Ipsilateral Cervical Node Research Articles

舌へん平上皮癌における対側頚部リンパ節転移の検討

The purpose of this study was to analyze the prevalence of and risk factors for contralateral cervical lymph node metastasis (CLNM) from squamous cell carcinoma arising in the mobile part of the tongue.Retrospective reviews of the tumor patient registry between 1985and 1999 revealed 84 patients with newly diagnosed carcinoma of the mobile part of the tongue that had been controlled by initial treatment. Thirteen of these patients (15.5%) had CLNM. On stepwise logistic regression analysis, T-stage, histopathological grade, and level of ipsilateral cervical lymph node metastasis were found to be significant predictors of CLNM. Our results suggest that CLNM is unlikely in patients with T 1 tongue cancer or no involvement of ipsilateral lymph nodes. It was also suggested that we should pay careful attention to CLNM in patients with advancing T-stage, histopathological grade, or level of ipsilateral lymph node metastasis.

Oncolytic herpesvirus effectively treats murine squamous cell carcinoma and spreads by natural lymphatics to treat sites of lymphatic metastases.

Oncolytic herpesviruses have significant antitumoral effects in animal models when delivered directly to established tumors. Lymphatic metastases are a common occurrence for many tumor types. This study investigates the potential of an attenuated, replication-competent, oncolytic herpes simplex virus (NV1023) both to treat a primary tumor by direct injection and to travel through the lymphatic system to treat metastatic tumor within the lymph nodes draining lymph from the site of primary cancer. Isosulfan blue dye was injected into murine auricles to determine normal lymphatic drainage patterns and demonstrated consistent blue staining of a group of ipsilateral cervical lymph nodes. Auricular injections of NV1023 resulted in viral transit to these lymph nodes as measured by 5-bromo-4-chloro-3-indolyl-beta-D-galactopyranoside histochemistry and viral plaque assay. An oncolytic herpesvirus (NV1066) expressing green fluorescent protein also demonstrated viral transit from the auricle to the cervical lymph nodes on fluorescence microscopy. Using the SCC VII cell line, a novel murine model of auricular squamous cell carcinoma was developed with an approximately 20% incidence of cervical lymph node metastases. Delivery of NV1023 or NV1066 to the surgical beds after excision of auricular SCC VII tumors resulted in successful viral infection of metastatic SCC VII cells within the cervical lymph nodes. After a 7-week follow-up, significantly enhanced locoregional control (p < 0.05, Fisher exact test) and disease-free survival (p < 0.05, log rank test) were evident with NV1023 treatment. This study demonstrates that the delivery of an oncolytic herpesvirus to a primary tumor site after surgical excision may have a significant impact on reducing both primary site recurrence and regional nodal metastases.

Parotid gland malignant melanomas.

Malignant melanomas are relatively unusual tumors in the parotid gland. The majority of previously reported cases appear to represent metastatic lesions, often from cutaneous head and neck primaries. Retrospective clinicopathologic review of 12 cases of malignant melanoma involving the parotid gland encountered between 1980 and October 1999 at a tertiary referral center. Patients consisted of 9 men and 3 women ranging in age from 30 to 84 years (median, 66 years). Eleven of 12 patients presented with a neck mass or nodule. In 9 of 12 patients, a cutaneous or conjunctival primary was noted in the head region. In 2 patients, a cutaneous melanoma and the parotid gland melanoma were diagnosed at the same time. In 1 patient, melanoma was initially diagnosed in the parotid gland, and a definite primary was not uncovered. All patients underwent excision of the parotid melanoma, which was accompanied by a lymph node biopsy or dissection in 10 out of 11 patients. Four patients received adjuvant radiotherapy, and 3 patients received adjuvant chemotherapy. Four of 11 patients had ipsilateral cervical lymph node metastasis at the time of parotid tumor resection, and 5 patients had involvement of intraparotid lymph nodes by metastatic melanoma. Tumors ranged in size from 0.3 to 2.5 cm in greatest dimension. Multiple parotid nodules were noted in 4 patients. All tumors were characterized by a diffuse proliferation of cells with abundant eosinophilic cytoplasm and prominent nucleoli. Four tumors demonstrated focal spindle cell regions. Intravascular and/or lymphatic involvement by tumor within the parotid gland was noted in 3 lesions. At last known follow-up, 6 patients had died with tumor at a median follow-up period of 11 months after parotid gland surgery. Four patients were alive with evidence of tumor at follow-up intervals of 4, 17, 21, and 113 months after parotid gland surgery. Two patients were alive with no evidence of residual tumor at 20 and 148 months of follow-up. The majority of melanomas involving the parotid gland appeared to be associated with lymph node metastasis in and around the gland from a cutaneous primary in the head region. Prognosis is generally poor, although rare patients may survive a long period of time following surgery.

Pulmonary lymphangitic carcinomatosis from an oropharyngeal squamous cell carcinoma: a case report

Pulmonary lymphangitic carcinomatosis (PLC), a form of lymphatic spread of cancer cells, from head and neck cancers is extremely rare. We report here a case of PLC from an oropharyngeal squamous cell carcinoma in a 68-year-old man. The patient underwent inductive chemoradioimmunotherapy which resulted in complete tumor remission. The tumor, however, recurred 6 months later and was resected. Late metastasis occurred in the ipsilateral cervical lymph nodes 13 months post surgery and these lymph nodes were dissected. Three months later, the patient suffered from a fever, cough and dyspnea and a chest radiograph revealed an interstitial linear pattern from the right hilum to the right upper lung field. Without diagnosis of the pulmonary lesion, swelling of the bilateral lymph nodes followed after a few months and dyspnea worsened with spread of the reticular shadow and appearance of Kerley's B line on the roentgenogram, suggesting PLC. The patient gradually became more distressed and finally died 6 months after the onset of dyspnea. The microscopy of the autopsied pulmonary tissue revealed tumor cell nests in the lymph vessels in the septa and the pulmonary lesion was histopathologically diagnosed as PLC. The present case indicates that we should consider PLC when cough and dyspnea with reticular shadows and Kerley's B line are observed in patients with head and neck carcinoma.

Ceruminous adenocarcinoma with cervical lymph node metastasis

Ceruminous glands are modified apocrine sweat glands of the external ear. Tumours of the ceruminous glands are rare. Hence we report a case of adenocarcinoma of the ceruminous galnd with ipsilateral cervical lymph node metastasis.

Extraneurale Metastasierung von Hirn- und R�ckenmarktumoren Bericht �ber 2 F�lle

This case report refers to two patients with the rare entity of an extraneural metastasizing central nervous system tumor. The first patient presented with ipsilateral cervical lymph node metastases 4 years after a diagnostic biopsy and 2 years after removal of an anaplastic oligodendroglioma, respectively. The origin of the metastases was confirmed by immunohistochemistry. The second case described was found in a 26-year-old female who had suffered from a spinal cord pilocytic astrocytoma in infancy and been treated by surgery and radiotherapy. On postmortem examination, transformation to a primitive neuroectodermal tumor was found. Morphological and immunohistochemical features of the metastases were exactly identical with those of the primary tumors in both cases. The pathomechanisms of metastasizing CNS tumors are discussed with reference to the reasons why such cases are so rarely observed. The incidence of remote metastases and differences depending on tumor type are estimated. No relation to malignancy grade can be detected.

Hyalinizing clear cell carcinoma of salivary gland.

We describe 11 patients with a distinctive salivary gland neoplasm. Most of the patients were adult women who presented with a painless mass. Nine tumors arose in minor salivary glands of the oral cavity (82%). Microscopically, they were characterized by the formation of trabeculae, cords, islands, and/or nests of monomorphic clear cells that were glycogen rich and mucin negative and were surrounded by hyalinized bands with foci of myxohyaline stroma. Cells with eosinophilic and granular cytoplasm were also noted. Both cell types showed minimal nuclear pleomorphism and a very low mitotic index. The neoplasms all had infiltrative borders. Immunohistochemically, the tumor cells expressed cytokeratins and epithelial membrane antigen, but not S-100 protein and smooth muscle actin. Ultrastructurally, the tumor cells contained abundant glycogen, desmosomes, peripheral tonofilaments, and prominent interdigitating microvilli without actin myofilaments or dense bodies. These immunohistochemical and ultrastructural findings provide evidence of epithelial differentiation without myoepithelial differentiation. For these tumors, we propose the name, hyalinizing clear cell carcinoma (HCCC). These are low-grade malignant neoplasms. Two patients had ipsilateral cervical lymph node metastases at presentation, but with surgical excision and either preoperative or post-operative radiotherapy in three cases, eight of 10 patients with clinical follow-up are alive and well without evidence of recurrence. The mean clinical follow-up is 3.6 years, with a range of 6 months to 11 years. One patient died as a result of surgery, another died of unrelated causes, and one patient was lost to follow-up.

Evidence that precursor cytotoxic T cells mediate acute necrosis in HSV-1-infected retinas

Following uniocular anterior chamber injection of HSV-1 (KOS) in BALB/c and A/J mice, it is paradoxical that (a) acute retinal necrosis (ARN) develops only in the uninjected eyes, and (b) ARN occurs only in mice that are immunocompetent, event though these mice invariably display anterior chamber associated immune deviation (ACAID), wherein delayed hypersensitivity to HSV antigens is grossly impaired. Previous studies have revealed that ARN develops only if the titer of infectious virus in the contralateral eye exceeds 4 Log10 PFU, indicating that virus infection is essential to ARN. However, HSV-1 titers in contralateral eyes of similarly infected athymic mice also exceed 4 Log10 PFU, even though these mice never develop ARN - implying that virus alone is insufficient to cause retinal cell destruction. In an effort to define the pathogenic immune component of ARN, we have evaluated in vitro viral antigen-specific T cell responses in mice with ARN and ACAID. We found that T cells, harvested from draining ipsilateral cervical lymph nodes and contrateral eye proliferate in response to viral antigens, express IL-2 receptors, and include HSV-1-specific precursor cytotoxic T cells (pTc), but not direct cytotoxic T cells (Tc). Since the time of appearance of HSV-specific pTc in the contralateral eye coincides with entry of infectious virus into that eye, and since their mutual appearance heralds the onset of retinal necrosis, we conclude that destruction of the retina is initiated by virus-specific cytotoxic T cells that lyse HSV-infected retinal cells.

Germ cell neoplasms of head and neck soft tissues: A pathologic spectrum of teratomatous and endodermal sinus tumors

Germ-cell neoplasms, in particular teratomas with immature and mature somatic type tissues, are some of the most commonly found tumors in children. Approximately 5% of these neoplasms appear in one of several extracranial sites in the head and neck region. This study reports the clinical, pathologic and immuno-histochemical findings in six germ-cell neoplasms occurring in the neck and facial areas. A mass was recognized at birth in five children, and the sixth patient was 2 1 2 years old at diagnosis. Four of the six neoplasms contained one or another element of endodermal sinus tumor; two of these had a mixed pattern of endodermal sinus tumor and teratoma. The other two cases were purely teratomas. The serum alpha-fetoprotein was known to be elevated in three children whose tumors had endodermal sinus elements; it returned to normal level in two of the children, but remained high in the one fatal case. Placental alkaline phosphatase and alpha-fetoprotein were demonstrated immunohistochemically in two of the three cases, with available tissue containing endodermal sinus tumor. Teratomatous metastases in ipsilateral cervical lymph nodes were found in one patient with a pure teratoma; that patient is disease-free one year after surgery. Only nine previous examples of endodermal sinus tumor have been reported in the head and neck region, exclusive of the central nervous system. There is one other case in the literature of a congenital cervicothyroidal teratoma with metastatic disease. These six neoplasms illustrate the clinical and pathologic spectrum in this nosologically homogeneous, but morphologically diverse, category of tumors.

Sebaceous carcinoma of the ocular adnexa: Radiotherapeutic management

A total of 30 patients with histologically confirmed sebaceous carcinoma of the ocular adnexa were evaluated at our institution from 1974–1986. There were 18 women and 12 men in the series with a median age of 61 years. Ten cases received radiotherapy with curative intent. Four patients were treated definitively with doses ranging from 45–63.0 Gy over 4–7 weeks. Six patients received post-operative radiotherapy to the parotid bed and ipsilateral cervical lymph node chain for parotid metastases developing within 36 months of initial surgical treatment. Patients with lower lid lesions and significant pagetoid histologic components were more likely to develop parotid lymph node metastases. Local control at the primary site after radiation and/or surgery was 90% with follow-up ranging from 2–10 years. Overall disease specific actuarial survival at 5 years was 96%. Radiation therapy is an effective treatment modality in adnexal sebaceous carcinoma. With employment of careful technique and state-of-the-art technology, long term local control and survival with satisfactory cosmetic and functional results can be anticipated.