Lateral Retropharyngeal Nodes Research Articles

Lymphatic drainage of the nasal fossae and nasopharynx: Preliminary anatomical and radiological study with clinical implications

The lymphatic pathways of the nasal cavity are of enormous clinical importance. To date there has been no accurate radiographic record of these pathways. Four halves of the head and neck from 2 fresh human cadavers were studied. The capillary network arises from the mucous membrane of the atrium, the turbinates, the floor of the nasal cavity, and the nasopharynx. They drain into the lateral pharyngeal and retropharyngeal lymph nodes. There is 1 lymphatic communication at the junction of the lateral posterior wall of the turbinates and the nasopharynx and another communication between 2 groups of lymph nodes situated between the origin of the facial artery and the bifurcation of the carotid artery. A rich avalvular lymph capillary network exists in the mucous membrane and 2 major lymph collecting vessels course through the parapharyngeal space to multiple first tier lymph nodes.

Transoral resection of thyroid cancer metastasis to lateral retropharyngeal nodes

Lymph node metastasis from differentiated thyroid carcinoma may occur outside of the basins at greatest risk of spread, such as the lateral retropharyngeal lymph nodes. The extensive surgery of traditional approaches to the retropharyngeal space are rarely justified in the treatment of metastatic differentiated thyroid cancer. Therefore, a less invasive surgical approach is advantageous in resection of metastatic lateral retropharyngeal nodes. To assess feasibility and safety, we report transoral excision guided by preoperative ultrasonography in a series of 3 consecutive patients with differentiated thyroid cancer metastatic to the retropharyngeal space. In all cases, the metastatic lateral retropharyngeal lymph node was successfully removed by transoral retropharyngotomy without complications. We advocate a transoral approach guided by preoperative ultrasonography for resection of differentiated thyroid cancer metastatic to the retropharyngeal lymph nodes. The approach is feasible, minimally invasive, and safe in achieving the goals in management of regionally metastatic disease.

Retropharyngeal lymph node metastases from oral cancer: A report of 2 patients

The prognosis is extremely poor for patients with head and neck cancers involving the lateral retropharyngeal (RP) lymph nodes. The literature contains very few reports concerning RP node metastases from oral cancers, because the majority deal with pharyngeal cancers. We report and document 2 cases with RP node metastases from oral squamous cell carcinomas (SCC) observed during a recent 10-year period.

En bloc resection of the primary tumour and cervical lymph nodes through the parapharyngeal space in patients with squamous cell carcinoma of the maxilla: a preliminary study

We retrospectively studied 72 patients with maxillary carcinoma (48 of the gingiva, 22 of the antrum, and one each of the hard palate and maxillary bone). The 5-year survival was 73% for those with gingival carcinoma, and 45% for those with antral carcinoma. Nine patients died of local recurrence, three of cervical metastases, six of distant metastases, and five died of metastases in lateral retropharyngeal nodes despite successful control of local and regional disease. We have recently done en bloc resections of the maxilla and cervical lymph nodes through the parapharyngeal space for patients with posteriorly invasive maxillary cancer accompanied by lymph node metastases in the upper jugular region.

MR study of lateral retropharyngeal lymph nodes at different ages

The purpose of this study was to investigate the age-related morphologic changes of the lateral retropharyngeal lymph nodes using MR imaging. The maximal axial diameter of the nodes was measured on the MR image in 120 healthy subjects (younger group 6-19 years (n = 40), middle group 20-38 years (n = 48), older group 42-74 years (n = 32)). Between-group differences in the diameter of the nodes were analyzed. Mean values of the maximal axial diameter of the nodes were 9.0 +/- 1.6 mm, 6.6 +/- 1.7 mm, and 5.3 +/- 1.6 mm, corresponding to younger group, middle group, and older group, respectively ( P <.01). The information obtained in the current study is useful for the differential diagnosis of normal and abnormal lateral retropharyngeal lymph nodes according to age.

Papillary thyroid carcinoma metastasis to the parapharyngeal space

Thyroid papillary carcinoma presenting as a pharyngeal mass is a rare clinical occurrence and has only been reported sporadically. We present here two patients who had papillary carcinoma metastasis of the thyroid gland to the parapharyngeal space. Each patient had a different clinical progress. Upward lymphatic spread of the tumor to involve the parapharyngeal space via the lateral retropharyngeal nodes was indicated. This pattern of spread is in keeping with Rouviere's description of a direct lymphatic pathway from the thyroid gland to the retropharyngeal nodes and parapharyngeal space.

Topographical analysis of lymphatic pathways from the meso- and hypopharynx based on minute cadaveric dissections: possible application to neck dissection in pharyngeal cancer surgery.

To facilitate the development of new operative procedures for pharyngeal cancer, it is important to understand the precise location of the lymph nodes and their pathways. Minute dissection of 22 neck-halves (11 adult cadavers) was undertaken to determine the location and topographical relationships of the lymphatics of the pharynx. Four groups of lymph nodes on the drainage pathways from the meso- and hypopharynx to the internal jugular nodes were classified according to their topographical relationships to the carotid arteries: lateral pharyngeal, superior thyroid, lateral retropharyngeal and medial retropharyngeal nodes. Lymphatics from the mesopharynx passed laterally to lateral pharyngeal or jugulodigastric nodes or slightly upward to lateral retropharyngeal nodes. Lymphatic drainage from the hypopharynx was multidirectional with the pathways being classified as follows: ascending pathway to the lateral pharyngeal and lateral retropharyngeal nodes, lateral pathway to the internal jugular chain, and descending pathway connecting to the uppermost vessels ascending from the recurrent laryngeal nerve chain. In addition, a contralateral pathway was found originating from the hypopharynx extending to the contralateral internal jugular chain. These findings provide valuable information for comparison with CT and MRI studies, as well as with clinicopathological data, to clarify the precise mode of metastasis in head and neck cancers. These results are also applicable to neck dissection in meso- and hypopharyngeal cancers.

The parotid, mandibular and lateral retropharyngeal lymph nodes of the camel (Camelus dromedarius).

The parotid, mandibular and lateral retropharyngeal lymph nodes of the dromedary camel were examined using both light and electron microscopy. All three lymph nodes were lobulated. They did not show the characteristic medulla, cortex and paracortex of typical lymph nodes. Instead, they contained lymphatic nodules, dense anodular lymphoid tissue and diffuse lymphoid tissue dispersed throughout the lymph node. Networks of sinuses were present in the diffuse lymphoid tissue. The diffuse lymphoid tissue in the periphery of all lymph nodes examined was characterized by numerous erythrocytes within and around its network of sinuses. The nodal sinuses were contiguous with the septal vessels, which are considered the possible source of erythrocytes seen in this study. The lymph nodes that were seen in this study resembled the haemolymph nodes of other mammals with regard to their content of erythrocytes but were unique in being located in sites that were typical of ordinary lymph nodes. Morphometric analysis has shown that the percentage volume densities of the stroma and the various parenchymal components were similar in the three lymph nodes.

Diagnostic investigation of chronic porcine reproductive and respiratory syndrome virus in a breeding herd of pigs

Forty-five sows and 15 boars were selected at random from a breeding herd known to be chronically infected with porcine reproductive and respiratory syndrome virus (PRRsv) and lymphoid, immune-privileged, and...

局所再発に伴い両側の咽頭後リンパ節に転移を生じた下顎歯肉癌の１例

Metastasis to the lateral retropharyngeal lymph nodes frequently occurs in nasopharyngeal cancers; however, it is very rare in oral carcinomas. This report describes a case of recurrent carcinoma of the lower alveolus with metastasis to retropharyngeal lymph nodes. The patient was an 84-year-old woman who underwent radical neck dissection with marginal resection of the right side of the mandible for a squamous cell carcinoma arising in the lower gingiva (T 2 N 1 M 0). Twenty-five months after the operation, she complained of a mass with ulceration in the floor of the mouth. A smear of the ulcer proved tumor recurrence. Computed tomography and magnetic resonance imaging showed that the mass invaded the tongue, with metastasis to the submental and bilateral metastases to the retropharyngeal lymph nodes. The patient and her family refused salvage treatment. She died of tumor 6 months after recurrence.

Paranasopharyngeal Space Involvement in Nasopharyngeal Cancer: Dectection by CT and MRI

Paranasopharyngeal tumour extension (PTE) from nasopharyngeal carcinoma (NPC) is staged in its own subgroup in the American Joint Committee on Cancer classification. Most large clinical trials use computed tomography (CT) to stage PTE, but diagnosis relies on indirect signs of tumour invasion such as asymmetry of the parapharyngeal fat. Magnetic resonance imaging (MRI) has the advantage of directly revealing PTE because of its ability to depict the complex anatomical structures that form the boundary of the nasopharynx. The aim of this study was to compare CT and MRI in the identification of PTE and to determine whether the imaging modality used influenced staging of the disease.The MRI and CT scans of 78 patients (156 parapharyngeal regions) with NPC were assessed for PTE. On MRI, PTE was considered to be positive when there was tumour invasion through the complex anatomical structures of the nasopharyngeal wall. When using CT, it was considered positive when there was: (1) distortion of the parapharyngeal fat plane; or (2) extension beyond a line drawn from the medial pterygoid plate to the lateral aspect of the carotid artery. CT scanning and MRI were compared.PTE was judged to be present in 28 of 78 (36%) patients by MRI and in 41 of 78 (53%) scanning by CT when using criterion 1 or 2. An analysis of the discordant findings revealed that MRI was positive in three sides of the nasopharynx in early tumour extension through the pharyngobasilar fascia but not identified with CT by using criterion 1 or 2. MRI was negative in 20 and 21 sides of the nasopharynx that were judged to be positive on CT by using criterion 1 and 2 respectively. In these patients MRI revealed that the positive CT scan was caused by a large tumour compressing but not invading the parapharyngeal fat space, a metastatic lateral retropharyngeal node, or a combination of the two.The imaging modality used for staging NPC has an impact on the staging of PTE. CT scanning suggested the presence of PTE more frequently than MRI because of its inability to distinguish the primary tumour from lateral retropharyngeal nodes, and direct tumour invasion of the parapharyngeal region from tumour compression. The imaging modality and criteria used for staging PTE should be taken into consideration when assessing the results of clinical studies.

副咽頭間隙に転移をきたした甲状腺癌例

The parapharyngeal space is a complex area where a variety of both primary and metastatic neoplasms can originate. Metastatic lymph nodes in this region are common in pharyngeal squamous cell carcinoma. However it is a rare clinical occurrence that a metastatic thyroid carcinoma occupies the parapharyngeal space. We reported a 58-year-old male who had been operated upon for a thyroid carcinoma at 44 years of age and had a large metastatic lymph node in the right parapharyngeal space. We removed the metastatic lymph node by the mandibular swing-transcervical approach. Rouviere described a direct lymphatic pathway from the posterior surface of the superior thyroid lobe to lateral retropharyngeal lymph nodes. The possibility must be considered that thyroid carcinoma existing in that particular region can metastasize to the parapharyngeal space.

Development of a model of natural infection with Mycobacterium bovis in white-tailed deer.

The objective of this study was to develop a suitable experimental model of natural Mycobacterium bovis infection in white-tailed deer (Odocoileus virginianus), describe the distribution and character of tuberculous lesions, and to examine possible routes of disease transmission. In October 1997, 10 mature female white-tailed deer were inoculated by intratonsilar instillation of 2 x 10(3) (low dose) or 2 x 10(5) (high dose) colony forming units (CFU) of M. bovis. In January 1998, deer were euthanatized, examined, and tissues were collected 84 to 87 days post inoculation. Possible routes of disease transmission were evaluated by culture of nasal, oral, tonsilar, and rectal swabs at various times during the study. Gross and microscopic lesions consistent with tuberculosis were most commonly seen in medial retropharyngeal lymph nodes and lung in both dosage groups. Other tissues containing tuberculous lesions included tonsil, trachea, liver, and kidney as well as lateral retropharyngeal, mandibular, parotid, tracheobronchial, mediastinal, hepatic, mesenteric, superficial cervical, and iliac lymph nodes. Mycobacterium bovis was isolated from tonsilar swabs from 8 of 9 deer from both dosage groups at least once 14 to 87 days after inoculation. Mycobacterium bovis was isolated from oral swabs 63 and 80 days after inoculation from one of three deer in the low dose group and none of four deer in the high dose group. Similarly, M. bovis was isolated from nasal swabs 80 and 85 days after inoculation in one of three deer from the low dose group and 63 and 80 days after inoculation from two of four deer in the high dose group. Intratonsilar inoculation with M. bovis results in lesions similar to those seen in naturally infected white-tailed deer; therefore, it represents a suitable model of natural infection. These results also indicate that M. bovis persists in tonsilar crypts for prolonged periods and can be shed in saliva and nasal secretions. These infected fluids represent a likely route of disease transmission to other animals or humans.

稀なリンパ節転移をきたした甲状腺癌症例

Clinically, nodal metastases from well-differentiated thyroid papillary carcinoma usually present primarily in the pretracheal, paratracheal, and infraglandular groups of lymph nodes, secondly, along the ipsilateral jugular chain nodes, thirdly in the accessory nodes, and then in the other distant regional nodes such as the submandibular and submental groups.We report two cases of rare metastases of thyroid papillary carcinoma.Case 1: A 72-year-old male was referred to our hospital because of a right neck mass. A CT scan revealed that his right jugular nodes were swollen and involved in the deep cervical fascia, and that a minute calcification existed in the left lobe of the thyroid gland. This was a case of a minute carcinoma which metastasized only to the contralateral jugular chain nodes. No metastatic lymph nodes were found in the left side region. Thyroid carcinomas usually metastasize to the ipsilateral side at first. Metastases to the contralateral nodes without ipsilateral nodal involvement are unusual.Case 2: A 57-year-old female was referred to us because of postoperative vocal cord paralysis, and a thyroid tumor was found by chance. Enhanced CT scan showed a high density mass in the retropharyngeal space. After surgery, this was diagnosed as being a lateral retropharyngeal nodal metastasis of a thyroid papillary carcinoma. Metastases to the lateral retropharyngeal nodes are rare.

Retropharyngeal lymphadenopathy in nasopharyngeal carcinoma

Purpose: This study reports the incidence, numer, size and distribution of enlarged lateral retropharyngeal (LRP) nodes in patients with nasopharyngeal carcinoma (NPC). Materials and methods: One-hundred and fourteen patients with histopathologically proven NPC were staged prospectively with magnetic resonance imaging (MRI) and computed tomography (CT). T1-weighted, gadolinium-DTPA enhanced, T2-weighted images and CT were obtained. Results: Ninety-one (80%) patients showed enlargement of both LRP and cervical nodes. LRP lymphadenopathy was detected in 59 (65%) of these 91 patients. A total of 347 neck nodes were identified. There were 72 enlarged LRP nodes (average 13 mm, range 6–34 mm). Sixteen groups of fused nodes were also seen (average 24 mm, range 15–40 mm). Thirty-two patients (35%) with cervical lymphadenopathy showed no LRP lymphadenopathy. LRP nodes were seen at the following levels: C1, 35 (49%) nodes; C1/C2, 23 (32%); C2, 13 (18%) and C2/C3, one (1%). It is not known if all these nodes are due to metastasis or hyperplasia as no histopathological proof is available. Conclusion: LRP lymphadenopathy may be seen in up to 65% of NPC patients with neck node enlargement. All the retropharyngeal nodes were located in the lateral group. Although medial retropharyngeal nodes are mentioned in the literature, they were not seen in this study. LRP nodes should be documented when surgical resection is contemplated in malignancy of the head and neck.

外側咽頭後リンパ節（いわゆるＲｏｕｖｉｅｒｅリンパ節）に転移を生じた上顎歯肉癌の２例

Although metastasis to the lateral retropharyngeal node (Rouviere node) is often found in nasopharyngeal cancer, it is rare in oral cancer. One 67-year-old man and one 69-year-old man with metastasis to this node from oral cancer are reported. Both patients had squamous cell carcinoma of the upper gingiva (case 1, T 3 N 2 b M 0 case 2, T 1 N 0 M 0). Metastasis to the Rouviere node was detected along with other cervical lymph node metastases by CT scan after preoperative radiotherapy (case 1) or radiotherapy and surgical excision of the primary lesion (case 2). Further radiotherapy to treat cervical lymph node metastases, including the Rouviere node, combined with CDDP or CBDCA was ineffective, and both patients died of metastases after about six months.

Metastasis to the Lateral Retropharyngeal Node from the Maxillary Cancer: Report of 3 Cases

Metastasis to the Lateral Retropharyngeal Node from the Maxillary Cancer: Report of 3 Cases

CT of Retropharyngeal Lymph Node Metastasis from Maxillary Carcinoma

CT findings for retropharyngeal lymph node metastasis in 25 patients with histologically proven carcinoma of the maxillary sinus and with no prior treatment were evaluated retrospectively. Four lateral retropharyngeal node metastases (16%, 4/25) could be identified by CT. All retropharyngeal metastatic nodes were located between the ipsilateral internal carotid artery and the longus colli muscle at the level of the first cervical vertebral body. The metastatic nodes ranged from 8 mm to 35 mm in size at the long axis. The risk of retropharyngeal node metastasis depends on the degree of carcinoma involvement to the posterior nasal cavity, the posterior ethmoid sinuses, the sphenoid sinuses, the palate (soft and hard) and the nasopharynx. This study indicates that CT is useful for detecting these lymph node metastases.

Can Rouvière's Lymphnodes in Non-Malignant Subjects be Identified with MRI?

The lateral retropharyngeal lymph nodes lie between the carotid artery and prevertebral muscles. These are most obvious anterior to the arch of C1, but can be seen to the level of the soft palate. The uppermost-positioning nodes anterior to the atlas are called as the nodes of Rouvière. Introduction of CT and MR has provided us the chance to detect them. In order to find out the frequency of identifying them in normal subjects, I examined axial MR images which had been taken for the last 3 years. A total of 90 patients (86 adults and 4 children) with a variety of diseases except for malignancies were selected. All 4 children showed Rouvière's nodes bilaterally, while only 5 of 86 adults (5.8%) depicted them. The lymph nodes were identified as isointense masses as nasopharyngeal lymphoid tissues (adenoids), when presented, with the size ranged from 4 to 13 mm. The nodes with a diameter of 5 mm or more were easily identified particularly with T2-weighted images. The benign reactive adenopathy appeared indistinguishable from that demonstrated in patients with malignant tumors in the head and neck.

Major lymph nodes of the head of the fallow deer (Dama dama) and lymphatic drainage of antlers

Heads from 10 fallow deer bucks were examined to provide a description of the major lymph nodes in this region. The distribution and size of these nodes were similar to those of sheep and goats. To determine whether there was drainage of lymph from the skin of antlers, and to follow the route of this drainage, a solution containing Evans blue was injected intradermally into the antlers of 2 bucks whilst the animals were anaesthetised. Dye appeared in tracheal lymph ducts 14 to 30 min after injection. The spread of blue colouration in lymphatic ducts and nodes, seen at post-mortem examination, indicated that lymph flowed from antlers laterally into the ipsilateral parotid lymph nodes and from these via medial and lateral retropharyngeal lymph nodes to the tracheal ducts.