Hilar Node Swelling Research Articles

The utility of serum C-C chemokine ligand 1 in sarcoidosis: A comparison to IgG4-related disease

We previously reported higher levels of C-C chemokine ligand (CCL) 1 in the bronchoalveolar lavage (BAL) fluid (BALF) of patients with sarcoidosis than in BALF of patients with immunoglobulin G4 (IgG4)-related disease (IgG4-RD), indicating that CCL1 might act as a marker of disease activity in sarcoidosis. Notably, less invasive sampling sources are desirable, as BAL cannot always be performed due to its inherent risk. In this study, we sought to decipher the correlation between serum levels of CCL1 and clinical characteristics of sarcoidosis. Serum samples were obtained from 44 patients with clinically confirmed sarcoidosis, 14 patients with IgG4-RD, and 14 healthy controls. The clinical and radiological findings were retrospectively evaluated. Serum levels of CCL1 were measured using a sandwich enzyme-linked immunosorbent assay. Serum levels of other 17 cytokines and chemokines were measured using a MILLIPLEX® MAP KIT and Luminex® magnetic beads. Serum levels of CCL1 were significantly higher in patients with sarcoidosis than in patients with IgG4-RD and healthy controls. Serum CCL1 was positively correlated with the degree of hilar lymph node swelling on chest computed tomography and serum levels of soluble interleukin 2 receptor. Positive correlations were also observed between serum CCL1 and total cell counts, lymphocyte counts in BALF, and serum T helper 1 mediators such as IP-10 and TNF-α in patients with sarcoidosis. Serum CCL1 levels were significantly elevated in sarcoidosis and correlated with clinical parameters of the disease. In addition, serum and BALF levels of CCL1 were positively correlated in a statistically significant manner. Although further research in this field is necessary, CCL1 might have the potential to be a reliable serological marker of disease activity in sarcoidosis.

A case of neuroendocrine carcinoma in the hepatic hilar lymph nodes concomitant with an adenocarcinoma of the gallbladder

BackgroundNeuroendocrine tumors (NETs) are rare especially in the gallbladder. They have not been elucidated in the pathogenesis, clinicopathological characteristics, and treatment options.Case presentationWe present a 76-year-old woman with a gallbladder tumor and hepatic hilar lymph node swelling. The lymph node biopsy demonstrated neuroendocrine carcinoma (NEC). We performed cholecystectomy, hepatic hilar lymphadenectomy, extrahepatic biliary duct resection, and hepaticojejunostomy prior to chemotherapy. Pathological examination revealed the gallbladder mass was an adenocarcinoma invading to the muscular layer without any NEC components, whereas the hepatic hilar lymph nodes were filled with high-grade NEC cells with negligible area of adenocarcinoma. The patient received general chemotherapy consisting of carboplatin and etoposide, but a recurrence in the para-aortic lymph nodes occurred 4 months after surgery.ConclusionsWe report a rare case of NEC of the hepatic hilar lymph nodes that were concomitant with an adenocarcinoma of the gallbladder. High-grade NEC generally has an aggressive behavior and an optimal treatment strategy should be chosen for each patient.

Sarcoidosis With Multisystem Lesions

Sarcoidosis is a chronic multisystemic inflammatory disease that is characterized by noncaseous epithelioid cell granulomas infiltration of all affected tissues. Sarcoidosis generally involves the lungs, neurological system, lymphatic system, and the skin. However, this disease has a broad spectrum of clinical manifestations, and hence it is difficult to make a clear diagnosis. The diagnosis is usually based on radiographic findings of the mediastinal and hilar lymph node swelling. The male genitourinary tract is rarely affected, and testicular with epididymal lesions are rare. This case report documents radiographic imaging and pathologic features in a patient with sarcoidosis with extensive multisystem involvement.

P3-30-3 - Combination of Repeated Surgery and Perioperative Chemotherapy for Metachronous Double Bile Duct Cancer

A 69-year-old woman was admitted due to jaundice. Enhanced CT scan showed advanced gallbladder cancer invading the liver parenchyma. After three courses of gemcitabine (GEM) therapy were administered as neoadjuvant chemotherapy, extended right hemihepatectomy was performed. Postoperative adjuvant chemotherapy was canceled due to the patient's refusal. Nine months after the surgery, CA19-9 level was increased and follow-up CT detected hilar lymph node swelling, which strongly suggested recurrence of the disease. Chemotherapy using S-1 was introduced but was stopped because of progressive disease response. Instead, GEM therapy was administered and a partial response was observed which persisted for about five years thereafter. However, 76 months after the operation, jaundice was noted and solitary hilar mass lesion was detected by a follow-up CT and FDG-PET, without any other distant metastasis. The patient underwent extrahepatic bile duct resection with partial resection of the portal vein due to direct tumor invasion, and pathologically the tumor was diagnosed hilar cholangiocarcinoma. Since cancer infiltration of the intrahepatic bile duct stump was histologically positive, combination chemotherapy using GEM plus CDDP was administered. The patient is currently 76 years of age, 7 years after the initial surgery, and she is still doing well without any signs of recurrence. Metachronous multiple carcinomas of the biliary system are relatively uncommon due to the rarity of cholangiocarcinoma and its poor prognosis. Although some selected patients with bile duct cancer have a chance of long-term survival thanks to recent advances in both surgical resection and combination chemotherapy, standardization of chemotherapy or other therapeutic modalities has not been established for the treatment of such critical patients. We discussed feasibility and safety of multidsciplinary treatment for metachronous multiple bile duct cancers with the review of the literature.

Superficial-type endobronchial metastases from colon cancer: A case report.

Certain internal malignancies, including colon cancer, can develop endobronchial metastasis. The present study reports a case of colon cancer with superficial-type endobronchial metastases in a 76-year-old male. Chest computed tomography revealed small masses and infiltrates in each lung, with bilateral hilar lymph node swelling. Superficial endobronchial tumors in each of the bronchi were unexpectedly found by bronchoscopic examination. A biopsy specimen obtained from the endobronchial tumor was diagnosed as colon cancer. Superficial-type endobronchial metastasis from colon cancer is extremely rare, however, such metastasis should be considered for patients who have a history of colon cancer. There should be no hesitation in performing a bronchoscopic biopsy as an additional examination.

The Effectiveness of 18F-FDG PET/CT Combined with STIR MRI for Diagnosing Nodal Involvement in the Thorax

The purpose of this study was to compare the efficacy of short-tau inversion-recovery (STIR) MRI and 18F-FDG PET/CT for the detection of metastasis in mediastinal and hilar lymph nodes in patients with lung cancer. Ninety-three patients with known or suspected lung cancer with mediastinal and hilar lymph node swelling underwent STIR MRI and 18F-FDG PET/CT examinations. STIR MRI scans were obtained with a 2% copper sulfate phantom placed along the back of each patient, with the lymph node-to-phantom ratio calculated for quantitative analysis. For qualitative analysis, the results of all STIR MRI scans were evaluated using a 5-point visual scoring system. To evaluate the diagnostic capabilities of STIR MRI and 18F-FDG PET/CT, we used receiver-operating-characteristic curve analysis to determine the optimal thresholds for the lymph node-to-phantom ratio, visual score, and maximal standardized uptake value. Further, the capability of each to determine N-stage was compared in each patient using the McNemar test. A total of 137 lymph nodes (82 malignant lesions, 55 benign lesions) were analyzed. When optimal threshold values were adopted, the quantitative and qualitative sensitivity, specificity, and accuracy of STIR MRI were not significantly different from those of 18F-FDG PET/CT. However, 18F-FDG PET/CT in combination with qualitative STIR MRI analysis had a significantly higher capability to detect nodal involvement on an individual-patient basis (96.9% specificity, 90.3% accuracy) than did 18F-FDG PET/CT alone (65.6% specificity, 81.7% accuracy). We found that the diagnostic capability of STIR MRI was not significantly different from that of 18F-FDG PET/CT. However, when those methods were combined, the diagnostic capability for N-staging was significantly improved.

食道癌に合併したサルコイドーシスの１例

A 57-year-old female was admitted because of dysphagia. Esophagogram showed tumorous carcinoma at the lower third of the intrathoracic esophagus. The right hilar lymphnode swelling was recognized on the chest X-ray. The patient had a few flat ruber tetter on he cheak. Through the right thoracolaparotomy, subtotal esophagectomy, and lymphnode dissection were performed. Histologically, the specimen showed well differentiated squamous cell carcinoma. Epithelioid cell glanulomas with giant cells were observed in lymphnodes of the mediastinum, intraabdomen and skin lesion. In mediastinal lymphnodes, metastasis associated with squamous cell carcinoma and sarcoid glanuloma were mixturelly detected. The coexistence, associated with esophageal carcinoma and sarcoidosis is rare. There was only two case reports in Japan.

Clinical and Experimental Studies on Sinobronchial Syndrome

From the nasal investigations of 330 cases having chronic bronchitis or bronchiectasis, the chronic paranasal sinusitis was found in 79 or 91.8% of 86 cases having chronic bronchitis, of which bronchogrames revealed slight dilatation of the bilateral basal bronchi, while that was found in 63 or 25. 8 or 244 cascs having bronchiectasis, of which bronchograms demonstrated mostly saccular dilatations. In the cases of the former series the syndrome occured generally in relatively younger childhood and occasionally without the manifestation of preceding respiratory disease, and characterized frequently by obstructive ventilatory insufficiency on the lung function tests and markedly increased hilar marking on x-ray films. Therefore it is more difficult to obtain complete cure of bronchial disorders as well as of paranasal sinusitis in the former series than in the latter.From this clinical observation, it seemed reasonable to recognized a close causality between paranasal sinusitis and swelling of hilar lymphnodes. As an experiment to examine this causality, P32, Au198 or P32-labeled staphylococcus aureus were injected into the maxillary sinus of rabbits and the specific activity calculated one or two hour after the injection was observed to be significantly stronger in the hilar lymphnodes than that in the other regions.

Studies on tuberculous tracheobronchitis. I. Experimentally established tuberculous bronchial ulcer.

From the view point of implanatation theory on the tuberculous tracheobronchitis, tuberculous bronchial ulcer was experimentally estab-lished by attaching tubercle bacilli of human type on the main bronchus of dogs by various methods. 1. In the normal bronchial mucosa, ulceration was not caused by repeated painting of tubercle bacilli on the site twice a week for a period of 5 weeks. 2. Ulceration was produced when bacilli painting was done on the inflammatory or the scratching site previously made on the mucosa. 3. Ulceration was caused always by repeated submucous injections of bacilli but not by a single injection. 4. From these results, locus minolis resistentiae and repeated in-vasions of bacilli are considered to be favourable factors for the develop-ment of tracheobronchial tuberculosis. 5. In case submucous injection with bacilli was tried one to four weeks after an abdominal injection, no marked difference was observed as compared with the case of similar injection without any preliminary procedure. 6. In the group of long period observation after pulmonary injec-tion, mucous epithelial cells of the orifice of the lobe bronchus were found necrotic or partly desquamating due to the attaching of secretion., that brought tubercle bacilli from the pulmonary lesions especially from cavities. Peripheral bronchiolus-wall without cartilage was easily influenced by the surrounding pulmonary lesions, whereas the bronchus with cartilage was hardly affected. 7. When bacilli were painted after applying arsenious-acid paste, there was a marked bronchial stenosis which was mostly cicatricial, while in the case of repeated injections of bacilli, the stenosis was also marked owing to the thickness of mucous membrane and to the swelling of hilar lymph nodes.