Metastatic Cancer Involvement Research Articles

Investigation of optical coherence micro-elastography as a method to visualize micro-architecture in human axillary lymph nodes.

BackgroundEvaluation of lymph node involvement is an important factor in detecting metastasis and deciding whether to perform axillary lymph node dissection (ALND) in breast cancer surgery. As ALND is associated with potentially severe long term morbidity, the accuracy of lymph node assessment is imperative in avoiding unnecessary ALND. The mechanical properties of malignant lymph nodes are often distinct from those of normal nodes. A method to image the micro-scale mechanical properties of lymph nodes could, thus, provide diagnostic information to aid in the assessment of lymph node involvement in metastatic cancer. In this study, we scan axillary lymph nodes, freshly excised from breast cancer patients, with optical coherence micro-elastography (OCME), a method of imaging micro-scale mechanical strain, to assess its potential for the intraoperative assessment of lymph node involvement.MethodsTwenty-six fresh, unstained lymph nodes were imaged from 15 patients undergoing mastectomy or breast-conserving surgery with axillary clearance. Lymph node specimens were bisected to allow imaging of the internal face of each node. Co-located OCME and optical coherence tomography (OCT) scans were taken of each sample, and the results compared to standard post-operative hematoxylin-and-eosin-stained histology.ResultsThe optical backscattering signal provided by OCT alone may not provide reliable differentiation by inspection between benign and malignant lymphoid tissue. Alternatively, OCME highlights local changes in tissue strain that correspond to malignancy and are distinct from strain patterns in benign lymphoid tissue. The mechanical contrast provided by OCME complements the optical contrast provided by OCT and aids in the differentiation of malignant tumor from uninvolved lymphoid tissue.ConclusionThe combination of OCME and OCT images represents a promising method for the identification of malignant lymphoid tissue. This method shows potential to provide intraoperative assessment of lymph node involvement, thus, preventing unnecessary removal of uninvolved tissues and improving patient outcomes.

Neurosurgical management of metastases in the central nervous system

Metastases in the central nervous system (CNS) are identified in up to 30% of patients at autopsy. Rates of CNS involvement in metastatic cancer are believed to be increasing, possibly owing to better control of systemic disease with novel chemotherapies or improved metastasis detection. The neurosurgical treatment of patients with metastatic cancer is an integral component of multimodality therapy for brain and spinal metastases. Survival benefit has been demonstrated for the addition of open surgery as well as the use of stereotactic radiosurgery (SRS) to whole-brain radiation therapy for treatment of patients with isolated cranial and spinal metastases compared with whole-brain radiation therapy alone. New clinical trials that directly compare open surgical procedures with SRS are underway, as are trials examining the role of neurosurgical procedures, such as vertebroplasty and kyphoplasty, in association with radiotherapy as methods for pain control in cancer patients with metastatic lesions in the spinal column. In this article, I review data from current randomized clinical trials that examine the role of neurosurgical intervention in the treatment of patients with CNS metastases.

Metastatic Tumors to the Adrenal Glands in Domestic Animals

Although metastases to the adrenals are common in humans, they have not been thoroughly studied in animals. The purpose of this retrospective study was to document the types of malignant tumors that metastasize to canine, feline, equine, and bovine adrenals, and the rate at which they do so. The average rate of adrenal involvement in metastatic cancer was 112/534 (21.0%) in dogs, 12/81 (14.8%) in cats, 18/67 (26.9%) in horses, and 5/16 (31.3%) in cattle. In dogs, 26 different tumor types metastasized to the adrenals. Pulmonary, mammary, prostatic, gastric, and pancreatic carcinomas, and melanoma had the highest rates of metastasis to the adrenal glands in dogs. Hemangiosarcoma and melanoma had high rates of adrenal involvement in horses. In cats and cattle, relevant data were only available for lymphoma. Adrenal metastases usually occurred in the late stages of the disease. One dog had developed Addison's disease (hypoadrenocorticism) secondary to lymphoma. Metastatic lesions represented 126/472 (26.7%) of canine, 12/20 (60.0%) of feline, 21/80 (26.3%) of equine, and 5/9 (55.5%) of bovine adrenal neoplasms. This study shows that adrenal glands should be thoroughly examined during both clinical work-up and postmortems when disseminated neoplasia is suspected.

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A rare autopsy case of granular lymphocyte proliferation disease (GLPD) accompanied by hemophagocytic histiocytosis and systemic lymph node swelling due to metastasis from prostatic carcinoma, was reported.An 87-yr-old man was admitted because of general fatisue, loss of consciousness and paresthesia of the right foot. General clinical examination revealed systemic lymphadenopathy without splenomegaly and mild hepatic dysfunction. Hematological examination showed leucocytosis with a marked increase of large granular lymphocytes (LGL) and a decrease of T cells in the peripheral blood. Upon immunological examination, CD3- CD57+ CD16+ LGL were numerically dominant which was suggestive NK-type GLPD.After a two months' asymptomatic course, sudden severe repiratory distress and mild jaundice appeared, and the patient died 3 days later.Autopsy revealed enlargement of the systemic lymph nodes due to cancer metastasis, central liver cell necrosis, and bleeding and marked congestive edema of the lungs with pleural effusion. Microscopic exmination disclosed well differentiated adenocarcinoma of the prostate with lymph node involvement. However, there were no metastatic lesions in the other organs and tissues examined. Prominent distribution of hemophagocytic histiocytosis was recognized in the lymph nodes, spleen and liver.Immunohistochemically, T cells were decreased in number in the lymphoid tissues, and also CD57+ LGL were decreased in the lymph nodes involved with cancer cells. The CD57+ LGL in lymph nodes failed to express HLA-DR (LN 3).In this case, it was considered that latent prostatic carcinoma might be have undergone rapid growth with widespread lymph node involvement within a short period under condition of disturbed immunoregulation due to GLPD, decrease of T cells and hemophagocytic histiocytosis. And also, it was possible that metastatic cancer involvement caused proliferation of LGL.