Involvement Of Mesenteric Nodes Research Articles

Non-hodgkin's lymphomas: Characteristics of long-term survivors following conservative treatment

A most important set of prognostic factors for survival among 467 patients with non-Hodgkin's lymphoma receiving conservative treatment was determined statistically by the Cox proportional hazards model. Non-Hodgkin's lymphoma was diagnosed in these patients between 1958 and 1969. Initial biopsy material was classified according to the Working Formulation, and the Rappaport, Kiel, and Lukes-Collins systems. The Cox analysis identified a group of 37 patients with a median survival of 150 months. These patients had the following characteristics: (1) small lymphocyte, plasmacytoid lymphocyte, small cleaved, large cleaved or non-cleaved follicular center cell histologic subtype (Lukes-Collins); (2) no bulky involvement of mesenteric nodes or critical organs-kidney, urinary tract, or pleura; (3) stages I to III disease (78 percent stage I or IE); (4) no B symptoms; (5) age below 60 years; (6) initial resection as a reflection of localized disease. Paients with advanced-stage non-Hodgkin's lymphoma receiving conservative treatment have a relatively short survival (median, less than five years) regardless of histologic subtype.

Appearance of killer (K) cells in the mesenteric lymph nodes in Crohn's disease

The local lymph node in Crohn's disease contains killer (K) cells which are able to lyse antibody-coated heterologous target cells. K cells are not found in mesenteric lymph nodes from control patients not suffering from Crohn's disease, whereas they are regularly found in similar amounts in the peripheral blood of both controls and patients with Crohn's disease. Even mesenteric lymph node cells from areas not macroscopically affected by inflammatory disease show increased K cell activity as compared to control lymph node lymphocytes, suggesting a generalized mesenteric lymph node involvement with regard to K cell activity in Crohn's disease.

Computed tomographic scanning in patients with lymphoma

Computed tomography (CT) of the chest and abdomen was performed in 40 patients with lymphoma and the results compared to conventional diagnostic techniques. Overall 34 (85%) of 40 CT scans correctly reflected the presence or absence of lymphoma. Close agreement between the findings of lymphography and CT was noted in 26 of 27 cases. CT has particular utility for assessment of lymphomatous involvement of mesenteric lymph nodes, high retroperitoneal lymph nodes, and extranodal abdominal sites other than the spleen or liver (e.g., pancreas, kidney). Abdominal CT is a useful noninvasive diagnostic technique for the initial staging and subsequent evaluation of selected patients with lymphoma.

Basic concepts in non-hodgkin lymphoma

Non-Hodgkin lymphoma is a heterogenous group of lymphoreticular malignancies that can be classified into six major cell types. In comparison with Hodgkin disease, non-Hodgkin lymphoma is more common and tends to occur in older persons. The investigative procedures for clinical and pathologic staging are similar to those used in Hodgkin disease, except that staging laparotomy is performed less frequently. Results of biopsy reflect a high incidence of bone marrow, liver, and splenic hilar and mesenteric lymph node involvement in Non-Hodgkin lymphoma than in Hodgkin disease.

Immunotherapy: its possible application in the management of large-bowel cancer.

The rapidly emerging therapeutic modality of cancer immunotherapy has been applied to a carefully selected group of patients with carcinoma of the large bowel. Patient selection was based on the extent of disease at the time of definitive surgery, and the strict provision that all discernible disease was removed. Thus, 20 consecutive patients who had mesenteric lymph node involvement were subsequently allocated to receive either BCG alone or the combination of 5-FU plus BCG as adjuvant treatment to surgery. After 10 months of patient accrual, all patients were clinically free of disease. Therapy was well tolerated without significant morbidity. Although general immunocompetence of these patients has improved on treatment, it is still too early to say whether immunotherapy will be clinically beneficial. Serial determination of plasma levels of CEA was useful in ruling out suspected recurrent disease. In contrast, preoperative plasma levels of CEA in patients with Dukes' C classification were elevated in only 40%. This indicates that its value in establishing the primary diagnosis is still doubtful.

Primary Lymphoma of the Gastrointestinal Tract

PRIMARY lymphoma of the gastrointestinal tract is diagnosed when tumor involvement of the intestine is the principal anatomic site of disease. The patient has abdominal symptoms that may be acute. Involvement of mesenteric nodes alone is not sufficient to place a patient in this classification. <h3>Nature of the Disease</h3><h3>General.—</h3> A number of characteristics are summarized in Table 5.^31-33 <h3>Staging.—</h3> A very simple staging was used for this discussion, ie, localized or extensive. Bowel perforations, or systemic symptoms, such as fever, weight loss or anemia, that are compatible with the local disease process do not change the staging in localized cases. The localized classification was used for those patients in whom the lymphoma involved the gastrointestinal tract alone or had spread to the regional mesenteric nodes only. There was no difference in the survival of those adult patients who did or did not have proven involvement of the regional

The role of radiography in the staging of non-Hodgkin's lymphoma with laparotomy correlation.

A prospective study of the yield of various routinely performed radiographic examinations in the initial evaluation of 93 patients with previously untreated non-Hodgkin's lymphoma was undertaken. Of these, 69 patients underwent staging laparotomy and, where pathologic correlation was possible, the lymphogram showed a 92% accuracy. Chest radiography, lymphography, and excretory urography are valuable routine procedures. Barium gastrointestinal studies should be employed if specific symptoms are present. Skeletal surveys had a very low yield. The staging laparotomy provides reliable information regarding involvement of spleen, liver, and mesenteric lymph nodes.

Malignant lymphoma in the Saudi Arab.

Forty-three cases of malignant lymphoma in Saudi Arabs were reviewed. Seventy-nine percent showed evidence of intra-abdominal disease when first seen, and 42 percent presented with primary abdominal disease. Jejunal, ileal, and mesenteric lymph node involvement were the most frequent manifestations of primary abdominal disease. The high frequency of primary abdominal lymphoma in Saudi Arabs is comparable with that found in Israel among Arabs and Sephardic Jews, and suggests a common environmental or ethnic factor which modified the expression of malignant lymphoma in Semitic populations.

Malignant Neoplasm of the Gallbladder: Roentgenological Diagnosis

The diagnosis of primary neoplasm of the gallbladder is a clinical problem the preoperative solution of which may be dependent on a thorough roentgenologic study. Because of the importance of this method of examination, a review of available roentgenograms has been undertaken in a search for possible distinctive and diagnostic characteristics. Films were available in 33 cases seen at the Massachusetts General Hospital in which primary cancer of the gallbladder had been histologically proved. Cases in which the tumor was of undetermined origin were excluded. Carcinoma of the gallbladder is not a common disease, the postmortem incidence being approximately 0.4 per cent (6). At this hospital, over the period covered by the present study, carcinoma of the pancreas was diagnosed four times more frequently than carcinoma of the gallbladder. The gross pathological picture of carcinoma of the gallbladder is conditioned by the anatomy of the organ and of the lymphatic drainage (2, 4). The gallbladder is a subserosal sac which lies along the inferior margin of the liver. Its posterior limit, as it joins the cystic duct, is closely related to the superior and lateral aspects of the upper flexure of the duodenal loop. Its anterior limit, the fundus, frequently is at the anterior margin of the liver, and may extend beyond this to be in contact with the anterior abdominal wall. The gallbladder generally lies lateral to the pyloric antrum and medial to the hepatic flexure. Its position, however, is quite variable, depending on such factors as the level and inclination of the inferior surface of the liver and the presence or absence of a gallbladder mesentery. The lymphatics of the inferior surface of the liver drain toward the lymph nodes of the porta hepatis, and the lymphatics of the gallbladder join these. Portal nodes also receive lymphatics from the peripancreatic and mesenteric regions. In addition there is a rich lymphatic and venous anastomosis between the gallbladder and the adjacent liver parenchyma. The histology of primary cancer of the gallbladder has been reviewed amply in the literature (11). The tumor is usually an adenocarcinoma but occasionally is of the squamous variety; sarcomas have been reported. Whatever the type, it is commonly associated with cholelithiasis, and almost invariably with cholecystitis. The carcinoma may form a bulky mass within or around the gallbladder, or it may provoke a scirrhous reaction resulting in a small fibrosed and contracted gallbladder. Direct spread to the liver occurs early. Local metastases to the porta hepatis and liver are frequent, and metastatic involvement of peripancreatic and mesenteric lymph nodes is not unusual. Peritoneal dissemination occurs occasionally, but distant metastases in lung or bone are uncommon. Carcinoma metastasizing to the gallbladder is extremely rare, except as part of a general peritoneal carcinomatosis. In the present series there were 28 adenocarcinomas and undifferentiated carcinomas, 3 squamous-cell carcinomas, 1 adenoacanthoma, and 1 sarcoma. The clinical picture associated with cholecystic cancer is well established (2, 6, 11). The patient is generally a female with moderately acute symptoms (the most common being upper abdominal pain and jaundice) of short duration. Occasionally these have been superimposed on chronic biliary symptoms of much longer duration. In the group presented, 28 of the 33 patients were women. The average age at admission to the hospital was sixty-six years; the youngest patient was forty-eight. The average duration of symptoms was less than six months. Twenty-seven of the 33 patients complained of pain, and in 18 there was jaundice, which was usually the immediate cause for seeking medical advice. Unusual presenting symptoms were the feeling of a mass, vomiting, ulceration of a cholecystostomy scar, and fever.