High Incidence Of Regional Metastasis Research Articles

Central neck lymph node dissection for papillary thyroid cancer

Relevance. Papillary thyroid cancer is often associated with regional metastases to lymph nodes including those of the central adipose tissue of the neck and the deep jugular lymph nodes. Assessment of metastatic involvement of the paratracheal lymph nodes in patients with well-differentiated thyroid cancer T1 and T2 is known to often produce false negative results. Surgical procedures in this region are technically challenging and associated with a certain risk of complications. Therefore, prophylactic removal of the central adipose tissue prevents local cancer recurrence and further metastatic involvement of the regional lymph nodes; moreover, it contributes to proper disease staging and planning of further patient management. Study goal. Was to determine the optimal extent of surgery for papillary thyroid cancer. Materials and methods. Sixty patients who underwent surgical procedures for papillary thyroid cancer were enrolled in the study. The study was carried out at SBHI Moscow Clinical Scientific Center named after A.S. Loginov of Moscow City Department of Healthcare from 2015 to 2017. Results. Regional metastases to the lymph nodes of the central adipose tissue of the neck removed during prophylactic central cervical lymph node dissection were revealed in 41.5% of cases. None of the patients demonstrated regional or distant metastases within 18 months of follow-up. Conclusions. Papillary thyroid cancer is associated with high incidence of regional metastases to the lymph nodes of the central adipose tissue of the neck, which necessitates central ipsilateral lymph node dissection simultaneously with thyroidectomy, which does not increase the postoperative complication rate.

Papillary Thyroid Carcinoma: Analysis of the Central Compartment's Lymph Nodes Metastases.

Papillary thyroid carcinoma is typical by regional lymph nodes metastases. Therefore we decided to analyse associated risk factors. In this retrospective study we focused on the incidence of metastatic involvement of the central compartment's lymph nodes correlated with age, size of the primary tumour, infiltration of thyroid gland capsule, positive lymphangioinvasion in order to assess risk factors. We analysed group of 156 patients with papillary carcinoma, who have undergone total thyroidectomy and bilateral elective central compartment neck dissection. We evaluated the occurrence of metastases, size, infiltration and lymphangioinvasion based on definitive histology of the whole group and separately for subgroups of patients under and over 45 years. We found metastatic involvement in 88 (56.4%) patients. When comparing the subgroups of patients under (73 patients) and over 45 years (83 patients), we found metastases in 56 vs. 32 (76.7% vs. 38.6%) patients. In the subgroup of younger patients we found significant higher incidence of metastases compared with the group of over 45 years, P < 0.001 (P = 0.000027). We found significant higher incidence of metastases in patients with positive capsule infiltration in the whole group, P < 0.001 (P = 0.00049); in the subgroup of under 45 years, P < 0.001 (P = 0.00091) and in patients with positive lymphangioinvasion in the whole group, P < 0.01 (P = 0.00177); in the subgroup of over 45 years, P < 0.001 (P = 0.0002). In patients with metastases we found tumour size ≥1cm more frequently in all groups. We recorded higher incidence of regional metastases in patients under 45 years, positive capsule infiltration, lymphangioinvasion. Age under 45 years itself does not correlate with less aggressive disease, to the contrary some of other analysed risk factors correlate with more aggressive disease.

Early T Stage Salivary Duct Carcinoma: Outcomes and Implications for Patient Counseling.

Salivary duct carcinoma (SDC) is a rare salivary malignancy that often presents at advanced stage. Outcomes of low T stage patients with SDC have not been previously examined in detail. We queried our institution's cancer database and identified 28 patients with SDC in situ or T1/T2 SDC. A retrospective chart review was performed, followed by comparison of clinicopathologic features with N stage, disease-free survival, and overall survival. Patients tended to be male, in their sixties, with a high incidence of regional metastases, as in prior reports. Five-year disease-free and overall survival were 49%. Median disease-free survival was 3.24 years, and overall survival was 4.65 years. Parotid location, vascular invasion, facial nerve sacrifice, and extracapsular extension were associated with worse survival. This study provides practical information for counseling of patients who undergo surgery for a parotid mass and are found to have this aggressive malignancy.

Esthesioneuroblastoma: An Update on the Massachusetts Eye and Ear Infirmary and Massachusetts General Hospital Experience with Craniofacial Resection, Proton Beam Radiation, and Chemotherapy

Objectives To update the Massachusetts General Hospital (MGH) and Massachusetts Eye and Ear Infirmary (MEEI) experience in the management of esthesioneuroblastoma (ENB) with multimodality therapy and to reassess treatment outcomes and complications in a larger cohort with longer follow-up times. Design A retrospective chart review. Setting A tertiary referral center. Participants All patients presenting with ENB and managed at the MGH and MEEI from 1997 to 2013. Main Outcome Measures Disease-free and overall survival. Results Twenty-two patients were identified with an average follow-up of 73 months. Ten patients presented with Kadish stage B disease and 12 with stage C disease. A total of six patients (27%) developed regional metastases. Treatment for all patients included craniofacial resection (CFR) followed by proton beam irradiation with or without chemotherapy. The 5-year disease-free and overall survival rates were 86.4% and 95.2%, respectively, by Kaplan-Meier analysis. Negative margins were a significant factor in disease-free survival. One patient experienced severe late-radiation toxicity. Conclusions ENB is safely and effectively treated with CFR followed by proton beam irradiation. The high incidence of regional metastases warrants strong consideration for elective neck irradiation. Proton beam radiation is associated with lower rates of severe late-radiation toxicity than conventional radiotherapy.

Penile and preputial tumours in the horse: A retrospective study of 114 affected horses

Preputial and penile tumours are more common in horses than in other domestic animals, but no large surveys of male horses with tumours of the external genitalia are available. To present a retrospective analysis of male horses with neoplasms of the external genitalia. The penile and preputial tumours of 114 horses were evaluated. Data recorded included age, gelding or stallion and breed; type and site of lesion; involvement of regional lymph nodes; histopathology (including grading of squamous cell carcinoma); and results of radiographic examination of the thorax. Mean age of horses was 19.5 years with no apparent breed predilection. Common presenting clinical signs were irregularities (e.g. the presence of a mass and/or ulceration) on the integument of the penis and prepuce, and purulent or sanguineous discharge from preputial orifice. Squamous cell carcinoma (SCC) was the most prevalent neoplasm followed by papillomas and melanomas. A basal cell carcinoma, neurofibrosarcoma, adenocarcinoma or fibrosarcoma were each found on single horses. Squamous cell carcinomas with poor differentiation had a higher tendency to metastasise than did more differentiated tumours. Squamous cell carcinoma is the most common urogenital tumour of the male horse and occurs primarily in old horses. Horses with poorly differentiated SCCs tend to have a higher incidence of regional metastases. Pathology of lymph nodes, even when not palpably enlarged, is a valuable diagnostic exercise. Radiology of the thorax to detect lung metastases is of little value.

Carcinoma of the oral cavity.

A retrospective study of 472 patients with oral cancer is presented. Though the total number of patients included is quite sizable, the number in several individual categories is too small to be conclusive. However, several features did emerge which we feel warrant presentation. Total determinate five-year survival was 76% with combined therapy, 45% with surgery alone, and 37% with radiation therapy. A relatively high incidence of regional metastases was noted in all categories studied. The survival of patients with T i lesions of the anterior tongue was no better than those with T 2 lesions. Survival of patients treated with radiation alone for carcinoma of the tonsil was markedly poorer when regional lymph nodes were palpable.

Carcinoma of the male breast

1. 1. Since carcinoma of the male breast occurs so infrequently, large series of cases have been lacking. Therefore, we believe we are justified in presenting our series of five cases, four of which have at least five-year follow-ups. 2. 2. Approximately 0.14 per cent of all cancer in males is due to cancer of the breast. 3. 3. The high incidence of regional metastasis is probably largely due to delay upon the patient's part before consulting a physician. 4. 4. One can find no definite relationship of the type or grade of carcinoma to the prognosis. 5. 5. Postoperative radiation can be considered a true adjuvant in the therapy of male breast carcinoma, especially when metastatic axillary glands are present. 6. 6. In the presence of distant bone metastases orchiectomy has been shown by Treves to be of definite value in lengthening life span and alleviating pain.