Laterocervical Nodes Research Articles

Prolonged survival of an HIV-infected subject with severe lymphoproliferative disease and rhinocerebral mucormycosis

Prolonged survival of an HIV-infected subject with severe lymphoproliferative disease and rhinocerebral mucormycosis

Cell differentiation and iodine-131 uptake in poorly differentiated thyroid tumour in response to nevirapine

On Feb 13, 2003, a 76-year-old woman was referred with a follicular variant of a thyroid papillary carcinoma and underwent a total thyroidectomy and debulking of the right laterocervical region, which showed several metastases in the right laterocervical lymph nodes, vessel infiltration, and a neoplastic thrombosis of the internal jugular vein (pathological stage T4bN1aMx). During the next 2 years, apart from the persistence of the disease in the upper mediastinum and right laterocervical lymph nodes, the rapid and progressive appearance of multiple lung and bone metastases was noted during whole-body scans with recombinant thyroid-stimulating hormone (TSH)-stimulated iodine-131. She therefore underwent another surgical debulking of the right laterocervical region and upper mediastinum, and excision of the right internal jugular vein with the neoplastic thrombus on July 29, 2003, with external-beam radiotherapy (50 Gy in 28 fractions) of the laterocervical region and upper mediastinum in November, 2003, and three applications of recombinant TSH-stimulated 131I metabolic treatment (4834 MBq on June 6, 2003; 7400 MBq on Feb 23, 2004; and 5374 MBq on Nov 15, 2004). However, these treatments had little effect on disease progression, as shown by persistence of the disease in the upper mediastinum and right laterocervical lymph nodes in the first 131I whole-body scan after treatment, followed rapidly by multiple bone and lung metastases seen in the second and third scans after treatment.

Prognostic Importance of Sclerosing Variant in Papillary Thyroid Carcinoma

The diffuse sclerosing variant (DSV) of papillary thyroid carcinoma is known for its high aggressiveness, high incidence of lymph node metastases, and high incidence of pulmonary metastases, and thus its consequently poorer prognosis. In this study, we undertook a retrospective analysis of papillary thyroid carcinomas to assess whether DSV can be considered a predictive factor for prognosis. We performed a retrospective evaluation of the Department's database of patients with papillary thyroid carcinoma who had undergone total thyroidectomy from January 1992 to December 2000. Group I consisted of 83 DSV patients and Group II was 168 pure papillary carcinoma (PC) patients. A significant prevalence of multinodular thyroid disorder on diagnosis was found for PC (P < 0.05), whereas with DSV, there was a significantly higher prevalence of post-thyroiditis nodular thyroid disorder than with PC (P < 0.001). The incidence of laterocervical lymph node pathology on diagnosis was significantly higher for DSV (P < 0.05). In 3.6 per cent of PC patients and 15.7 per cent of DSV patients, we observed recurrences in the regional lymph nodes (P < 0.001). We found 1.2 per cent distant metastases in PC patients and 7.2 per cent in DSV patients (P < 0.05). One PC patient (0.6%) and three DSV patients (3.6%) died of tumor-related causes (P < 0.05). Our study demonstrated that diffuse sclerosing carcinoma leads to a poorer prognosis to the extent that its classification as an autonomous clinical pathological entity is justified. In conclusion, we can state that DSV is a form of papillary thyroid tumor characterized by its higher aggressiveness, diffuse intrathyroid growth, and high incidence of lymph node and pulmonary metastasis. Ultimately, this means a poorer prognosis. In the presence of risk factors indicating a possible increase in biological aggressiveness, adequate postoperative treatment and close follow-up become essential.

Follicular dendritic cell tumor of the mediastinum: expression of fractalkine and SDF-1α as mast cell chemoattractants

Follicular dendritic cell tumor (FDCT) is a rare tumor mainly located in laterocervical lymph nodes. We report one case of mediastinal FDCT associated with a history of bullous skin disease and clinically obvious immunosuppression. This tumor was characterized by heavy mast cell infiltration. Mast cells were in close relationship with tumor cells as demonstrated by ultrastructural examination and their presence are probably related with the strong expression of mast cell chemoattractants as fraktalkine and stromal cell-derived factor-1alpha by tumor cells. The long follow-up period of more than 17 years allowed to us assess the relatively indolent evolution of this tumor characterized by three slowly growing local recurrences without metastasis.

Ph'-Positive (Ph'+) Chronic Myeloid Leukemia (CML) Presenting as Ph'+ T-Lymphoblastic Lymphoma (LL) Resistant to High-Dose Chemotherapy and Gleevec.

BACKGROUNDExtramedullary blast crisis (BC) of Ph'+ CML is infrequent and commonly affects bone, lymphoid tissue, skin and soft tissues and central or peripheral nervous system. Most of nodal lymphoid tumors occuring in the setting of CML derive from T-cell precursors and represent the evolution of CML to a lymphoid nodal BC.CASE HISTORYIn February 2004, a 52 year-old patient underwent diagnostic wide biopsy of a nasopharingeal mass that caused severe acute respiratory symptoms. At the histological examination, the nasopharyngeal mucosa exhibited a diffuse pattern of infiltration by neoplastic cells with a characteristic single-file arrangement. The cells showed typical convoluted nuclei with one or two nucleoli and abundant cytoplasm (L2, lymphoblasts). The malignant cell population expressed a preT-cell immunophenotype: cytoplasmic CD3(+), CD43 (+), TdT (+/−), CD34(+), CD4(−), CD8(−). Thus, the diagnosis of T-cell LL was formulated. Whole-body CT scan revealed nasopharingeal mass, retropharyngeal, laterocervical, axillary, inguinal enlarged nodes and splenomegaly. Laboratory tests indicated leukocytosis (58,000/μl) with a differential WBC count typical of CML in chronic phase (myeloblasts <1%). This diagnosis was confirmed by a low alkaline phosphatase value (score: 1), histological features of bone marrow (BM) biopsy, classical cytogenetics (presence of the Ph' in 100% of 25 metaphases analysed and absence of other cytogenetic abnormalities) and FISH evaluation (D-FISH bcr-abl in interphase and metaphase, Oncor probe). The nested RT-PCR (JQ Guo et al., Leukemia ; 2002, 15:2447) disclosed the presence of the hybrid protein p210 (b2,a2), but not that of p190. A laterocervical node was excised to perform cytogenetic and molecular analyses in order to determine whether the T-cell LL was an unrelated disease or the expression of an extramedullary BC. The histology confirmed the presence of a uniform population of T-lymphoblasts in which classical cytogenetic analysis disclosed the following kariotype: 49,XY,t(9;22)(q34;q11),+9,+19,+der(22)t(9;22)(q34;q11) and 50–52,XY t(9;22)(q34;q11),+6+9,+9q+,+19,+20,+22q−. The FISH analysis showed the presence of bcr-abl gene in all cells analyzed and the presence of multiple copies of this gene as well as of double Ph' chromosome. Nested RT-PCR showed the presence of both p210 and p190 transcripts. These findings indicated that the T-cell LL was an extramedullary BC of a CML simultaneously diagnosed in chronic phase in BM and peripheral blood. The patient was initially treated with vincristine, daunomicine, asparaginase and prednisone combined with Gleevec (800mg/die). Consolidation therapy, consisting of high-dose Ara-C (4g/m2 for 4 days) and mithoxantrone (10mg/m2 for 2 days), followed by a mieloablative course with mithoxantrone (60 mg/m2) and melphalan (180 mg/m2) and autologous stem cell support (ASCT) was administered after an initial clinical response. Gleevec was given during the entire treatment period. A fugacious complete clinical-hematological and a partial cytogenetic (FISH: 12% of cells bcr-abl+) and molecular (number of bcr-abl/104 ABL copies= 184, real-time quantitative RT-PCR: J Gabert et al., Leukemia ; 2003:1) remission was documented after ASCT. The patient refused further consolidation treatment with Gleevec and died, due to progressive disease, in December 2004.

Long-term complete remission of laryngeal Kaposi's sarcoma after palliative radiotherapy

A 43-year-old Caucasian man presented with enlarged right laterocervical lymph nodes, and a 6-month history of diarrhea and 9 kg weight loss. His previous medical history was unremarkable. Physical examination and a cervical CT scan showed several indistinct necrotic right laterocervical lymph nodes of 4 cm maximal diameter, but with no lesions of the respiratory or digestive tracts. Physical examination, cervical CT scan, laterocervical lymph node biopsy, laboratory tests, and endoscopy. Clinical stage 4 AIDS with stage T0 I1 S1 epidemic AIDS-related Kaposi's sarcoma of the laterocervical lymph nodes and, subsequently, the larynx. Highly active antiretroviral treatment (stavudine, didanosine, and nelfinavir), tracheotomy, and palliative radiotherapy.

Sclerosing Papillary Carcinoma Arising in a Lingual Thyroid: Report of a Case

Ectopic lingual thyroid tissue is an uncommon congenital anomaly. Tumors with identical pathological characteristics to those arising in thyroid tissue may be present in ectopic locations, but there are very few cases of malignant ectopic thyroid tumors reported in the literature. We present a review of this phenomenon and report a case of papillary carcinoma of the base of the tongue, located in ectopic lingual thyroid tissue, in a 30-year-old woman. The patient's presenting symptoms were dysphagia and oral bleeding, and we performed radical resection of the neoformation at the base of the tongue with part of the muscles of the floor of the mouth and the body of the hyoid bone, as well as total thyroidectomy. Histological examination revealed a "sclerosing" papillary carcinoma. The patient was treated with 131I and substitutive thyroid hormonal therapy. An ultrasonogram done 5 years later showed bilateral laterocervical lymph node recurrence, which was effectively treated with bilateral laterocervical lymphectomy.

Multiple primary malignant neoplasm in patients with laryngeal carcinoma.

The aim of this study was to study the incidence, localization, and nature of second primary tumors arising in patients with primary laryngeal carcinoma and their correlation with the site, staging, and grade of differentiation. Between 1979 and 1996, 877 patients underwent laryngeal surgery (850 male and 27 female; age range = 30.5-76 years). The second primary tumor was multicentric in 7 cases (14%), systemic in 16 cases (33. 3%), and "coincidental" in 25 cases (52%). In 3 cases the tumors were simultaneous, in 7 cases they were synchronous, and in 38 cases they were metachronous. In the 48 patients with multiple primary malignant neoplasm, the index tumor was glottic in 38 cases and supraglottic in the remaining 10, but the incidence of second tumors in these two groups was virtually matching, respectively: 38/709 (5. 3%) and 10/168 (5.9%). This study did not identify any correlation between the second primary tumor and the extension of the first neoplasm (T) and the presence of laterocervical lymph node metastases (N). Our data showed a higher incidence of second tumor in patients having G1 carcinomas compared with the other series with G2 and G3 carcinomas. As far as survival rates are concerned, a significant reduction was observed in patients developing a second primary tumor, regardless of whether the index tumor was glottic or supraglottic. The incidence of new tumors in patients with laryngeal carcinoma is not linked to the site, size, staging, or grade of differentiation of the index tumor.

SQUAMOUS-CELL CARCINOMA OF THE UPPER LIP - ANALYSIS OF 123 CASES

Squamous cell carcinoma of the upper lip is rare and poorly described in the literature. We analysed retrospectively 123 cases occurring from 1929 to 1987. Greatest incidence was in the seventh decade and the M/F ratio was 2:1. Treatment was radiotherapy (36) or surgery (87). In early disease stages radiotherapy and surgery were equally effective, but in advanced disease surgery provided better results. Involved nodes indicate mandatory laterocervical submandibular lymph node dissection (bilateral for central lesions) but prophylactic dissection is inappropriate. The high frequency of relapse, tendency to plurifocality (as with all cercicofacial tumors) and risk of lymph node involvement underline the importance of regular and careful follow-up.

Primary Hodgkin's Disease of the Tonsil. Report of a Case and Review of the Literature

A 31 year-old woman with mixed cellularity Hodgkin's disease with isolated tonsilar involvement is reported. Local radiotherapy was given, and the patient remained assymptomatic, without evidence of disease 16 months from the time of diagnosis. After a review of the literature only 17 well-documented cases of Hodgkin's disease arising in the nasopharynx have been found. After reviewing this data, we suggest that systematic examination of the Waldeyer's ring should always be performed in cases of Hodgkin's disease arising in the laterocervical lymph nodes.

Human immunodeficiency virus infection in multi-transfused patients with thalassaemia major.

We investigated the incidence, clinical and immunological characteristics of human immuno-deficiency virus (HIV) infection in a group of multi-transfused patients with thalassaemia major who were exposed to transfusion-associated HIV infection. Seropositivity to HIV by Western blot and immunofluorescence analysis was detected in 26 out of 590 patients. At a follow up 21-40 months later, none of these seropositive patients had developed acquired immuno-deficiency syndrome (AIDS), and six manifested the AIDS related complex (ARC). ARC was unusually mild and consisted of moderate laterocervical and submandibular lymph node enlargement associated with hypergammaglobulinaemia and a reduced CD4/CD8 ratio resulting from the decreased number of CD4 lymphocytes. These findings suggest that multi-transfused patients with thalassaemia major are relatively resistant to the development of severe manifestations of HIV infection, presumably because their immune status is relatively better preserved than that of other infected populations. Longer follow up is, however, necessary to determine whether the incidence of AIDS will be lower in this population or whether overt AIDS merely takes longer to develop.

Indications, limitations and results of traditional latero-cervical lymph node excision

Indications, limitations and results of traditional latero-cervical lymph node excision

Secondary metastatic tumors of the mandible

A study on 229 cases of oral cavity tumors with the invasion of the mandible observed at the National Cancer Institute, Milan, and at the Institute of Radiology, University of Milan, from 1928 to 1967 is reported. Of these cases 73 were subjected to radical surgery, 15 were conservatively operated, 46 had radiant therapy, and 95 received no cure at all for tumor extension. Radical surgery, that is the surgical removal of the hemimandible invaded by the tumor, associated with the ablation of homolateral laterocervical lymph node chains, is the most rational measure and can yield excellent results; for radical surgery the median survival rate is of 2 years; the relative survival rate is of 49%, 5 years after the operation. Conservative surgery and radiotheraphy are secondary measures which, in principle, should be carried out only in case of technical contra-indications or patients refusal of radical surgery.

HISTOPATHOLOGICAL STUDIES OF THE CARCINOMA OF THE MAXILLARY SINUS WITH THE LARGE SECTIONS

Forty-seven specimens of the maxillary sinus cancer removed en bloc with the normal suround- ing tissues were observed macroscopically and his- tologically by means of large section. The sections were made in mass without sepa- rating organs or tissues of the specimens. 18 cases of those observed were preoperatively irradiated. The specimens were investigated from the points of view of the effect of the preoperative irradiation, invasion of the cell into the bone, the periost, surrounding tissues as such fatty tissues, muscles, etc. and compared with their clinical fin- dings. The results obtained were as follows. 1) 40 squamous cell carcinomas, 3 basal cell and 4 adenocarcinomas were found in the specime- ns. There was no significant relationship between their histological types and prognosis. 2) In the preoperatively non-irradiated cases, higher structural atypism, smaller alveolar struc- ture, irregularity of cellular structure and direct bony destruction by cancer cells had bad influences upon their prognosis. While in preoperatively irradiated cases, the differences in histological fin- dings were not concerned with their prognosis. 3) In many cases cancer had already destroyed the walls of the maxillary sinus, especially the na- sal wall and posterior wall (85% of the cases). 4) In 12 cases there were submaxillar lymph node metastases and in 4 cases laterocervical lymph node metastases. Their prognosis was worse than those without metastases. 5) The cases undergoing sinectomy, polypoto- my, extraction of teeth, incision of the palate be- fore adjust treatments, also had worse prognosis. In such cases histologically severe invasion into the surrounding tissues were observed. 6) Thickning of the periostal layer on the outer side of the sinus wall were observed in ma. ny cases, and those cases had good prognosis. 7) The preoperative irradiation (4000r) resul- ted into degeneration and necrosis of the cancer cell, the increase of the connective tissues thickning of the periostal layer on the outer side of the sinus wall destroyed by cancer and decrease of the can- cer in size. 18 months after the treatment 66.6% of preoperatively irradiated cases was free of recu- rrences. There were marked differences in progno- sis between the irradiated and non-irradiated cases (35.0%).

Histochemical research on the laterocervical lymph nodes in the rabbit irradiated with high-speed betatron electrons

Histochemical researches were carried out in order to visualize nucleic acids and mucopolysaccharides in laterocervical lymph nodes of the rabbit, after irradiation with fast electrons by a 33 Mev betatron. Histochemical changes were found only with rather high dosages. The behaviour of nucleic acids showed a decrease in DNA which was more marked when the administered dose as higher. With regard to mucopolysaccharides, a decrease in the Alcian-positivity was observed, and an increase of the PAS positivity in comparison with the controls, especially with highest dosage.