Jugular Nodes Research Articles

7708 Navigating Thyroid Cancer With Differences in Thyroglobulin Assessment Techniques

Abstract Disclosure: M.S. Shah: None. S. Humayon: None. N.A. Mungo: None. This case report delves into the diagnostic journey of a patient with papillary thyroid carcinoma, emphasizing the importance of precise thyroglobulin measurement methods. The case highlights the differences between immunoassay and mass spectrometry in monitoring disease progression and treatment response.A 42-year-old female with a family history of thyroid-related issues, was found to have a thyroid nodule on physical exam. She underwent fine-needle aspiration (FNA) revealing papillary thyroid carcinoma, Bethesda category VI. Lymphatic invasion was present necessitating total thyroidectomy and lymph node dissection. Left level 3 and 4 lymph node excision showing 2 of 15 positive for metastatic papillary thyroid carcinoma without extranodal extension. Left superficial jugular lymph node excision showing 1 of 3 lymph node being positive for metastatic thyroid carcinoma without extranodal extension. RAI therapy and post-ablative scan showed focal moderate increased activity adjacent to the left hyoid bone. CT scan of the neck later showed stable appearance of the thyroidectomy bed with no new suspicious soft tissue mass. A small crescentic focus of enhancing soft tissue medial to the left common carotid artery is favored to represent residual thyroid tissue. Multiple small enhancing lymph node in the left neck at level llB and junction of levels ll and lll. Several of these are new or increased in size from prior examination and somewhat acidly enhanced. Although these are within normal limits by size criteria, recurrent diseases cannot be excluded. She underwent another surgical neck dissection with no cancer found. Given the negative findings, a shift from checking thyroglobulin (TG) from immunoassay to mass spectrometry was ideal.Patient was found to have persistent thyroglobulin elevation with Immunoassay, thyroglobulin level (60.5 ng/mL, n<35 ng/ml), without the presence of TG antibodies, whereas liquid chromatography-tandem mass spectrometry (LC-MS/MS) showing (<0.5 ng/mL), highlighting the methodological divergence. To date she has no imaging concerns and repeat testing from different labs similarly demonstrated undetectably Tg by LC-MS/MS and varying levels when tested by Immunoassay. Her levels by Immunoassay have trended down to her most recent level of (38 ng/ml).This case emphasizes the critical role of accurate thyroglobulin assessment in thyroid carcinoma follow-up. Immunoassay and mass spectrometry present divergent results, with LC-MS/MS proving more reliable in monitoring disease progression but more expensive and time consuming. Clinicians should consider the implications of methodological choices on patient management, particularly in cases of persistent elevation despite treatment. The potential discrepancies between these methods should be emphasized considering the impact on treatment decisions. Presentation: 6/1/2024

Visualising cervical lymph nodes in jaw osteonecrosis using diffusion-weighted imaging.

This study aimed to apply diffusion-weighted imaging to the evaluation of cervical lymph nodes affected by medication-related osteonecrosis of the jaw (MRONJ). This retrospective study analysed the diffusion-weighted imaging data of 70 patients with or without MRONJ (Stages 0-3). The mean apparent diffusion coefficient (ADC) values of the submandibular (level IB) and superior internal jugular (level IIA) nodes in the control and MRONJ groups were calculated, and differences were analysed using the Mann-Whitney test. Moreover, receiver operating characteristic (ROC) curve analysis was performed to evaluate the ability of ADC values to predict lymph nodes that were affected by MRONJ. p < 0.05 was considered statistically significant. The median [interquartile range] (×10-3 mm2/s) of level IB was 0.74 [0.7-0.81] and 0.93 [0.84-1.09] and that of level IIA was 0.79 [0.76-0.85] and 0.97 [0.84-1.06] in the control and MRONJ groups respectively. ROC analysis revealed that the ADC value had excellent ability to discriminate between the control and MRONJ groups. The study findings indicate that diffusion-weighted imaging can contribute to differentiation of MRONJ from other cervical lymph node diseases and facilitate early detection of MRONJ.

CT-Based Screening for Pulmonary Metastases in Head and Neck Squamous Cell Cancers: Diagnostic Accuracy and Cost Comparison with PET-CECT.

This study's objective was to compare detection rates of radiograph, computed tomography (CT), and positron emission tomography-contrast-enhanced computed tomography (PET-CECT) for pulmonary metastasis/synchronous primary lung tumors in head and neck squamous cell cancer (HNSCC) and its association with clinico-radio-pathological factors. Our retrospective study included 837 HNSCC patients from January 2012 to December 2017. Lung nodules were characterized on CT as benign, indeterminate, and metastatic. The true detection rate and statistical significance of associated risk factors were calculated. Risk factors for metastasis were determined using univariate and multivariate logistic regression models. Seventy-five (8.9%) patients had pulmonary metastasis and 3 (0.3%) had second lung primary. Detection rate of pulmonary metastasis by CT was higher (sensitivity-97.3%, specificity-97.2%) as compared to radiograph (sensitivity 49% and specificity 89%). Correlation was found between pulmonary and extra-pulmonary metastasis and N classification (P = 0.01, P = 0.02) and positive low jugular node (P = 0.001, P = 0.001). Using PET-CECT in place of CT costed an extra outlay of 7,033,805 INR (95,551.85 USD) while detecting distant metastasis in only 4 (0.47%) extra cases. Chest CT is a useful pulmonary metastases screening tool in advanced HNSCC patients with reasonable imaging cost as compared to PET-CT.

Lymphangiography and lymphatic embolisation for the treatment of chyle leaks after neck surgery: assessment of lymphangiography findings and embolisation techniques.

To assess lymphangiography findings and outcome of lymphatic embolisation to manage chyle leak after neck surgery. Consecutive cases of lymphangiography performed between April 2018 and May 2022 for management of chyle leaks related to neck surgery were retrospectively reviewed. Lymphangiography findings, techniques, and outcomes were analysed. Eight patients (mean age: 46.5 years) were included. Six patients had undergone radical neck dissection for thyroid cancer, and two had undergone lymph node excision. Clinical presentations were: chyle drainage through Jackson Pratt catheters in five patients, lymphorrhea through surgical wounds in two, and enlarging lymphocele in one. Lymphangiography techniques included: inguinal lymphangiography in four patients, retrograde lymphangiography in three, and transcervical lymphangiography in one. Lymphangiography revealed leaks in the terminal thoracic duct in two patients, bronchomediastinal trunk in two, jugular trunk in three, and superficial neck channels in one. Embolisation techniques included: non-selective embolisation of terminal thoracic duct (n = 2), selective embolisation of the jugular trunk (n = 3), selective embolisation of the bronchomediastinal trunk (n = 2), and intranodal glue embolisation of superficial neck channels (n = 1). One patient underwent a repeat procedure. Chyle leak resolved in all patients over a mean of 4.6 days. No complication was encountered. Lymphatic embolisation seems to be effective and safe in managing chyle leaks after neck surgery. Lymphangiography allowed for the categorisation of chyle leaks according to their location. Post-embolisation patency of the thoracic duct may be preserved in chyle leaks that do not directly involve the thoracic duct. Lymphatic embolisation is safe and effective in managing chyle leaks after neck surgery. On lymphangiography, the location of contrast media extravasation may not be consistent. The technique for embolisation should be based on the location of the leak. Post-embolisation patency of the thoracic duct may be preserved in chyle leaks that do not directly involve the thoracic duct.

Dual-energy computed tomography for improved visualization of internal jugular chain neck lymph node metastasis and nodal necrosis in head and neck squamous cell carcinoma.

To evaluate and compare the utility of 40-keV virtual monochromatic imaging (VMI) reconstructed from dual-energy computed tomography (DECT) in the assessment of neck lymph node metastasis with 70-keV VMI, which is reportedly equivalent to conventional 120-kVp single-energy computed tomography. Patients with head and neck squamous cell carcinoma who had neck lymph node metastasis in contact with the sternocleidomastoid muscle (SCM) and underwent contrast-enhanced DECT were included. In 40- and 70-keV VMI, contrast differences and contrast noise ratio (CNR) between the solid component of neck lymph node metastasis (SC) and the SCM and between SC and nodal necrosis (NN) were calculated. Two board-certified radiologists independently and qualitatively evaluated the boundary discrimination between SC and SCM and the diagnostic certainty of NN. We evaluated 45 neck lymph node metastases. The contrast difference between SC and SCM and SC and NN were significantly higher at 40-keV VMI than at 70-keV VMI (p < 0.001). The CNR between SC and SCM was significantly higher at 40-keV VMI than at 70-keV VMI (p < 0.001). Scoring of the boundary discrimination between SC and SCM as well as the diagnostic certainty of NN at 40-keV VMI was significantly higher than that at 70-keV VMI (p < 0.001). The inter-rater agreements for these scores were higher at 40-keV VMI than at 70-keV VMI. Additional employing 40-keV VMI in routine clinical practice may be useful in the diagnosis of head and neck lymph node metastases and nodal necrosis.

Suppuration in the adult Lincoln’s highway-surgeon’s dilemma

The carotid sheath enclosing the common carotid artery, internal jugular vein, vagus and the deep jugular lymph nodes continues around the vessels of the superior mediastinum. This sheath formed by the investing fascia, prevertebral fascia and the pre-tracheal fascia is captioned the Lincoln s highway. Suppurative pathology of the Lincoln highway presents as a vertical swelling at the anterior border of the sternomastoid. USG, CT and MRI confirms the diagnosis and prompts surgical intervention and thus prevents intra thoracic spread with its morbidity and mortality.

Quantitative analysis of age-related changes in cervical lymph nodes using diffusion-weighted imaging

ObjectivesThis study aimed to investigate age-related changes in apparent diffusion coefficient (ADC) values of cervical lymph nodes using diffusion-weighted imaging (DWI). MaterialsWe conducted a retrospective cohort study of patients who underwent pantomography and magnetic resonance imaging (MRI) between November 2017 and July 2018. The participants comprised 101 patients with 389 nodes (males: 22, females: 79, mean age: 44.33 [range: 14–77] years). The correlation between the age group of the criterion variable and ADC value of the explanatory variable was analyzed using Spearman's correlation coefficient. p < 0.05 was considered statistically significant. ResultsThere was a significant negative correlation between age and the ADC values for each sex (p < 0.001). The mean ADC value of the submandibular nodes for all age groups was 0.88 ± 0.15 × 10−3 mm2/s in men and 0.83 ± 0.12 × 10−3 mm2/s in women (p = 0.211). The mean ADC value of the superior internal jugular nodes for all age groups was 0.90 ± 0.14 × 10−3 mm2/s in men and 0.91 ± 0.16 × 10−3 mm2/s in women (p = 0.857). ConclusionsThis study demonstrated that normal ADC values of cervical lymph nodes exhibited significant negative correlation with increasing age. These findings could be useful for the diagnosis of cervical lymph node diseases, including malignant tumors.

Subcutaneous axillary primary epithelioid hemangioendothelioma: report of a rare case

BackgroundEpithelioid hemangioendothelioma (EHE) is a rare and slow-growing malignant vascular neoplasm composed of epithelioid endothelial cells within a distinctive myxohyaline stroma. It most commonly involves somatic soft tissue, lungs, liver and bone. Herein, we describe a case of EHE arising in the axillary region.Case presentationA 61-year-old man was under observation for multiple hepatic hemangiomas. Fluorodeoxyglucose–positron emission tomography/computed tomography showed specific uptake in a right axillary tumor. The patient was referred to our department for further investigation of the axillary tumor. An elastic-soft and poorly mobile tumor was palpable in the right axilla. Contrast-enhanced computed tomography showed a right axillary tumor and enlarged hepatic hemangiomas. In addition, multiple nodules in both lungs, a left renal angiomyolipoma, and left adrenal adenoma were revealed. Ultrasonography showed masses in both lobes of the thyroid gland, and a 30-mm lobulated hypoechoic mass in the axilla with well-defined and rough borders, showing internal heterogeneity. Fine-needle aspiration cytology was performed on the thyroid and axillary tumors: the thyroid tumor was class V, raising suspicion of papillary thyroid cancer (PTC); the left superior internal jugular node was class V, raising suspicion of metastasis of PTC; and the axillary tumor was class III, raising suspicion of a mesenchymal tumor with few epithelioid cells. The multiple lung nodules were diagnosed as metastatic tumors derived from thyroid cancer. We diagnosed these diseases as PTC of T1b(m)N1bM1(lung) Stage IVB and a right axillary tumor of unclear origin. However, it was assumed to be a primary mesenchymal tumor or a lymph node metastasis from lung cancer or occult breast cancer. We performed total thyroidectomy, left cervical lymph node dissection, and right axillary tumor excision. Histopathologic examination revealed the thyroid tumor as a PTC and the axillary tumor as an EHE. The EHE showed nuclear atypia, necrosis and high mitotic figures. Hence, it was considered to be a high-risk EHE.ConclusionsWe experienced a rare primary subcutaneous axillary EHE with metastatic thyroid cancer in the lung. Since our case was classified as a high-risk EHE, a close follow-up would be appropriate.

Do not Forget the ‘Forgotten Disease’ in the Covid Era: A Case Report of Lemierre’s Disease with a Rare Complication of Acute Renal Failure

<strong>Background:</strong> Lemierre’s disease, also known as the “Forgotten disease”, is a rare yet rapidly deteriorating clinical entity associated with high morbidity and mortality. We present a unique case of acute renal failure in Lemierre’s Disease which has not been previously reported in published literature. <strong>Case report:</strong> An obese 18-year-old female with intermittent asthma presented with a one-week history of sore throat, dysphagia and odynophagia associated with anuria. She was found to be in severe sepsis with tachycardia (163 bpm), hypotension (BP 113/43) and acute renal failure with bilateral tonsillar exudates, mild anterior neck swelling and trismus. Initial labs were also significant for leukocytosis (WBC 29.4 k/ul), transaminitis (AST 1115 u/L, ALT 240 u/L), and severe rhabdomyolysis (creatine kinase 96848 u/L). She received intravenous fluids with good response and started on vancomycin and piperacillin-tazobactam. Initial infectious work-up was negative for group A streptococcus (throat), SARS-CoV-2 PCR and antibody, HIV, RPR, EBV, hepatitis A/B/C. Initial chest x-ray revealed bilateral nodular opacities with likely miliary distribution for which TB evaluation was considered but later aborted. Admitting diagnoses were severe sepsis from soft tissue infection (neck vs. pneumonia) with possible bacteremia and acute renal failure (pre-renal exacerbated by severe rhabdomyolysis). The patient’s case was complicated early on by the development of anuric renal failure (creatinine 7.5 mg/dL) and hyperkalemia for which she required hemodialysis by day 3 of hospitalization. Other complications included respiratory distress and hypoxia requiring transient BiPAP support and transiently elevated pro-BNP and troponin which all spontaneously resolved. An echocardiogram revealed borderline normal LV systolic function. A non-contrast head and neck CT showed asymmetric enlargement of the left parotid gland and palatine tonsil with no obstruction and enlargement of left internal jugular lymph nodes compatible with reactive changes. On the 4th hospital day, the initial blood culture was found to be positive forFuscobacterium necrophorum, for which metronidazole was added pending culture sensitivity results. Due to concerns for septic thromboemboli, contrast CT studies of the head, neck and chest were done revealing multiple large bilateral pulmonary nodules with cavitation and bilateral lower lobe consolidation concerning for septic emboli and pneumonia as well as diminished calibre and poor opacification of the left internal jugular (IJV) concerning for thrombosis, solidifying the diagnosis of Lemierre’s Disease. A Doppler ultrasound of the neck showed diminished flow through the left IJV and a venogram study confirmed the presence of the left IJV thrombus. In consultation with vascular surgery and interventional radiology specialists, it was decided that medical anticoagulation with heparin was preferable over thrombectomy. An abdominal CT on hospital day 9 further revealed bilateral renal infarcts thought to be from septic emboli. The patient completed a course of piperacillin-tazobactam and transitioned from heparin infusion to apixaban once repeat studies showed resolution of LIJV thrombus. She underwent 8 cycles of dialysis over the period of two weeks with subsequent spontaneous return of adequate renal function without need for further dialysis. <strong>Discussion:</strong> Lemierre’s disease presents with fever, sore throat, lymphadenopathy, thrombosis of IJV and metastatic infection to other organs, mainly the lungs. This patient’s case was uniquely complicated by renal infarcts from septic emboli with acute kidney failure requiring hemodialysis. With antibiotics, anticoagulation and hemodialysis, the patient has fully recovered without any long-term organ system deficits.

The Diagnostic Yield of Excisional Biopsy in Cervical Lymphadenopathy: A Retrospective Analysis of 158 Biopsies in Adults.

Cervical lymph nodes are the most common site of peripheral lymphadenopathy. The underlying etiologies are usually benign and self-limiting but may include malignancies or other severe life-threatening diseases. The aim of the current study was to investigate the various underlying pathologies of cervical lymphadenopathy as assessed by the diagnostic yield of excisional lymph node biopsies of the neck in a tertiary adult practice. The evaluation was performed in light of previous literature and regional epidemiological patterns. Retrospective analysis of hospital charts of 158 adult patients who underwent an excisional biopsy for suspected cervical lymphadenopathy at a tertiary referral head and neck service between January 2017 and December 2019. The most common underlying pathology was unspecific and/or reactive lymphadenitis in 44.5% of specimens, followed by malignant disease in 38.6% of cases. An age above 40 years was significantly correlated with an increased likelihood of malignant disease. Lower jugular and posterior triangle lymph nodes showed higher malignancy rates than other groups (100% and 66.7%, respectively). The overall surgical complication rate was 2.5%. The results of the current study serve as an indicator of the variety of etiologies causing cervical lymphadenopathy. In particular, given the increasing incidence of malignant diseases in recent decades, the findings should alert physicians to the importance of lymph node biopsy for excluding malignancy in persistent cervical lymphadenopathy especially in older adults. The findings emphasize the value of excisional lymph node biopsy of the neck as a useful diagnostic tool in adult patients with peripheral lymphadenopathy.

Papillary Microcarcinoma: AN Epidemiological, Clinical, therapeutic and Prognostic Study of 35 Cases

Papillary microcarcinoma of the thyroid is defined as cancers having a diameter equal or inferior to 10 mm in the anatomopathological examination; The problematic of this pathology lies in its latent character, it is, thus, much more frequent than we thought or predicted. That is why, beyond specifying the epidemiological and clinical characteristics of papillary thyroid microcarcinoma, our ultimate goal was to determine the "gold standard" for the management of this entity.&#x0D; We carried out a descriptive retrospective study spread over 4 years including all cases of Papillary Microcarcinoma of the thyroid diagnosed within the department of ENT and Head and Neck Surgery of the medical center Mohammed VI in Marrakech; We collected 35 cases, and using their medical records we summarized their epidemiological, clinical and paraclinical data.&#x0D; None of our patients had a normal clinical examination, the palpation of our patients showed an isolated nodule in 20% of patients, the rest of our patients had clinically bilateral noticeable nodes. 80% of which were not clinically suspicious, and only three of our patients had palpable lymph nodes which was confirmed by the ultrasound, where the major suspicious character was their hypoechoic character ( 17 % were EU-TIRADS 5 ) With regard to surgical treatment, 28 of our patients (80%) underwent total thyroidectomy as a first step,4 patients underwent secondary totalization during the same operation after the extemporaneous examination came back positive for papillary microcarcinoma , 2 cases of remote loboisthmectomy after final histological examination showing papillary microcarcinoma , and one final case of totalization after extemporaneous examination of a superior right jugular lymph node with central necrosis. Neck dissection was performed in three cases. Postoperative outcomes were simple in all patients. Isotopic totalization by iodine 131 therapy was performed in four of our patients. Their indications were respectively: infiltrating tumor, extension to neighboring parenchyma, multifocality, lymph node metastasis. The survival rate of our series was 100%. The therapeutic protocol of papillary microcarcinoma is punctuated, to this day, with controversy, and faces a conservative attitude versus a radical one, it is the surgeon's duty to distinguish between the two attitudes.

Cerebellar Tuberculoma in a Patient with Lung Tuberculosis New Case: A Case Report

Background: Tuberculosis (TB) is an infectious disease which can occur in the lungs and extra lung. One kind of extra lung TB is Cerebellum tuberculoma, which is one of rare manifestations form of TB, difficult to diagnosed, because sign and symptom is not specific.Case: A 17-year-old female presented a TB symptoms. She also had contact with her neighbor that was diagnosed with TB. In physical examination there was reduced motor function on her right extremities. Chest radiology revealed opacities in 2/3 superior in the left lung before treatment. Computed Tomography (CT) head scan with contrast showed ring contrast enhancement in left subcortical hemisphere cerebellum with size as 1.8 x 1.8 x 1.7 cm. Multiple lymphadenopathy in right-left upper-aid jugular and lymph node subcentimeter in right of submandibular, right-left lower jugular with varieties of size, the biggest is 1.6 x 1.5 cm. After 6 months treatment the tuberculoma of cerebellum was gone. Conclusion:Cerebellum tuberculoma is a rare presentation of active TB. Radiological imaging plays an important role in the diagnosis and monitoring of the disease. The appereance of tuberculoma on our patient CT showed nodular-enhancing lesion. Intracranial tuberculoma should be treated conservatively, since the majority of these lesions resolve completely with Anti-Tuberculosis Drugs (ATD). Our patient started ATD and the lesions completely disappeared within 6 months. We wanted to present our case due to well-responded to ATD and being an example of atypical presentation of tuberculosis both clinically and radiologically.

Papillary Thyroid Carcinoma Associated with Caseating Granulomatous Inflammation: A Case Report from United Arab Emirates

The study presents the case of a 37-year-old female expatriate who was referred with a neck swelling and was managed further in Tawam Hospital, Al Ain. Initial ultrasonography and fine needle aspiration cytology from the right thyroid nodule confirmed papillary carcinoma of thyroid Bethesda type 6 and fine needle aspiration cytology from the right mid jugular lymph node proved metastasis from the primary. Further evaluation by CT scan neck with contrast and a total thyroidectomy and bilateral selective neck dissection was done.

Pathologic Analysis of Submandibular Triangle and Jugular Chain Lymph Nodes in Oral Cavity Squamous Cell Carcinoma

Pathologic Analysis of Submandibular Triangle and Jugular Chain Lymph Nodes in Oral Cavity Squamous Cell Carcinoma

Is the Internal Jugular Node Dissection without Level V Sufficient in Patients with Papillary Thyroid Carcinoma with Lateral Neck Node Metastasis?

Is the Internal Jugular Node Dissection without Level V Sufficient in Patients with Papillary Thyroid Carcinoma with Lateral Neck Node Metastasis?

Dissection of posterior triangle and lower deep jugular lymph node is mandatory in therapeutic neck dissection as a part of treatment for squamous cell carcinoma of oral cavity with clinically N1 neck

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; In India oral cancer is the commonest malignant neoplasm, accounting for 20-30% of all cancers. Southern India presents the highest oral cancer incidence rates among women worldwide.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study was conducted in R. L. Jalappa Hospital and Research Centre and SDU Medical College Kolar, Karnataka. Thirty patients having oral squamous cell carcinoma with clinically N&lt;sub&gt;1 &lt;/sub&gt;neck undergoing modified radical neck dissection between December 2010 and June 2012 were enrolled in the study. The objective of study was to determine whether dissection of posterior triangle and lower deep jugular lymph node is mandatory in therapeutic neck dissection as a part of treatment for squamous cell carcinoma of oral cavity with clinically N&lt;sub&gt;1 &lt;/sub&gt;neck. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of 24 patients, 16 patients underwent wide excision with hemimandibulectomy. In these 16 cases, 2 patients had reconstruction with double flap while rest 14 cases with island pectoralis major myocutaneous flap. Out of remaining 8 patients, 2 patients underwent marginal mandibulectomy. In all these 8 patients, reconstruction was done using nasolabial flap in 1 patient, buccal pad of fat in 2 patients, masseter flap in 1 patient and forehead flap in 4 patients. In carcinoma anterior 2/3&lt;sup&gt;rd&lt;/sup&gt; tongue, all 6 patients underwent hemiglossectomy with simultaneous modified radical neck dissection.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; It was concluded that during neck dissection, it may be oncologically safe to avoid level IV and level V clearance in buccal mucosa squamous cell carcinoma with N&lt;sub&gt;1&lt;/sub&gt; neck.&lt;/p&gt;

Frequency of metastasis to posterior triangle and lower deep jugular lymph nodes in patients with squamous cell carcinoma of oral cavity having clinically N1 neck

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Oral cancer is the sixth most common cancer in the world and is largely preventable. The objective of the study is to find out the frequency of metastasis to posterior triangle lymph nodes and lower deep jugular (supraclavicular) lymph nodes in patients with squamous cell carcinoma of oral cavity having clinically N&lt;sub&gt;1 &lt;/sub&gt;neck.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A hospital based prospective study.&lt;strong&gt; &lt;/strong&gt;This prospective study was conducted in R. L. Jalappa Hospital and Research Centre and SDU Medical College Kolar, Karnataka. 30 patients having oral squamous cell carcinoma with clinically N&lt;sub&gt;1 &lt;/sub&gt;neck (single ipsilateral lymph node less than 3cms in diameter) undergoing modified radical neck dissection in R. L. Jalappa Hospital and Research Centre. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our study, 4 were male (13%) and 26 were females (87%). The age of the patients ranged from 41-70 years with a mean age of 53 years.&lt;strong&gt; &lt;/strong&gt;Majority of primary tumours were buccal mucosa tumours (24). We had 6 anterior 2/3&lt;sup&gt;rd&lt;/sup&gt; tongue tumours. The primary tumour staging included 17 T&lt;sub&gt;2 &lt;/sub&gt;lesions (57%), 3 T&lt;sub&gt;3 &lt;/sub&gt;lesions (10%), 10 T&lt;sub&gt;4 &lt;/sub&gt;lesions (33%) in patients with buccal mucosa carcinoma, fourteen patients had T&lt;sub&gt;2 &lt;/sub&gt;disease, 9 patients had T&lt;sub&gt;4&lt;/sub&gt; and one patient had T&lt;sub&gt;3&lt;/sub&gt; disease.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Most common nodal involvement in buccal mucosa carcinoma was level Ib (submandibular lymph node). The incidence of level IV (supraclavicular) and level V (posterior triangle) lymph node metastasis is low in buccal mucosa carcinoma patients with clinically N&lt;sub&gt;1&lt;/sub&gt; neck.&lt;/p&gt;

Incidence and Risk Factors of Distant Metastases of Head and Neck Carcinoma.

Head and neck carcinomas are characterized by frequent metastases to cervical lymph nodes and locoregional recurrence. By contrast, distant metastases (M1) are seldom detected. This study retrospectively analyzed patients with head and neck cancer who were treated at the Department of Otorhinolaryngology of F. D. Roosevelt Faculty Hospital in Banska Bystrica in 2011-2017. M1 incidence, localization, and risk factors were determined, as well as time to development of M1, methods of M1 diagnosis, and patient survival. M1 was diagnosed in 50 (10.5%) of 474 patients and was significantly more frequent in patients with oropharyngeal cancer, more extensive primary tumors (T3 and T4 status), nodal disease (N2 and N3 status), and poorly differentiated carcinomas. M1 was most often detected in the lungs (59%) and skeleton (47%). M1 was detected by computed tomography (CT) scans in 84% of patients and by, positron emission tomography/CT (PET/CT) in 12%. Mean patient survival was 10.4 ± 3.5 months, with two patients being in remission. M1 is detected most frequently by CT scans. PET/CT screening is indicated in patients with risk factors, including metastases to 3 lymph nodes or bilateral lymph nodes, lymph nodes &gt;6 cm, low jugular lymph node metastases, or regional recurrence. Curative treatment is possible for patients with good performance status, solitary M1, and locoregional remission. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers. Submitted: 22. 2. 2019 Accepted: 30. 5. 2019.

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.

Patterns of local extension and nodal involvement from 1300 nasopharyngeal carcinoma patients: An imaging-based predictor of distant metastases.

e17516 Background: Distant metastasis is a main determinant of prognosis in patients with nasopharyngeal carcinoma(NPC). We explored the patterns of disease spread in NPC patients and identified the pattern correlates with distant metastases. Methods: The imaging documents of 1300 consecutive newly diagnosed nasopharyngeal carcinoma between 2012 and 2016 were reviewed. According to the incidence rates of tumor invasion, the anatomic sites were classified into high-risk group (≥50%), medium-risk group (≥10%~ &lt; 50%) and low-risk group ( &lt; 10%). The location of lymph nodes was determined by 2013 updated guidelines for neck node levels. Additionally, we developed a novel classification based on tumor spreading patterns, as shown in Table. Moreover, we validated the prognostic accuracy of the classification in a validation cohort from a different institution, 241 non-metastatic NPC patients were retrospectively enrolled. Kaplan-Meier method and log-rank test were used to analyze all time-to-event data. Results: The incidence rates of tumor invasion were 0.2% ~91.2%, 95.2% cases across the midline. If anatomic sites in high-risk group or median-risk group were involved, the incidence rates in adjacent medium-risk sites or low-risk group were increased. On the contrary, the incidence rates were decreased when the adjacent high-risk sites or median-risk group were not involved. 85.9% cases had involved lymph nodes. Only 3.9% had skip metastases. The incidence rates of nodal involvement were increased when adjacent upper nodal level was involved. In validation cohort, distant metastases were present in 32/241 NPC patients (13.3%) and 3-year distant metastasis-free survival(DMFS) in local, superior, inferior, and mixed type were 95.0%, 91.3%, 89.0%, and 78.7%, respectively. Cumulative survival curves for former three patterns were relatively similar and were clearly separated from mixed type. DMFS was significantly lower for patients with mixed type pattern than for those with other patterns(P = 0.018). Conclusions: Local disease in NPC patients spreads stepwise from proximal sites to more distal sites. The frequency of metastases in the jugular lymph node chains decreased in the cranio-caudal direction. Based on the patterns of tumor extension, an imaging-based predictor of distant metastases was developed and may be used as a prognostic marker for selecting patients to further systemic treatments. [Table: see text]