 locally advanced carcinoma cervix patients treated with definitive chemoradiation. Materials and Methods: EI, II, and OB groups of lymph nodes were delineated on computed tomography data sets of selected 25 patients, and D100, D50, and D2cc to each lymph node were analyzed. The dose received by each pelvic lymph node group from all the 3 fractions of HDR-ICRT, corresponding equivalent 2 Gy dose, and percentage of brachytherapy (BT) contribution to each pelvic lymph node were calculated. Results: Mean D100 received by EI, II, and OB lymph node groups after summation across 3 fractions was 1.1 Gy, 2.34 Gy, and 3.11 Gy, respectively. Mean 2 Gy equivalent doses (D100) were 1.66 Gy, 3.41 Gy, and 4.53 Gy, respectively. Corresponding percentage of the dose received by EI, II, and OB was 4.89%, 10.43%, and 13.83% when 7.5 Gy per fraction for 3 fractions was prescribed to Point A. Conclusions: There is a significant contribution from HDR intracavitary BT to the pelvic lymph nodes in the radical treatment of cervical cancer. The dosimetric results given in this work can be used by a radiation oncologist to estimate BT doses to affected lymph nodes and integrate them into the preceding EBRT planning phase.

Role of Sonoelastography for Differentiating Benign and Malignant Cervical Lymph Nodes: A Cross-sectional Study

Introduction: Cervical nodes form one of the major groups of Lymph Nodes (LN) that are frequently involved in inflammatory and neoplastic diseases. Metastasis causes the most apparent change in consistency of the node among the various nodal pathologies. Ultrasound elastography provides an estimate of tissue consistency by measuring the degree of distortion under the application of an external force. Aim: To estimate the diagnostic accuracy of sonoelastography in the differentiation of malignant and benign cervical LN with fine needle aspiration cytology/biopsy considered as a gold standard. Materials and Methods: A cross-sectional study was carried out from March 2020 to January 2021 in a tertiary care hospital in south India, a total of 50 patients with cervical lymphadenopathy underwent ultrasonography followed by elastography of superficial neck LN using high frequency linear transducer by freehand technique. The ultrasound characteristics of selected LN were determined and colour elastogram pattern was assessed using colour mapping elastography. The chi-square test was performed. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were obtained. The results were then compared to the fine needle aspiration cytology. Results: A total of 50 subjects(median age of 40.5±18.71 years ; 19 (38%) males and 31 (62%) females). The grayscale and colour Doppler features of cervical LN which helped predict malignancy were short axis ≥8 mm, S:L axis ratio ≥0.5, absence of normal central fatty hilum, abnormal echogenicity, lobulated border, presence of calcification and peripheral/mixed vascularity. With reference to the above variables of cervical LN characterisation on grayscale, colour doppler ultrasound and sonoelastography findings, elastography pattern was the most promising variable to differentiate malignant from benign cervical LN with 95.2% sensitivity, 75.0% specificity, 95.2% PPV, 75.0% NPV and 92.0% accuracy. Conclusion: Sonoelastography is useful in the assessment of elastic properties of cervical LN with short examination time required, real-time display, immediate interpretation and limited cost. Sonoelastography had higher diagnostic accuracy than gray scale and doppler ultrasound in differentiating benign from malignant cervical LN. Sonoelastography is an effective supplement to conventional gray scale and colour doppler ultrasound and that the combination is clinically recommended for a more accurate diagnosis of metastatic LN.

An International Survey of the Operative Management of Gallbladder Cancer (OMEGA-S) – Global Consistency or Widespread Heterogeny?

Introduction: The rarity of gallbladder cancer (GBC) means that definitive evidence for optimal management is lacking. The extent of variability in diagnostic workup and management of GBC across HPB units globally has not been hitherto assessed. Method: A survey on the management of GBC was designed by the EAHPBA Scientific and Research committee and OMEGA study collaborators and disseminated to EAHPBA, A-PHPBA and AHPBA members. Results: Over 110 surgeons responded from more than 35 countries. Pre-operative staging was mainly via CT, while PET was predominantly performed for suspected metastases. Factors considered contraindications to resection varied between centres. Solitary right-sided liver metastasis or main portal vein involvement were only considered contraindications to resection by around 50% of centres. Half the centres would abort planned surgery if coeliac, SMA or para-aortic nodal involvement was suspected preoperatively for any stage of disease. However, for T3/4 tumours, regardless of pre-operative imaging appearances, a quarter of centres always resected this group of lymph nodes and 50% of centres always sampled para-aortic nodes for frozen section. SIVb/V resections were more commonly performed for T2b compared to T2a tumours, and extent of liver resection increased with stage of disease. Hepaticojejunostomy was always performed for T3/4 disease in 20% of units regardless of cystic duct margin histology. Conclusions: This is the first survey of GBC management across HPB units internationally, highlighting areas of consistency but also surprising areas of heterogeneity. More robust evidence and clinical trials are required to help guide the management and improve outcomes from GBC.

Histopathological Study and Pattern of Lymph Node Involvement in Carcinoma Esophagus: A Tertiary Care Centre Experience from Northern India

Background: Esophageal cancer remains one of the deadliest cancers with an overall 5-year survivalrate estimated to be less than 18%. Squamous cell carcinoma of the esophagus is the predominanthistology in the cervical esophagus and upper and middle thirds of the thoracic esophagus, whereasadenocarcinoma predominates in the distal esophagus. Lymph node involvement and the number oflymph node metastases are important prognostic factorsMaterials and Methods: 30 patients of mid and lower thoracic esophageal carcinoma treated between2008 to 2014 were studied retrospectively. Histopathological profiles were analysed mainly in terms ofpattern of lymph node involvement.Results: 26 cases were squamous cell carcinoma and 3 were adenocarcinoma while 1 case waspathological complete response after neoadjuvant treatment. 22/30 were moderately differentiated.24/30 had lymph node involvement where T3N1 was the commonest stage as 50% had achieved thisstage. Mediastinal group of lymph nodes were involved in 23 cases upper abdominal lymph nodeswere involved only in 1 case while cervical lymph nodes were not involved in any case. Amongmediastinal group paraesophageal, paratracheal lymph node involvement was the commonest followedby subcarinal and recurrent laryngeal group of lymph nodes.Conclusion: Squamous cell carcinoma is still the commonest variety prevailing in this region. Majorityof the cases present in advanced stage with lymph node involvement. Mediastinal group of lymph nodesare involved in majority of the cases hence precise clearance of this group is of utmost importance toprevent local recurrence and prolonged survival.

A survey of lymph node involvement under preoperative medical imaging in cervical cancer patients

Objective: To investigate the characteristics and distribution patterns of clinically metastatic nodes assessed by Computed Tomography (CT) in preoperative cervical cancer patients; to address the importance of obturator and/or inguinal lymph nodes as sentinel lymph nodes. Methods: A total of 217 patients with cervical carcinoma treated by lymph node dissection (LND) between 2009 and 2014 were included. All preoperative CT/MRI (Magnetic Resonance Imaging) imaging data of these patients were reviewed. The relationship of patient characteristics age, tumor stages, and corresponding lymph node metastasis status were analyzed. We put emphasis on the distribution pattern of positive lymph nodes from pre-operative imaging and compared the different frequencies of each regional and non-regional lymph node group respectively. The data of the 5-year survival rate from follow-up was taken into consideration too. SPSS 24.0 (IBM Corp., Chicago, IL, USA) was used for statistical analysis. Results: The overall lymph node metastasis (LNM) rate was 92.6% in 217 cases. When regional nodes were involved, obturator groups were concerned in 154 (76.6%). The inguinal group was involved in 146 (72.6%) in the area of non-regional lymph node. The 5-year survival rates of return visits were 92.6% and 82.1% in stage IB and IIA, respectively. Age distribution was not associated with the International Federation of Gynecology and Obstetrics (FIGO) stage as well as the incidence and patterns of nodal metastasis. Conclusions: obturator and inguinal groups play a decisive role in the metastases process of cervical cancer, and can be regarded as a candidate for sentinel lymph nodes.

Pencil Beam Scanning (PBS) Intensity-Modulated Proton Therapy (IMPT) Chemoradiotherapy for Anal Canal Cancer-Single Institution Experience.

Background: A favourable dose distribution has been described for proton beam therapy (PBT) of anal cancer in dosimetric studies. The relationship between dosimetric parameters in bone marrow and haematologic toxicity, treatment interruptions, and treatment efficacy has also been documented. There are only few references on clinical results of PBT for anal cancer. The primary objective of the retrospective study was to assess the efficacy of pencil beam scanning intensity-modulated proton therapy (PBS IMPT) in the definitive chemoradiotherapy of anal cancer. Secondary objectives were established to identify the risks of acute chronic toxicity risks and to assess colostomy rates. Materials and methods: Patients were treated for biopsy-proven squamous cell cancer (SCC) of the anus at initial or advanced stages. Eligible patients received PBS IMPT at a single institution. Treatment was administered in two volumes: 1-tumour with margins plus involved lymph nodes; 2-regional lymph node groups: perirectal (mesorectal), obturatory, inguinal, internal, external, and common iliac. The total doses of 57.5 GyE and 45 GyE, respectively, were administered in volumes 1 and 2 in 25 fractions, 5 fractions per week, respectively (a simultaneous integrated boost). Concomitant chemotherapy cisplatinum (CDDP) plus 5-FU or CDDP plus capecitabine was administered as per protocol. The treatment effect was assessed using DRE (digital rectal examination) and MRI (magnetic resonance imaging) within the follow-up period. Toxicity was scaled using CTCAE version 4.0 criteria. Results: 39 of 41 patients treated during the period of February 2014-August 2021 were eligible for analysis. All patients completed treatment, 76.9% without interruption. The median treatment time was 35 days (32-35). The median follow-up period was 30 months, 34 patients are alive to-date, 5 patients died prior to the date of analysis, and 2 deaths were unrelated to the primary disease. The 2-year overall survival, relapse-free survival, and colostomy-free survival were 94.2%, 93.8%, and 91.0%, respectively. Complete regression was achieved in 36 patients (92.3%), partial regression was achieved in 2 (5.1%), and immediate progression at end of treatment occurred in 1 patient (2.6%). Salvage resection was indicated for two patients in partial regression and due to severe chronic dermatologic toxicity. The grade 3 and 4 haematological toxicity rates were 7.7% and 5.1%, respectively. The most frequent non-haematological acute toxicities of grade 3-4 observed were dermatitis (23.1%), diarrhoea (7.7%), and dehydration (7.7%). Chronic toxicity emerged predominantly as skin atrophy/ulceration grade 2 (26.5%) and grade 3-4 (5.8%), and radiation proctitis grade 2 (38.2%) and grade 3 (2.9%). Discussion, conclusions: This single-institution study showed the high efficacy of PBS IMPT, achieving a high rate of complete regression. The haematological acute toxicity of grade 3-4 remained low; however, the impact of altered chemotherapy (CDDP instead of mitomycin C) remains unclear. The incidence of other acute toxicities shares similarity with photon therapy investigated in large studies. The acute toxicity completely resolved in all patients, had no lethal outcomes, and never resulted in the necessity for colostomy. By contrast, it was chronic toxicity, skin ulceration, perirectal fistulation, and fibrosis that resulted in salvage surgery and/or the need for a colostomy. A challenging question remains: to what extent can PBT prevent chronic toxicity? Longer follow-up remains necessary.

Disseminated Kaposi sarcoma with osseous metastases in patients with HIV infection. Case report

Background. Kaposi sarcoma is a low-grade vascular tumor affecting blood and lymphatic vessels associated with the human herpes virus type 8 (HHV-8). As a rule, the skin of the lower extremities is involved in the process first of all, and then other organs and lymph nodes are involved. There are 4 various types of the disease with different clinical picture: the classic, the endemic, the epidemic and immunosuppression subtype. The epidemic subtype is the most common and has the most aggressive course, with specific lesions of a multiple kind, including the skin, mucous membrane layers, the lymph nodes, the gastrointestinal tract, the lungs and the spleen. Osseous metastases are extremely rare.&#x0D; Aim. Show the case of Kaposi sarcoma with osseous metastases in patient with the human immunodeficiency virus (HIV) infection.&#x0D; Results. We observed a 43-year-old patient with HIV infection and stage 4b Kaposi sarcoma against the background of the irregular antiretroviral therapy in the progression stages. The duration of the anamnesis was 32 months. The clinical debut of the cancer process was noted with skin lesions on the shoulder. Histological and immunohistochemical analysis of skin biopsies showed the morphological picture of Kaposi sarcoma. HHV-8 was expressed in tumor cells. During the endoscopic examination the lesions of oral mucosa, stomach and proximal colon were confirmed morphologically, and spiral computed tomography of the chest revealed the lesions in the lungs. On this point, the patients received oxaliplatin-based chemotherapy and aetoposidum for 6 months and against the background of this treatment we observed the disease progression associated with the involvement of the retroperitoneal lymph nodes, the left adrenal gland and the penis. Circumcision was performed in the case associated with the involvement of the penis. The treatment was continued. The lytic left iliac bone lesion, the retroperitoneal lymph nodes, the iliac lymph node groups, as well as the left inguinal lymph nodes, the left adrenal gland and the lungs were characterized by a high F-18 FDG uptake after 3 months of the treatment, according to the results of Fluorine-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography combined with computed tomography (PET/CT).&#x0D; Conclusion. Kaposi sarcoma in patients with HIV infection had an aggressively course with disseminated skin lesions and internal organ involvement, including bones as showed in this clinical case. In this case, the axial skeleton was more commonly involved. PET/CT is a diagnostic imaging method in the differential diagnosis and determination of the prevalence of the cancer process.

A Clinico-Pathological Study on Cervical Lymphadenopathy

Background: The analysis of lymph node enlargement in the neck is not an easy task. It is a challenge for surgeon to assess its clinical behaviour and come to a final diagnosis. Those diseases which can be neoplastic also demands correct diagnosis for further management. The study intends to find out systematically the various pathological conditions presenting with enlarged lymph nodes in the neck, also the various modes of clinical presentation and behaviour of these conditions. Relevant investigations have also been studied. Methods: The study population consisted of patients above 12 years presenting with cervical lymph node enlargement. The proforma which was drafted is used. Patient was examined systematically giving utmost importance to local examination. After making a clinical diagnosis, further relevant investigations were done to confirm the diagnosis. Treatment was instituted appropriately and patients were followed up. Results: Majority of the cases in this study had non-neoplastic causes for cervical lymphadenopathy in which tuberculosis is most common. Male to female ratio of 1.38:1 is noted with most cases between 20 and 40 years. Posterior triangle group of lymph nodes was most commonly affected in tuberculosis. In lymphomas level 2 group of lymph nodes is most commonly involved. Variable results were noted among the groups of lesions, with regard to local characteristics like number, laterality, mobility and involvement of other group of lymph nodes, etc. FNAC by virtue of it being inexpensive, quick in getting the results and easy to perform, is one of the important and essential diagnostic procedures. Conclusion: Clinical symptoms in cervical lymphadenopathy is of limited significance because clinical behaviour can be highly variable and mostly non-specific. As cervical lymphadenopathy is an important condition, which always calls for meticulous attention, analysis and treatment. FNAC is found to be a frontline investigation of choice with ......

Shear Wave Ultrasonic Elastometry in Diagnostics of Metastatic Lymph Nodes in Neck Thyroid Cancer

Purpose: Determination of informative value of a new method of ultrasound tomography, based on the properties of elasticity of soft tissues, in the differential diagnosis of metastatic lesions of the lymph nodes of the neck thyroid cancer.Material and methods: To assess the capabilities of shear wave ultrasound elastometry in the diagnosis of metastatic lesions of the lymph nodes in thyroid cancer, a study was carried out with 45 patients with suspected thyroid cancer. The work was performed by devices Acuson S2000 Siemens, Avius hi vision Hitachi using a linear sensor with a frequency of 5–12 MHz. For each object of the study, from 5 to 10 measurements of the shear wave velocity in m / s were made, depending on the size of the lymph nodes.Results: Reliable results were obtained in the group of altered lymph nodes (statistical significance p &lt; 0.05). Interquartile intervals and the most common values of shear wave velocities do not overlap: in metastases — 2.20– 3.36 m/s, with hyperplasia of lymph nodes — 0.70–1.88 m/s, and medians show a significant difference in velocities: metastases — 3.00 m/s, hyperplastic lymph nodes 1.38 m/s.Conclusions: Shear wave elastography objectifies ultrasound studies, obtaining specific indicators of shear wave velocity in the areas of interest, and can be used as an additional diagnostic tool in the differential diagnosis of metastatic and hyperplastic lymph nodes.

Prognostic value of different N1 lymph node zones in pN1M0 non-small cell lung cancer: a systematic review and meta-analysis

The IASLC lymph node map grouped the lymph node stations into “zones” for prognostic analyses. In the N1 lymph nodes group, N1 nodes are divided into the Hilar/Interlobar zone (N1h) and Peripheral zone (N1p). There is no consensus on the different prognostic values of N1 lymph nodes in N1h and N1p. Therefore, we conducted a systematic review and meta-analysis to assess the survival difference between N1h and N1p in patients of pN1M0 NSCLC. Medline, the Cochrane Library, Embase, and the Web of science were systematically searched to identify relevant studies published up to April 4th, 2020. A retrospective and prospective cohort study comparing N1h versus N1p to the pN1M0 NSCLC was included. Hazard ratios (HRs) for OS were aggregated according to a fixed or random-effect model. Ten publications for 1946 patients of pN1M0 NSCLC were included for the meta-analysis.The 5-year OS was lower for patients with N1h (HR: 1.67, 95% CI 1.44–1.94; P < 0.001). The pooled 5-year OS in N1h and N1p were 40% and 56%, respectively. The patients in pN1M0 NSCLC have different survival according to different N1 lymph node zones involvement: patients with N1p metastasis have a better prognosis than those with N1h metastasis.

Immunomonitoring During Radiotherapy of Prostate Cancer: Effect of Dose & Volume on Peripheral Immune Cells

<h3>Purpose/Objective(s)</h3> To assess the effect of radiotherapy (RT) on peripheral immune cells (B- and T-lymphocytes, Natural Killer (NK) cells) in prostate cancer (PCa) patients treated with different fractionation schedules. Here we report a preliminary analysis on the first 18 patients. <h3>Materials/Methods</h3> The present IRB approved prospective study was conducted at a single institution from February to October 2019; all patients referred for definitive, adjuvant or salvage radiotherapy for PCa were offered participation. Accrued patients were treated according to institutional guidelines/ongoing research protocols as it follows: stereotactic body radiation therapy (40 Gy/3 fractions; Group 1); definitive moderately hypofractionated RT (62 Gy/ 20 fractions; Group 2); postoperative moderately hypofractionated fractionated RT (66-69 Gy/30 fractions; Group 3). Target volumes were: prostate only (Group 1); prostate and seminal vesicles (Group 2); prostatic bed + pelvic lymph nodes (Group 3). All accrued patients underwent blood collection at baseline (PRE), 3 hours after the first dose of RT (3H) and at the end of RT (LAST). The immuno cell profiles were analyzed in isolated peripheral blood mononuclear cells, by multicolor flow cytometry, at each time point in terms of CD3, CD8, CD4, CD8/CD4-ratio, CD19 and CD3-, CD56+ expressions. Data were analyzed with the Wilcoxon-Mann-Whitney test. Statistical significance was claimed for <i>P</i> values < 0.05. <h3>Results</h3> 18 patients were accrued (5 pts Group 1; 6 pts Group 2; 7 pts Group 3). Baseline immunoprofiling did not demonstrate any significant difference among groups. Compared to PRE, both CD3 and CD4 cells increased significantly (<i>P</i> < 0.05) at 3H in all groups. CD8 cells decreased significantly at both 3H and treatment end in Group 1 (<i>P</i> = 0.043), but no statistically significant differences were noticed in Groups 2 and 3. The CD8/CD4-ratio decreased significantly in Group 1 at 3H (<i>P</i> = 0.04), while decreased after the last dose in both Groups 2 and 3 (<i>P</i> = 0.06). Compared to baseline, total NK cells decreased at 3H (Groups 1-2, <i>P</i> = 0.043; Group 3, <i>P</i> = 0.028), while increased for all 3 Groups at LAST. Finally, B cells were found to be decreased for both Groups 2 (<i>P</i> = 0.028) and 3 (<i>P</i> = 0.018) at LAST. <h3>Conclusion</h3> Systematic immunomonitoring at precise time points for PCa patients treated with different schedules/volumes shows different effects on lymphocyte subpopulations.

Diagnostic challenge in an immunocompromised patient

Abstract The article presents the case of a 66-year-old non-smoking female patient with HIV-negative status. In 2015, she was diagnosed with chronic lymphocytic leukaemia (CLL) at its early stages, with specific complete blood count changes, peripheral lymphadenopathy and hepatomegaly. No specific treatment was recommended at that time. In July 2018, the diagnosis of non-Hodgkin lymphoma (NHL) IV B stage, with the involvement of all groups of peripheral lymph nodes, was confirmed histologically. No episodes of neutropaenia were recorded. Chemotherapy was initiated. Then, 3 months later, radiological examination revealed a bilateral pulmonary nodular dissemination in the upper lobes, and tuberculous aetiology was confirmed using sputum microscopy and cultural methods (a pansensitive strain). At the end of 8 months of antituberculosis treatment, chest X-ray revealed that apical lung consolidation had diminished, while sputum conversed after 4 months of treatment. After 3 months, the patient presented to the pneumology clinic with haemoptysis. CT revealed bilateral pulmonary consolidation, with cavitation in the left upper lobe and nodules in the surrounding region. Relapse of tuberculosis was excluded microbiologically [this was done using microscopy, cultures and molecular genetic examinations of the sputum and bronchoalveolar lavage (BAL) fluid]. A resistant strain of Staphylococcus aureus (MRSA) was identified, with susceptibility to amikacin and tobramycin. Treatment with amikacin had a positive clinical and imaging effect.