Malignant Lymphadenopathy Research Articles

Mediastinal lymphadenopathy: assessing clinical utility of EUS-FNA

In day-to-day clinical practice, oncologists often face the problem of how to manage patients whose mediastinal lymph nodes have increased in size. The diagnostic accuracy of lymph nodes is a general problem given that lymph nodes larger than 0.5–1 cm are not essentially affected by cancer and, in contrast, smaller lymph nodes may contain micrometastatic disease. In practice, preoperative treatment staging with endoscopic ultrasound (EUS), computed tomography, and positron emission tomography is associated with modest predictive accuracy, and pretreatment staging without histopathological examination of surgical specimen is inappropriate. In specialized hospitals with a high volume of endoscopic ultrasound-guided fine-needle aspiration (EUSFNA) performed, positive results in assessing mediastinal lymphadenopathy have been reported. Whether this approach can be a valuable diagnostic tool in low-volume EUS-FNA hospital is still unclear. To assess the safety, diagnostic accuracy, and costs of EUS-FNA in low-volume EUS centers (\50 mediastinal EUS-FNA/endoscopist/ year), Hirdes et al. [1] performed a study that was reported in the September issue of Surgical Endoscopy. The authors report the results of 213 consecutive patients who were referred to two Dutch endoscopy centers for mediastinal lymphadenopathy and who underwent EUS-FNA between 2002 and 2008. Sensitivity and specificity were 89 and 100%, respectively. Overall, EUS-FNA had a positive impact on the clinical management of 84% of cases by either influencing the surgical decision made or excluding malignant lymphadenopathy. In two patients a nonfatal perforation was occurred (0.9%). The authors concluded that mediastinal EUS-FNA can be performed safely and effectively in low-volume EUS centers. Although this was a retrospective study whose results were not compared with those of a high-volume EUS-FNA center and it did not include a control group whose members did not undergo EUS-FNA, sensitivity and specificity rates, the impact on treatment decisions for patients with mediastinal lymphadenopathy, and the risk associated with EUS-FNA were very positive. How could sensitivity and specificity be improved and how realistic is it to achieve accurate diagnostics without using an invasive method such as EUS-FNA? Could biomarkers be used to accurately distinguish between inflammatory and malignant disease?

Dignitätsbeurteilung von abdominellen Lymphadenopathien in der Powerdoppler-Sonografie

Ziel: FDS (Farbduplex-Sonografie) und PDS (Powerdoppler-Sonografie) zeigten bei Differenzialdiagnose peripherer Lymphadenopathien eine hohe diagnostische Wertigkeit. Ziel dieser Arbeit war es, die Wertigkeit der PDS bei der Differenzialdiagnose von abdominellen Lymphadenopathien zu bestimmen. Material und Methoden: Es erfolgte die retrospektive Auswertung von 88 in der PDS angefertigten Farbbildern abdomineller Lymphknoten (39 reaktive Lymphknoten und 49 maligne Lymphknoten [24 maligne Lymphome und 25 Lymphknotenmetastasen]). Die Auswertung der PDS-Bilder erfolgte anhand 9 definierter intranodaler Perfusionsmuster. Es wurden die relativen Häufigkeiten der einzelnen Perfusionsmuster bei malignen und benignen Lymphknoten berechnet und signifikante Unterschiede beschrieben. Ergebnisse: 3 der 9 Perfusionsmuster zeigten ein signifikant (p < 0,05) häufigeres Auftreten bei malignen Lymphknoten (aberrante Gefäße, Perfusionsausfall und subkapsuläre Gefäße), dagegen zeigte ein Perfusionsmuster ein signifikant häufigeres Auftreten bei benignen Lymphknoten (Hilusgefäß). Schlussfolgerung: Es gibt 3 malignitätstypische Perfusionsmuster (Perfusionsausfall, aberrante Gefäße, subkapsuläre Gefäße) und ein benignitätsytypisches Perfusionsmuster (Hilusgefäß). Liegt eines dieser Perfusionsmuster bei einer abdominellen Lymphadenopathie vor, handelt es sich mit hoher Wahrscheinlichkeit um einen malignen bzw. benignen Lymphknoten (Spezifität 87 – 100 %).

Contrast-enhanced endoscopic ultrasonography.

Contrast agents are increasingly being used to characterize the vasculature in an organ of interest, to better delineate benign from malignant pathology and to aid in staging and directing therapeutic procedures. We review the mechanisms of action of first, second and third generation contrast agents and their use in various endoscopic procedures in the gastrointestinal tract. Various applications of contrast-enhanced endoscopic ultrasonography include differentiating benign from malignant mediastinal lymphadenopathy, assessment of depth of invasion of esophageal, gastric and gall bladder cancers and visualization of the portal venous system and esophageal varices. In addition, contrast agents can be used to differentiate pancreatic lesions. The use of color Doppler further increases the ability to diagnose and differentiate various pancreatic malignancies. The sensitivity of power Doppler sonography to depict tumor neovascularization can be increased by contrast agents. Contrast-enhanced harmonic imaging is a useful aid in identifying the tumor vasculature and studying pancreatic microperfusion. In the future, these techniques could potentially be used to quantify tumor perfusion, to assess and monitor the efficacy of antiangiogenic agents, to assist targeted drug delivery and allow molecular imaging.

Role of Perfusion Magnetic Resonance Imaging in Cervical Lymphadenopathy

To assess the role of perfusion magnetic resonance (MR) imaging in patients with cervical lymphadenopathy. Dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging was performed on 45 cervical lymph nodes after a bolus injection of gadolinium-DTPA (0.1 mmol/kg body weight). Time signal intensity curve was created and dynamic susceptibility contrast (DSC) percentage of the lymph nodes was calculated. Receiver operating characteristic curve analysis was used to investigate whether DSC percentage could aid in the characterization of cervical lymphadenopathy. The mean (SD) DSC percentage of malignant nodes (44.8% [6.2%]) was significantly different (P = 0.001) from that of benign nodes (28.8% [4.8%]). The mean (SD) DSC percentage of metastatic nodes (48.72% [2.4%]) was significantly different (P = 0.001) than that of lymphoma (37.09% [3.5%]). The DSC percentage threshold value used for differentiating malignant from benign nodes and metastatic from lymphomatous nodes were 34.3% and 43.5%, with areas under the curve of 0.95 and 0.97, respectively. Perfusion MR imaging is a noninvasive promising method that can be used for differentiation of malignant from benign cervical lymph nodes, and it helps in the characterization of malignant cervical lymphadenopathy.

Successful treatment of metastatic hepatic epithelioid hemangioendothelioma with thalidomide: a case report

IntroductionHepatic epithelioid hemangioendothelioma is a rare malignancy arising from the vascular endothelial cells within the liver. Historically, the disease is characterized as being poorly responsive to both chemotherapy and radiotherapy, with liver resection or transplantation the treatment of choice when feasible. For patients with advanced disease, reports of long-term therapeutic benefits from conventional cytotoxic treatments are very limited. Owing to the rarity of this malignancy, there is no structured therapeutic research, but a small number of cases have been reported to respond well to treatment with inhibitors of angiogenesis. Thalidomide was originally developed as an anti-emetic but is a potent inhibitor of vascular neogenesis, and could offer potential in the treatment of hepatic epithelioid hemangioendothelioma by blocking the proliferation of the malignant vascular endothelial cells.Case presentationWe describe the case of a Caucasian British woman who presented at the age of 53 years with a hepatic mass, malignant lymphadenopathy and pulmonary metastases, which were confirmed as hepatic epithelioid hemangioendothelioma on biopsy. After unproductive treatment with interferon, our patient was started on thalidomide 400 mg daily. She has been successfully managed on this therapy for the past seven years, and has remained asymptomatic, with radiologically stable disease and minimal treatment-related side effects.ConclusionAt present, there is no standard therapy for advanced hepatic epithelioid hemangioendothelioma. Our case supports the role for thalidomide and potentially other inhibitors of vascular neogenesis in the treatment of patients with metastatic hepatic epithelioid hemangioendothelioma.

Characterization of mediastinal lymphadenopathy with diffusion-weighted imaging

Purpose To predict malignancy of mediastinal lymphadenopathy with diffusion-weighted imaging. Material and methods A prospective study was conducted on 35 patients with mediastinal lymphadenopathy (28 malignant and seven benign nodes). They underwent echoplanar diffusion-weighted magnetic resonance imaging of the mediastinum with b-factors of 0, 300 and 600 s/mm 2. The apparent diffusion coefficient (ADC) values of the mediastinal lymph nodes were calculated. The ADC values were correlated with the biopsy results and statistical analysis was done. A value of P<.05 was considered significant. Results The mean ADC value of malignant mediastinal lymphadenopathy (1.06±0.3×10 −3 mm 2/s) was significantly lower ( P=.001) than that of benign lymphadenopathy (2.39±0.7×10 −3 mm 2/s). There was an insignificant difference in the ADC values between metastatic and lymphomatous mediastinal lymph nodes ( P=.32) as well as within benign nodes ( P=.07). When an ADC value of 1.85×10 −3 mm 2/s was used as a threshold value for differentiating malignant mediastinal nodes from benign nodes, the best results were obtained with an accuracy of 83.9%, a sensitivity of 96.4%, a specificity of 71.4%, a negative predictive value of 95.2% and a positive predictive value of 77.1%. The area under the curve was 0.98. Conclusion Diffusion weighted magnetic resonance imaging is a promising noninvasive imaging modality that can be used for characterization of mediastinal lymphadenopathy and differentiation of malignant from benign mediastinal lymph nodes.

The diagnostic value and safety of transbronchial needle aspiration biopsy in children with mediastinal lymphadenopathy

Anterior mediastinal masses in children can have different causes which includes, Mycobacterium tuberculosis (MTB) or malignant lymphadenopathy. Transbronchial needle aspiration (TBNA) has been described as a safe and effective diagnostic procedure in adult patients with lung cancer. To describe the use of TBNA as a diagnostic test in children with large subcarinal lymphadenopathy and to determine the safety of the procedure in children. Prospective descriptive study of children with subcarinal mediastinal lymph nodes who underwent TBNA. The majority of the children were referred due to treatment failure. Children were enrolled if the diagnosis remained unclear after computer tomography of the chest. Thirty patients were enrolled in this study; TBNA was done in 28 patients. A definitive diagnosis was made by TBNA in 54% (n = 15) of patients; MTB lymphadenopathy (n = 13), metastatic nephroblastoma (n = 1), and fibrosing mediastinitis (n = 1). In seven (25%) cases the TBNA was the sole source of the specimens from which the definitive diagnosis was made. No serious complications were encountered during or after the procedure. TBNA is a safe procedure in children with mediastinal lymphadenopathy of unknown cause resulting in a definitive diagnosis in 57% of cases. TBNA adds additional value to flexible bronchoscopy in the diagnosis of mediastinal lymphadenopathy in children.

Hepatobiliary and Pancreatic: Bile duct dilatation caused by an aortic aneurysm

Awoman, aged 80, was admitted to hospital with abdominal pain. Blood tests revealed changes in liver enzymes as well as a significant elevation of serum amylase (3861 u/l). An abdominal ultrasound study showed multiple stones in a shrunken gallbladder as well as dilatation of the bile duct (12 mm). She also had an abdominal aortic aneurysm measuring approximately 5 cm in diameter. At magnetic resonance cholangiopancreatography, no stones were identified in the bile duct but the lower bile duct was narrow and deviated laterally by the aortic aneurysm (Figure 1). As multiple co-morbidities precluded cholecystectomy, endoscopic retrograde cholangiopancreatography and prophylactic endoscopic sphincterotomy were performed. There were no bile duct stones or biliary debris. With distension of the bile duct, narrowing of the lower bile duct was less prominent than previously but there was curvilinear calcification within the aneurysmal sac that resulted in compression of the distal bile duct (Figure 2). The patient is currently asymptomatic but does have persistent changes in liver enzymes. Bile duct dilatation caused by compression by an abdominal aortic aneurysm is rare. There are only 9 previous cases in the medical literature and, in only 2 of these, was there direct pressure on the bile duct from an intact aneurysm. In the remainder, bile duct compression was caused by a hematoma from extramural leakage. In the above patient, pancreatitis might have been related to spontaneous passage of a bile duct stone or to pancreatic or sphincteric compression by the aneurysm. Obviously, the absence of bile duct stones after sphincterotomy does not exclude the possibility of biliary pancreatitis. On the other hand, we are not aware of previous reports of pancreatitis with intact aortic aneurysms. The patient is currently in reasonable health but is under regular review by both general and vascular surgeons. More common causes of compression and lateral deviation of the lower bile duct include pancreatic neoplasms, pancreatic cysts, pancreatic abscesses and acute and chronic pancreatitis. There are also case reports of similar radiological features with malignant lymphadenopathy around the duodenum and with cavernous transformation of the portal vein.

Diagnostic Accuracy of Doppler Ultrasonography in Differentiation between Malignant and Benign Cervical Lymphadenopathies in Pediatric Age Group

Cervical lymphadenopathy is a relatively common finding in pediatric age group and is caused by a wide spectrum of diseases from transient infections to malignancies especially lymphomas. The present study was aimed at evaluating the diagnostic performance of grey-scale ultrasonography, color Doppler ultrasonography and power Doppler ultrasonography in differentiation of reactively and metastatically enlarged cervical lymph nodes in pediatric age group. Fifty children with cervical lymphadenopathies were assessed by ultrasonographic methods. In each patient, the longest (L) and transverse (T) diameters, L/T ratio and presence or absence of the normal hilar pattern were checked by grey-scale ultrasonography. Spectral parameters (resistive and pulsatility indices) and vascular distribution pattern of nodes were recorded by color and power Doppler ultrasonography, respectively. Following the ultrasonographic evaluations, biopsy and/or clinical follow up was applied for six months, based on the clinical and paraclinical findings. Statistical analyses were performed by chi-square test, independent t-test and receiver operator characteristic curves. The mean age of patients was 12.42 +/- 2.42 years. Twenty eight patients (56%) had malignant enlargement of lymph nodes. The mean value of L/T ratio in malignant group was 1.70 +/- 0.22 and 2.40 +/- 0.38 in non-malignant nodes (p < 0.001). Sensitivity, specificity and accuracy of combined grey-scale and power Doppler ultrasonography were 70, 86 and 81%, respectively. Combination of grey-scale and power Doppler ultrasonography is recommended for the differentiation between the malignant and benign lymphadenopathies in children. Moreover, our findings revealed no diagnostic role of color Doppler ultrasonography in the selection of malignant cervical lymph nodes in children.

Real‐time and computerized sonographic scoring system for predicting malignant cervical lymphadenopathy

To identify malignant cervical lymphadenopathy, we established a real-time, computerized scoring system based on sonographic findings and demographic data. One hundred eight patients with neck lymphadenopathy, receiving ultrasonography and ultrasound-guided fine-needle aspiration (US-FNA), were used to construct a predictive model. This model was validated by another independent patient cohort. A predictive scoring scale was proposed by multivariate logistic regression analysis: 0.06 x (age) + 4.76 x (S/L ratio) + 2.15 x (internal echo) + 1.80 x (vascular pattern). Cervical lymphadenopathy was regarded as malignant with a score >or=7. The formula was programmed into a synchronized, computerized sonographic reporting system. Prospective validation of this predictive tool showed excellent sensitivity (100%), specificity (88.0%), and overall accuracy (90.1%). A real-time and practical sonographic scoring system was built and validated to provide the physician prompt and reliable probability guidance for performing US-FNA cytology in managing cervical lymphadenopathy.

Performance of EUS-FNA for mediastinal lymphadenopathy: impact on patient management and costs in low-volume EUS centers

BackgroundEndoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of mediastinal lymphadenopathy has been shown to be a valuable diagnostic tool in high-volume EUS centers (≥50 mediastinal EUS-FNA/endoscopist/year). Our goal was to assess the diagnostic accuracy of EUS-FNA and its impact on clinical management and costs in low-volume EUS centers (<50 mediastinal EUS-FNA/endoscopist/year).MethodsConsecutive patients referred to two Dutch endoscopy centers in the period 2002–2008 for EUS-FNA of mediastinal lymphadenopathy were reviewed. The gold standard for a cytological diagnosis was histological confirmation or clinical follow-up of more than 6 months with repeat imaging. The impact of EUS-FNA on clinical management was subdivided into a positive impact by providing (1) adequate cytology that influenced the decision to perform surgery or (2) a diagnosis of a benign inflammatory disorder, and a negative impact which was subdivided into (1) false-negative or inconclusive cytology or (2) an adequate cytological diagnosis that did not influence patient management. Costs of an alternative diagnostic work-up without EUS-FNA, as established by an expert panel, were compared to costs of the actual work-up.ResultsIn total, 213 patients (71% male, median age = 61 years, range = 23–88 years) underwent EUS-FNA. Sensitivity, specificity, and negative and positive predictive values were 89%, 100%, 80%, and 100%, respectively. EUS-FNA had a positive impact on clinical management in 84% of cases by either influencing the decision to perform surgery (49%) or excluding malignant lymphadenopathy (35%), and a negative impact in 7% of cases because of inadequate (3%) or false-negative (4%) cytology. In 9% of cases, EUS-FNA was performed without an established indication. Two nonfatal perforations occurred (0.9%). Total cost reduction was €100,593, with a mean cost reduction of €472 (SD = €607) per patient.ConclusionsMediastinal EUS-FNA can be performed in low-volume EUS centers without compromising diagnostic accuracy. Moreover, EUS-FNA plays an important role in the management of patients with mediastinal lymphadenopathy and reduces total diagnostic costs.

Dignitätsbeurteilung von abdominellen Lymphadenopathien in der Powerdoppler-Sonografie

Recent studies have reported high accuracy of power Doppler sonography (PDS) and color Doppler sonography (CDS) in the differentiation of benign and malignant peripheral superficial lymphadenopathy. This study was conducted to determine whether PDS can differentiate benign from malignant abdominal lymph nodes on the basis of defined vascular patterns. We retrospectively evaluated 88 color pictures of abdominal lymph nodes (39 benign lymph nodes, 24 malignant lymphomas, 25 lymph node metastasis) done in the power Doppler mode. The goal was to determine whether benign and malignant abdominal lymph nodes can be differentiated in power Doppler sonography on the basis of 9 defined vascular patterns. Three vascular patterns showed a significantly (p < 0.05) higher appearance in malignant than in benign lymph nodes: aberrant vessel (specificity 87 %), avascular focus (specificity 92 %) and subcapsular vessel (specificity 100 %). The vascular pattern hiliar vessel showed a significantly higher appearance in benign lymph nodes (specificity 87.8 %). Three vascular patterns are detectable in power Doppler mode (avascular focus, aberrant vessel, subcapsular vessel) in abdominal lymph nodes, which are typical for malignant abdominal lymphadenopathy. The presence of one of these vascular patterns means with a high specificity (87 - 100 %) that an abdominal lymphadenopathy is malignant. One vascular pattern (hiliar vessel) shows a significantly higher appearance in benign lymph nodes.

Detection of Cervical Lymph Nodes in Head and Neck Cancer: A Study of the Correlation Between Ultrasonic and Histological Findings in Wales

Detection of Cervical Lymph Nodes in Head and Neck Cancer: A Study of the Correlation Between Ultrasonic and Histological Findings in Wales

The role of endoscopic ultrasonography in Barrett's esophagus and early esophageal cancer

Endoscopic ultrasonography is established as the most accurate modality for the local staging of esophageal neoplasms. The minimally invasive management of high-grade dysplasia and early intramucosal cancer arising in Barrett's esophagus is in evolution, with the emergence of endoscopically delivered ablative therapies challenging the more conventional treatment of esophagectomy. The precise staging of these patients for depth of tumor penetration, lymph node status, and potential hematogenous metastases, is therefore crucial before considering a minimally invasive treatment strategy. The evidence suggests that endoscopic ultrasonography can successfully differentiate early (T1) from advanced intramural disease, but it is poor at differentiating mucosal from submucosal lesions. Its role in managing patients with early disease therefore appears to be limited, although it does appear valuable for detecting associated malignant lymphadenopathy.

Radiologic Findings of Various Diseases of the Axillary Lymph Node with Pathologic Correlations

Axillary lymphadenopathy has multiple variable pathologic conditions such as a malignant or benign condition. It is important that we determine the radiologic findings of malignant lymphadenopathy and in turn determine the further course of evaluation for the lesion, because metastatic axillary lymphadenopathy represents an important prognostic factor. Recently, an ultrasonographic-guided axillary lymph node biopsy has been widely used as a diagnostic tool. We discuss the radiologic and pathologic findings of variable axilla diseases and outline the specific findings for determining the results of a lymph node biopsy.

LETTERS TO THE EDITOR

Dear Editor, Vulval location: An indication for staging in basal cell carcinoma? Recently, DeAmbrosis et al. reported in the journal a case series of four vulval basal cell carcinoma (BCC). All the tumours were primary, and the maximum tumour size was 15 mm. The histopathological exam did not report invasion of deep structures, and none of the patients had previous history of radiation therapy. No clinical evidence of lymphadenopathy was reported at time of presentation. All patients underwent computed tomography (CT) of the abdomen and pelvis as a component of screening prior to surgery.1 The authors make several assertions that we disagree with. In the discussion, the authors recommend the use of this technique, as ‘CT scanning improves diagnosis accuracy’.1 In their opinion, ‘the risk of missing malignant inguinal lymphadenopathy is greater than the very marginal risk of the radiation from the CT scan’.1 We believe that in medical practice, before carrying out a particular technique, a careful benefit/risk analysis should be performed. A clear example is cutaneous malignant melanoma. Despite the marginal risk of the radiation from the CT scan, asymptomatic stage I melanoma patients should not be staged by imaging, as the true-positive pick-up rate is low and the false-positive rate is high.2 In other words, the benefit/risk relationship is unfavourable because the risk is low but the benefit is even lower. Although BCC is the most common skin cancer, metastatic BCC (MBCC) is rare, with an incidence of 0.0028–0.1%.1 Risk factors that should lead to a higher index of suspicion among clinicians for identifying MBCC include large tumour size, significant tumour depth, previous irradiation, recurrence, immunocompromised patients, and primary BCC of the head and neck.3, 4 Even though higher rates of metastasis occur from primary lesions on the face, scalp and genitalia, MBCC arising from a primary tumour less than 2 cm in diameter is extremely infrequent.4 Risk of metastasis has been further shown to specifically correlate with the size of the primary tumour: tumours greater than 3 cm conferring 2% risk, greater than 5 cm conferring 25% risk, and greater than 10 cm conferring 50% risk.3 Except for their location, none of the cases of DeAmbrosis et al. exhibit any of the recognizable risk factors for MBCC (with the exception of case 1, which presents squamous differentiation). Although we agree that vulval location is a risk factor for MBCC, we feel that CT scanning should not be performed in all cases of vulval BCC, as it should not be performed in all cases of facial BCC (albeit two-thirds of MBCC arise from primary tumours on the face4). We believe that ‘the very marginal risk of the radiation from the CT scan’ does not justify the routine staging use of this technique in asymptomatic patients unless it is supported by the presence of the risk factors recognized in the medical literature.

Trichomegaly of the Eyelashes After Colorectal Cancer Treatment With the Epidermal Growth Factor Receptor Inhibitor Cetuximab

A 67-year-old man began treatment for metastatic colorectal cancer (CRC) with 5-fluorourcail (5-FU), oxaliplatin, and cetuximab (a monoclonal antibody [MoAb] to epidermal growth factor receptor [EGFR]). Eight years previously, he had been diagnosed with localized rectal cancer that was treated with neoadjuvant radiation therapy, surgical anterior resection, and adjuvant chemotherapy with 5-FU/leucovorin (LV). He was diagnosed with a single lung metastasis 5 years later that was treated with surgical resection followed by adjuvant 5-FU/LV chemotherapy. Follow-up imaging 3 years later revealed malignant mediastinal lymphadenopathy for which he was started on his current chemotherapeutic regimen. Three weeks after starting cetuximab, he noticed abnormal growth of his eyelashes. They became lengthened and curly, with increased thickness (Figures 1 and 2). Despite the unusual appearance, the growth did not trouble him. He also noticed mild increased hair growth in his truncal region and a grade 1 facial acneiform rash. His only regular medication was oral minocycline for the rash. He has continued treatment for the past year with stabilization of his disease. Both cetuximab and panitumumab are MoAbs specific to EGFR that are used in the treatment of metastatic CRC. Both can cause skin and hair toxicity, including acneiform rash, dry skin, paronychial inflammation, and hypertrichosis. In one series of 17 patients treated with cetuximab, acneiform rash occurred in 82%, dry skin in 59%, paronychial inflammation in 29%, and altered hair growth in 18%.1 EGFR is highly expressed in the epidermis and hair follicle epithelium, which probably explains this.2 Cetuximab-associated trichomegaly is uncommon, with only 8 confirmed reports in the literature.1-7 Trichomegaly is not usually problematic but can be complicated by trichiasis and secondary corneal ulceration, so patients who complain of eye irritation should be treated by an ophthalmologist. Simple trimming and epilation are appropriate therapeutic modalities.8 It is unknown whether the occurrence of eyelash trichomegaly is associated with clinical response to EGFR inhibitors. With increas

Experiment study on MR diffusion weighted imaging in rabbit models of lymphadenopathy:comparison between inflammatory and metastatic lymph node

Objective To investigate the value of MR DWI in comparing inflammatory with metastastic lymph node in animal models of lymph disease.Methods Eighteen rabbits with benign lymphadenopathy and 9 rabbits with malignant lymphadenopathy underwent routine MRI and DWI examination.Independent-samples t test was used to compare the sizes and apparent diffusion coefficient (ADC) values between the two groups.Results Thirty-four inflammatory lymph nodes and 18 metastastic lymph nodes were observed .The size of lymph nodes was (8.14±2.79) and (6.29±1.48) mm in the benign and malignant groups, respectively.There was no significant statistical difference between the sizes of the two groups (t=2.624, P 0.05).Mean ADC value of lymph nodes was (1.19±0.31)×10-3mm2/s and (1.31±0.27)×10-3mm2/s in the benign and malignant groups, respectively.There was no significant statistical difference between the ADC values of benign and malignant lymph nodes (t=1.449,P 0.05).Conclusion DWI sequence can be used to show lymphadenopathy, but the ADC value is insufficient to differentiate benign lymph nodes from malignant lymphadenopathy. Key words: Lvmph nodes: Diffusion magetic resonance imaing: Models.animal

Klinischer Stellenwert der Lymphknotensonographie

Percutaneous and endoscopic ultrasound are very useful complementary imaging tools in the detailed assessment of physiological as well as pathological lymph nodes in almost all anatomical regions of the human body. A comprehensive consideration of various features obtained by gray-scale and color Doppler sonography is the basis of the differentiation of benign from malignant lymphadenopathy. Sonographic elastography and contrast-enhanced sonography may provide further information. Nevertheless the sonographic differential diagnosis of enlarged and structurally altered lymph nodes has some limitations. (Endoscopic) ultrasound guided biopsy permits histological diagnosis of pathological lymph nodes with minimal risk, low cost, and high diagnostic accuracy. The sonographical evaluation of lymph nodes is an essential adjunct to the clinical investigation in staging of malignant tumors and lymphoma, in the case of palpable lymph nodes, and in various benign diseases.

Utility of color Doppler ultrasound in evaluating the status of cervical lymph nodes in oral cancer

The aim was to study the utility of color Doppler ultrasound (CDUS) in diagnosis of cervical lymphadenopathy in oral cancer patients. In a prospective study, 70 cervical lymph nodes in 30 known primary oral cancer patients were evaluated with CDUS during a period of 8 months. The intranodal perfusion sites and vascular resistance were the key CDUS features used to differentiate between reactive and metastatic cervical lymph nodes. Histopathologic confirmations were obtained by excisional biopsy of the lymph nodes. The results of preoperative clinical palpation of cervical lymph nodes and CDUS evaluation were compared with histopathologic outcome. Clinical evaluation suspected 61 cervical lymph nodes to be malignant. According to the CDUS, out of 70 nodes, 49 lymph nodes showed features of benign lymphadenopathy and 21 lymph nodes showed features of malignant lymphadenopathy, whereas histopathologic evaluations were in favor of reactive for 57 (81.42%) and for malignant lymphadenopathy in 13 (18.57%). The CDUS evaluation was found to be highly significant with a sensitivity of 92.90% and a specificity of 84.21%, after comparing the CDUS findings with histopathologic findings.