Para-aortic Node Biopsy Research Articles

Seminoma or sarcoid?

A 33-year-old man subsequently diagnosed as having sarcoidosis presented with the clinical features of a testicular tumour with metastatic spread to para-aortic lymph nodes. Histological examination of the testis and para-aortic lymph node biopsy showed florid granulomatous change and a Kveim test was positive. This is a previously unreported presentation of sarcoidosis and emphasizes that histological confirmation of malignancy is essential prior to institution of cytotoxic therapy.

Endometrial Cancer: Changing Concepts in Therapy

All patients with adenocarcinoma of the endometrium should have a total abdominal hysterectomy, bilateral salpingo-oophorectomy, peritoneal cytology study, and pelvic and para-aortic node biopsies when feasible. Patients with stage Ia disease do not need further therapy and have an excellent prognosis. Patients with stage Ib or Ic disease are at some risk for recurrence and should be considered for pelvic radiation, although their survival may be unaltered by this treatment. Patients found to have stage IIIc disease on the basis of metastases to the pelvic nodes should receive whole-pelvic radiation. Patients with multiple metastatic sites or with clear-cell or serous papillary adenocarcinomas should be considered for whole-abdominal radiation or other systemic treatment. Surgical staging with pelvic and para-aortic node biopsies is important, as it allows the clinician to make individualized treatment decisions based on accurate data and known prognostic factors.

Histologic disappearance of locally advanced vaginal cancer after combination chemotherapy

Clinically and histologically complete disappearance of local tumor and pelvic sidewall involvement was achieved in a patient with primary advanced squamous cell carcinoma of the vagina administered combination chemotherapy prior to operation. Radical hysterectomy, total vaginectomy, bilateral salpingo-oophorectomy, bilateral pelvic lymphadenectomy, and paraaortic lymph node biopsy were performed after seven courses of combination chemotherapy with vinblastine, bleomycin, and cis-platinum. This encouraging result warrants further investigation of combination chemotherapy in other patients.

Para-aortic lymph node biopsy before radical hysterectomy in early carcinoma of the cervix

SummaryIn a series of 150 consecutive patients with stage 1b or 2a carcinoma of the cervix, para-aortic lymph node biopsy with a frozen section was performed at the start of radical hysterectomy. The frozen section was positive in ten of 11 patients in whom the para-aortic nodes were eventually found to be positive on paraffin section. There were no false positives on frozen section but one false negative. There were four injuries to the vena cava, three of which required suture. In ten cases the operation was modified in some way as a result of the knowledge of the aortic lymph node status. Despite postoperative pelvic irradiation in ten cases and combination chemotherapy in one case, eight of the 11 patients died of their disease within 2 years of surgery and three are alive, having survived 3, 4 and 6 months, respectively. Operative removal of the uterus and parametria in all but one case prevented central pelvic recurrence although five patients developed lateral pelvic wall recurrence.

Preoperative CT study of lymph nodes in cervical cancer—Its correlation with histological findings

A study was conducted to retrospectively evaluate the accuracy of abdominopelvic computed tomography (CT) in the diagnosis of paraaortic and pelvic lymph node metastases from carcinoma of the uterine cervix. Seventy patients with a diagnosis of invasive carcinoma of the cervix had preoperative CT of abdomen and pelvis and subsequently underwent a radical hysterectomy with pelvic lymph node dissection and paraaortic lymph node biopsy or an exploratory laparotomy with paraaortic lymph node biopsy. Five of six patients with metastatic paraaortic lymph nodes larger than 15 mm in diameter on the histologic slides were diagnosed by CT scan to have enlarged nodes. CT diagnosis was true-positive in five of seven patients with paraaortic lymph node metastases (71.4%). Two patients with false-positive paraaortic lymph nodes had clusters of small lymph nodes less than 10 mm in diameter on the histologic slides. In contrast, only a small number of the metastatic pelvic nodes were diagnosed by CT as enlarged nodes. CT diagnosis was true-positive in 5 of 11 sites with pelvic lymph node metastases (45.5%).

Malignant pericardial effusion in endometrial adenocarcinoma

A case of endometrial adenocarcinoma in a 62-year-old woman with malignant pericardial effusion is presented. The patient underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic node dissection, and paraaortic node biopsy. Postoperatively, she was placed on a combination chemotherapy regimen of cisplatin, doxorubicin, and cyclophosphamide. The patient developed cardiac tamponade during the course of chemotherapy. Although we first suspected cardiotoxic effect of doxorubicin, cytologic examination revealed adenocarcinoma cells in the pericardial fluid. A review of the literature revealed no other cases of cardiac metastasis from endometrial carcinoma diagnosed during life.

Prognostic factors in stage II endometrial carcinoma.

The rarity of Stage II endometrial carcinoma and variable treatment modalities have made the evaluation of prognostic factors difficult. Clinical, surgical, and pathologic characteristics were evaluated in 64 patients treated with whole pelvic irradiation and intracavitary radium followed by hysterectomy at The University of Texas M.D. Anderson Hospital and Tumor Institute from January 1965 to December 1983. Comparison of 5-year actuarial survival rates revealed the following statistically significant categories: age, grade, depth of myometrial invasion, disease extent at surgery including lymph node metastases, and pelvic cytology. Race, weight, and cell type were not significant prognostic factors. Evaluation of prognostic factors at surgery includes pelvic and para-aortic lymph node biopsies, omental biopsy, pelvic cytologic washings, and biopsy of any suspicious tissues. Patients with adverse prognostic factors are candidates for trials with adjuvant therapy.

Para-aortic node biopsy in cervical and endometrial cancers: Does it affect survival?

International Journal of Gynecology & ObstetricsVolume 25, Issue 3 p. 264-265 Citations from the literature oncology Para-aortic node biopsy in cervical and endometrial cancers: Does it affect survival? JG Blythe, JG BlytheSearch for more papers by this authorKA Hodel, KA HodelSearch for more papers by this authorTP Wahl, TP WahlSearch for more papers by this author JG Blythe, JG BlytheSearch for more papers by this authorKA Hodel, KA HodelSearch for more papers by this authorTP Wahl, TP WahlSearch for more papers by this author First published: June 1987 https://doi.org/10.1016/0020-7292(87)90260-8AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume25, Issue3June 1987Pages 264-265 RelatedInformation

Para-aortic node biopsy in cervical and endometrial cancers: Does it affect survival?

Two hundred ten patients with endometrial and cervical carcinoma had para-aortic node biopsies. Nineteen of the 210 patients (9.0%) had positive para-aortic nodes. These 19 patients received pelvic irradiation, and 18 patients received para-aortic irradiation. The incidence of para-aortic nodal involvement in cervical carcinoma was directly related to the stage of the disease. Eleven of the 12 patients with cervical carcinoma and positive para-aortic nodes received both pelvic and para-aortic irradiation. Three of these patients are alive without disease, resulting in a survival rate of 25%. These patients are surviving for 16, 30, and 41 months. The incidence of positive para-aortic nodes in endometrial adenocarcinoma was related to the uterine length and the histologic grade. The survival rate for patients with endometrial adenocarcinoma and positive para-aortic nodes in this study was 57.1%. Four patients have survived for 1, 30, 60, and 71 months. There were no surgical deaths or radiation therapy complications directly attributable to para-aortic biopsy or irradiation.

Treatment of Advanced Invasive Cervical Cancer: Changing Times and Trends

A retrospective analysis of the treatment results and complications in 140 patients with advanced (Stage IIB or more) invasive cervical cancer treated at the Albert Einstein College of Medicine (AECOM) from 1962-1970 and the State University of New York at Buffalo (SUNYAB) from 1974-1982 is the subject of this report. All patients were clinically staged and received external pelvic radiotherapy followed by one to two intracavitary radium insertions, and those with histologically proven positive para-aortic nodes received on additional 4,500 to 5,000 rads to the para-aortic areas. Forty-four patients had pretherapy surgical staging (26 transperitoneal, 18 extraperitoneal). In the clinical staging group, a survival time of 5 years or longer was attained in 22 of 39 patients (56%); with Stage IIB, 11 of 30 patients (37%) with Stage IIIA, two of 13 patients with Stage IIIB and two of 12 patients with Stage IVA disease. Of 26 patients staged via transperitoneal approach, two survived more than 5 years and three others were alive at last contact (after more than 3 years follow-up). The last 18 patients have been subjected to laparoscopy and retroperitoneal pelvic and para-aortic node biopsies followed by tailored radiotherapy with [12] or without [6] chemotherapy. Chemotherapy consisted of alternating weekly courses of vincristine and bleomycin and hydroxyurea. Mitomycin-C was added to this regimen at the conclusion of the course of radiotherapy. Only one patient developed a vesicovaginal fistula. At last contact, seven patients in the combined therapy group were alive and free of disease. Combined therapy following extraperitoneal surgical staging appears to be feasible and justifiable. It deserves further trials in larger series.

Treatment of advanced invasive cervical cancer: changing times and trends.

A retrospective analysis of the treatment results and complications in 140 patients with advanced (Stage IIB or more) invasive cervical cancer treated at the Albert Einstein College of Medicine (AECOM) from 1962-1970 and the State University of New York at Buffalo (SUNYAB) from 1974-1982 is the subject of this report. All patients were clinically staged and received external pelvic radiotherapy followed by one to two intracavitary radium insertions, and those with histologically proven positive para-aortic nodes received on additional 4,500 to 5,000 rads to the para-aortic areas. Forty-four patients had pretherapy surgical staging (26 transperitoneal, 18 extraperitoneal). In the clinical staging group, a survival time of 5 years or longer was attained in 22 of 39 patients (56%); with Stage IIB, 11 of 30 patients (37%) with Stage IIIA, two of 13 patients with Stage IIIB and two of 12 patients with Stage IVA disease. Of 26 patients staged via transperitoneal approach, two survived more than 5 years and three others were alive at last contact (after more than 3 years follow-up). The last 18 patients have been subjected to laparoscopy and retroperitoneal pelvic and para-aortic node biopsies followed by tailored radiotherapy with [12] or without [6] chemotherapy. Chemotherapy consisted of alternating weekly courses of vincristine and bleomycin and hydroxyurea. Mitomycin-C was added to this regimen at the conclusion of the course of radiotherapy. Only one patient developed a vesicovaginal fistula. At last contact, seven patients in the combined therapy group were alive and free of disease. Combined therapy following extraperitoneal surgical staging appears to be feasible and justifiable. It deserves further trials in larger series.

Prognostic significance of morphology of tumor and retroperitoneal lymph nodes in epithelial carcinoma of the ovary: II. Correlation with survival

Correlation between prognostic indices derived from morphologic studies of retroperitoneal lymph nodes as well as primary tumor and survival in 39 patients with epithelial carcinoma of the ovary is reported. All had maximal surgery, adjuvant chemotherapy, and were followed for more than 2 years. A selective biopsy of pelvic and para-aortic lymph nodes was performed during the staging laparotomy in all instances. The chemotherapeutic regimen was a combination of Adriamycin, cis-platinum, and Cytoxan in a majority of cases. Prognostic indices, which showed positive correlation with survival, were cancer involvement, type of lymph node reaction, sinus histiocytosis, and fibroblastic proliferation in the regional lymph nodes; tumor grade, lymphocytic infiltration, stromal fibrosis, and histologic type in primary tumor; and stage of disease. Unfavorable factors for survival were nodal metastasis, lymphocytic depletion in abdominal nodes, and Grade 3 tumor. Clinical implications of our findings are discussed.

Prognostic significance of morphology of tumor and retroperitoneal lymph nodes in epithelial carcinoma of the ovary: I. Correlation with lymph node metastasis

The prognostic indices based on a morphologic study of tumor and retroperitoneal lymph nodes in 63 patients with epithelial carcinoma of the ovary are reported. The purpose of the study was to identify those variables most frequently related to nodal involvement. The cases in the series consisted of 11 Stage I, 10 Stage II, 34 Stage III, and 8 Stage IV. Histologic distribution was 60.4% serous type, 11.1% mucinous, 6.3% endometrioid, 6.3% clear cell and 15.9% unclassified. All patients had maximal surgery and selective biopsy of para-aortic and pelvic lymph nodes. The results showed statistically significant variables associated with nodal metastasis in both primary tumor and regional lymph nodes. The indices in primary tumor were grade of tumor, vascular invasion, lymphocytic infiltration, and stromal fibrosis; those in lymph node were type of lymph node reaction, sinus histiocytosis, and fibroblastic proliferation. The nodes with lymphocyte depletion were associated with nodal spread in 81.3% of cases. It is concluded that morphologic study of tumor and lymph node could identify prognostic factors predicting regional nodal metastasis in ovarian carcinoma.

Prognostic significance of morphology of tumor and retroperitoneal lymph node in epithelial carcinoma of the ovary

Abstract The prognostic indices based on a morphologic study of tumor and retroperitoneal lymph nodes in 63 patients with epithelial carcinoma of the ovary are reported. The purpose of the study was to identify those variables most frequently related to nodal involvement. The cases in the series consisted of 11 Stage I, 10 Stage II, 34 Stage III, and 8 Stage IV. Histologic distribution was 60.4% serous type, 11.1% mucinous, 6.3% endometrioid, 6.3% clear cell and 15.9% unclassified. All patients had maximal surgery and selective biopsy of para-aortic and pelvic lymph nodes. The results showed statistically significant variables associated with nodal metastasis in both primary tumor and regional lymph nodes. The indices in primary tumor were grade of tumor, vascular invasion, lymphocytic infiltration, and stromal fibrosis; those in lymph node were type of lymph node reaction, sinus histiocytosis, and fibroblastic proliferation. The nodes with lymphocyte depletion were associated with nodal spread in 81.3% of cases. It is concluded that morphologic study of tumor and lymph node could identify prognostic factors predicting regional nodal metastasis in ovarian carcinoma.

Value of lymphangiography in the diagnosis of paraaortic lymph node metastases from carcinoma of the cervix

A study was conducted to evaluate the accuracy of lymphangiography in the diagnosis of paraaortic lymph node metastases from carcinoma of the cervix. Thirty-nine patients with diagnoses of invasive carcinoma of the cervix underwent bipedal lymphangiography followed by exploratory laparotomy. In all, 37 required bilateral paraaortic lymphadenectomy, and 2 required paraaortic node biopsy. It was clear that lymphangiographic examination gave high predictive value when negative, but low predictive value when positive.

Extraperitoneal para-aortic lymph node biopsy and irradiation in cervical carcinoma

Extended field abdominopelvic radiation therapy delivering a dose of 6000 rad to para-aortic lymph nodes was tolerated without complication by a group of 8 patients. Para-aortic lymph node biopsy specimens from 30 patients by extraperitoneal surgical approach showed that these patients had metastatic involvement from primary squamous cell carcinoma of the cervix. Seven of the 8 treated patients developed recurrent and rapid dissemination 3–22 months after their diagnosis. Seven died 3–29 months after diagnosis; at this writing one was alive with pulmonary metastases.

Incidence, significance, and follow-up of para-aortic lymph node metastases in late invasive carcinoma of the cervix

One hundred and four patients with Stages II and III of cervical carcinoma underwent para-aortic node biopsies. Of these, 12.5 per cent of patients with Stage IIA, 14.9 per cent of patients with Stage IIB, and 38.4 per cent of patients with Stage III carcinoma of the cervix had positive para-aortic nodes. They subsequently recleve 6,000 rads to the para-aortic area. The radiotherapy complication rate was high. Within four years, 50 per cent of the patients with positive para-aortic nodes had other distant metastases. The two- and four-year follow-up is presented. Only one of 13 patients with positive para-aortic nodes was alive at the end of four years.

Urinary Polyamine Levels in the Diagnosis of Carcinoma of the Prostate

Urinary excretion of the basic polyamine, spermidine, was significantly elevated in patients with prostatic carcinoma as compared to a control group of patients. Of 44 urine specimens from patients with prostatic malignancy 31 had spermidine levels more than 2mg. per 24 hours, while only 3 of 13 urine specimens from the control groups had levels in excess of this value. The increase in spermidine appeared to be correlated with the histologic grading of the tumor, that is 30 of 34 specimens from patients with grade II, III or IV carcinoma had excessive spermidine excretion and only 1 of 10 urine specimens from patients with grade I tumors had similar spermidine elevations. High spermidine levels were found in tumors localized to the prostate and in 7 of 8 patients with negative pelvic and para-aortic lymph node biopsies. This study raises the possibility that urinary spermidine determinations may aid in the development of a biochemical screening test for prostatic neoplasms.

Surgical staging of abdominal involvement in unselected patients with Hodgkin's disease.

Abstract Fifty unselected patients with untreated Hodgkin's disease underwent diagnostic laparotomy, splenectomy, liver biopsy, and para-aortic lymph node biopsy as part of their evaluations. Histologic findings in para-aortic nodes, liver, and spleen are presented. No instance of liver involvement without concomitant splenic involvement was noted. Approximately 30% of patients whose preoperative work-up was negative or inconclusive proved to have unsuspected Hodgkin's disease, primarily in spleen and lymph nodes of splenic hilus. Left supraclavicular adenopathy appeared to correlate with intra-abdominal disease. Laparotomy with splenectomy and liver and para-aortic lymph node biopsies appears valuable for precise staging of intra-abdominal Hodgkin's disease.

The value of laparotomy and splenectomy in the staging of Hodgkin's disease.

Experience with 65 patients with biopsy-proven Hodgkin's disease who were subjected to laparotomy, splenectomy, liver biopsy, and para-aortic lymph node biopsy is presented. There were no major complications. Histologic findings in the para-aortic nodes, liver, and spleen are presented. A general correlation was observed between the occurrence of systemic symptoms and the extent of involvement below the diaphragm. There was no instance of liver involvement without concomitant splenic involvement. It is concluded that laparotomy with splenectomy is a valuable procedure for the more precise delineation of intra-abdominal sites of involvement in Hodgkin's disease prior to the initiation of extended field megavoltage radiation therapy with curative intent.