Submental Nodes Research Articles

Cat Scratch Disease

Cat scratch disease presenting as an enlarged submental lymph node in a 5-year-old boy is reported. There was clear history of contact with a cat, raised immunoglobulin G antibody titre against Bartonella henselae, and a granulomatous reaction in the excised lymph node.

Consolidation Radiotherapy following Brief Chemotherapy for Localized Diffuse Large B-cell Lymphoma: A Prospective Study

Many physicians administer involved field radiation therapy (RT) following brief chemotherapy for localized aggressive non-Hodgki n's lymphoma. Involved field irradiation usually implies treatment to the involved nodal regions with and without the contiguous lymphatic region, however, there is no agreements about its definition. Here we assess the appropriateness of RT irrespective of lymph node regions (localized field) following chemotherapy for patients with early stage diffuse large B-cell lymphoma. The localized field encompassed all original gross tumor volumes before chemotherapy with at least a 2- to 3-cm margin irrespective of lymphatic regions. We also evaluated the suitable radiation dose on the basis of response to chemotherapy. Twenty five eligible patients were treated with 3 cycles of chemotherapy (CHOP) followed by RT. All 25 patients had disease confined to Waldeye r's ring and/or cervical lymph nodes. Twenty two patients in complete response following chemotherapy received 30 Gy, and the remaining 3 in partial response received 40 Gy. With a median follow up of 42 months, both event free and overall survival rates at 2 years were 96.0%. There were no in-field recurrences, however, two patients experienced relapses. One developed central nervous system involvement and subsequently died of his disease. The other had mediastinal and submental lymph node relapse at 32 months, and is alive after salvage chemotherapy. Our study demonstrated that it should be possible to reduce treatment volume to less than the conventional involved field, and to limit the dose of RT in the range of 30–40 Gy.

Lymphatic mapping and sentinel node identification in squamous cell carcinoma and melanoma of the head and neck.

The aim of our study was to evaluate the role of scintigraphy in lymphatic mapping and in the identification of the sentinel lymph node (SLN) in patients with head and neck cancer. Between September 1999 and February 2001 we enrolled 22 consecutive patients with cancer in the head and neck region: five squamous cell carcinomas, one Merkel cell tumor of the cheek, and 16 malignant melanomas. Lymphoscintigraphy was performed three hours before surgery after injection of 30-50 MBq of 99mTc -Nanocoll in 0.3 mL; the dose was fractionated by injecting the radiotracer at two points around the lesion. Static acquisition (anterior and/or lateral views, 512 x 512 matrix, 5 mins pre-set time) was started immediately after the injections so as to visualize the pathways of lymphatic drainage. The skin projection of the SLN was marked with ink. Intraoperative SLN detection was performed with perilesional injection of patent blue. SLNs were found with lymphoscintigraphy in all patients. Thirty-three SLNs were identified: one occipital node, three nodes at the base of the tongue, 10 superficial lateral nodes (external jugular), five submandibular nodes, five submental nodes, three mastoid nodes and six supraclavicular nodes. Biopsy was performed in 21/22 patients. In 20/22 patients the first lymph nodes were visualized in the proximal cranial regions (retroauricular, jugular and submandibular) at five minutes post injection. The SLN positivity rate was 13.6% (three patients). All patients with tumor-positive SLNs were submitted to radical dissection. Poor concordance in the detection of sentinel nodes was observed with patent blue. The flow of nanocolloid in the lymph vessels of the head is rapid. In our experience immediate scintigraphic imaging was essential to visualize the pathways of lymphatic drainage and the first SLN. Radioguided SLN biopsy is therefore recommended within three hours. Injection of patent blue is inadvisable because of the poor concordance with lymphoscintigraphy and the risk of permanent tattooing of the face.

Lymphatic mapping and sentinel lymph node biopsy in squamous cell carcinoma of the lower lip

Aims: The risk of metastases to the submandibular and submental lymph nodes in squamous cell carcinoma (SCC) of the lower lip is closely related to the primary tumour size and the differentiation of the tumour. In order to determine the feasibility of the technique and the possible metastatic lymph nodes in SCC of the lower lip, intraoperative lymphatic mapping and sentinel lymph node biopsy was performed in patients with tumour size greater than 2 cm (T2) and clinically non-palpable regional lymph nodes (N0). Methods: Intraoperative lymphatic mapping with patent blue dye was performed in 20 patients with SCC of the lower lip. The stained lymph node (sentinel) was identified in each patient and sent for frozen section analysis in order to verify tumour metastasis. All patients had undergone bilateral suprahyoid neck dissection at the same stage. Results: Three of the patients were female and 17 were male. The median age was 66. Sentinel lymph nodes were identified in 18 of the patients (90%). Intraoperative or post-operative histopathologic examination of the sentinel lymph node showed tumour metastasis in three of the patients (16.6%). The histopathologic examination of the remaining 15 patients whose sentinel lymph nodes were free of metastasis, showed no metastasis in the non-sentinel lymph nodes. In two of the three patients with metastatic sentinel lymph nodes, non-sentinel lymph nodes were free of metastases. There were no false negative results and no local or systemic complications of the technique were seen among the patients. Conclusions: Intraoperative lymphatic mapping and sentinel lymph node biopsy is feasible in patients with SCC of the lower lip who have large tumour size and non-palpable regional lymph nodes. The technique may help to avoid neck dissection when the patient has negative sentinel lymph node and when positive provides useful information for more effective radical treatment.

頭頚部，えきか部におけるｓｅｎｔｉｎｅｌ ｌｙｍｐｈ ｎｏｄｅの検討

The location of sentinel lymph nodes was evaluated about the head and neck, and the axilla area using blue dye. In the axilla area, sentinel lymph nodes were mainly located in the central and lateral lymph nodes, because the lateral and central lymph nodes were draining mainly the deep lymph channels of the upper extremity. However, the case with metastasis in several lymph nodes has a lower detection rate in the original sentinel lymph nodes because of the change in lymph flow, and the evaluation of the cubital lymph node is a study assignment. In the head and neck area, the location of sentinel lymph nodes was almost in accord with anatomical lymph flows ; sentinel lymph nodes were recognized in submandibular lymph nodes which originated in cheek skin tumors, submental lymph nodes which originated in underlip skin tumors, pre-auricular lymph nodes which originated in temporal skin tumors, and occipital lymph nodes which originated in occipital skin tumors. The lymph vessels of the head and neck area were s ort, and both afferent lymph vessels and efferent lymph vessels were dyed. [Skin Cancer (Japan) 2001; 16: 299-304]

Power Doppler sonography of normal cervical lymph nodes.

This study was undertaken to investigate the vascular patterns and resistance of normal cervical nodes by power Doppler sonography. In 101 subjects who had a sonographic examination of the neck, 1050 lymph nodes were detected. Only central vascularity was found in normal cervical nodes. The degree of vascularity in submental and submandibular nodes was higher than that in other regional nodes. Submental nodes had a higher vascular resistance in association with a lower blood flow velocity than other regional nodes. No significant difference was found in blood flow velocities and vascular resistance between male and female subjects. The vascular resistance increased significantly with age. This study provides a baseline for vascularity within normal cervical nodes, as seen by power Doppler sonography.

両側顎下およびオトガイ下部にみられたリンパ節石灰化の１例

We report on a patient with calcification of the bilateral submandibular and submental lymph nodes. A 40-year-old woman had swelling of the buccal gingiva around 5.Panoramic radiography at presentation showed radiopaque images, one in the right submandibular region and one in the left submandibular region. CT examination showed multiple high density masses that appeared calcified, one in the right submandibular region, two in the left submandibular region, and one in the submental region. We excised the masses from both submandibular and submental regions under general anesthesia, and found that the masses were covered with a thin fibrous tissue coat ; calcified bodies of various sizes had formed in the lymph nodes. Although foreign body giant cells were observed around the calcified bodies, there were no epithelioid cells and no Langerhans' giant cells, which are typically observed in tuberculosis. Ziehl-Neelsen stain was negative. We histopathologically diagnosed the masses as fibrosis with calcification. The clinical course has been good to date, with no recurrence 1 year 5 months postoperatively.

悪性軟骨様汗腺腫（悪性混合腫よう）（原標題は英語）

We report a case of malignant chondroid syringoma affecting the preauricular portion of the left ear of a 67-year-old man. There were submental lymph node metastasis and multiple pulmonary metastases two months later. The local recurrence occurred at the primary site about 12 months after the initial insufficient surgical procedure. We suspected clinically squamous cell carcinoma was suspected. However, the findings of the histopathological, immunohistochemical and ultrastructual examinations for reccurent tumor led us finally to make a diagnosis of malignant chondroid syringoma. Patient received electron beam radiation followed by administration of chemotherapeutic agents including CDDP, 5-FU and irinotecan and taxotere. We discussed the usefulness of such combination therapy, particulary the chemotherapeutic agents including taxotere.

Submental metastases from nasopharyngeal carcinoma

The primary treatment for nasopharyngeal carcinoma is radiotherapy. Despite optimal treatment the incidence of recurrent persistent or recurrent regional disease is significant. It is believed that recurrent regional disease is usually associated with local disease. Recurrent nodal disease commonly involves the subdigastric and upper jugular region and submental involvement is less common. This study includes 25 patients who had palpable submental nodes 2 years or more after radiotherapy. Five of the seven patients with proven malignant submental nodal recurrence of nasopharyngeal carcinoma had no other evidence of disease. Ultrasound accurately identified enlarged nodes and correctly predicted involvement. The ultrasound appearances of these nodes and their impact on management and prognosis is discussed.

Role of suprahyoid neck dissection in the treatment of squamous cell carcinoma of the lower lip.

Treatment of squamous cell carcinoma of the lip is primarily surgical. Unlike other oral lesions, lower lip cancers do not metastasize to lower cervical lymph nodes without invading submental and submandibular lymph nodes. This study presents 30 patients with N0 lower lip carcinoma who were treated by en bloc resection of the tumor with suprahyoid neck dissection. Occult metastasis was found in 4 patients (13%). Four patients, 3 of whom had no occult metastases, died of local or regional uncontrollable disease. Suprahyoid or modified radical neck dissection appears to be beneficial, even in small tumors of the lower lip, in detecting occult metastases.

顎下リンパ節の腫脹を主症状としたリンパ節型トキソプラズマ症のｌ例

Toxoplasmosis is a parasite infection caused by the obligate parasite, Toxoplasma gondii. In several types of acquired toxoplasmosis, lymph node toxoplasma is very frequent and lymphadenopathy is often the only clinical finding present.This paper describes a 31-year-old male patient who presented with swelling in the submandibular lymph nodes. He was diagnosed to have lymph node toxoplasmosis by serological investigations (IHA and IFA).The patient was treated with sulfamethoxazole 1600mg/day and trimethoprim 320mg/day for 40 days. There was a decrease in the size of the submental lymph nodes and the toxoplasma antibody titer. This infection was supposed to have been acquired from a pet cat.

Disseminated Persistent Lymphoid Hyperplasia Containing Epstein-Barr Virus and Clonal Rearrangements of DNA

We describe the pathologic, molecular, and clinical features of a 52-year-old man who had a 7-year history of widely disseminated, persistent lymphoid hyperplasia. Exuberant follicular and interfollicular lymphoid hyperplasia with some histologic features of Castleman's disease were present at various times in the submental and cervical lymph nodes, lacrimal and parotid glands, right and left orbits, mediastinum, and hard palate of this patient. Flow cytometric and immunoperoxidase studies of two of the specimens indicated a slight predominance of cells expressing lambda-immunoglobulin light chain. In one specimen, there were clonal rearrangement of DNA coding for immunoglobulin heavy chain and for the T-cell beta-receptor. When DNA from this specimen was also examined by the polymerase chain reaction technique, Epstein-Barr viral DNA was detected. This case suggests that Epstein-Barr virus may be associated with an unusual form of aggressive and persistent lymphoid hyperplasia that contains clonal rearrangements of DNA.

オトガイ下リンパ節腫脹と結節性紅斑を初発症状としたサルコイドーシスの１症例

オトガイ下リンパ節腫脹と結節性紅斑を初発症状としたサルコイドーシスの１症例

口腔癌におけるオトガイ下リンパ節転移の臨床病理学的検討

A clinicopathological study was performed on 9 cases of metastasis of the oral cancer to the submental lymph node experienced in our department. As a result, it was found that the metastasis was extensive in these cases with a high incidence of recurrence in the contralateral cervical region. Compared with the submandibular lymph node, the tumor tended to develop outside the lymph node in the early stage for metastatic lesions of the submental lymph node, and the recurrence after radical neck dissection was also more frequently observed in the submental region. Therefore, the metastatic aspect in the submental lymph node apparently differed from that of the submandibular lymph node.Thus, a more elaborate treatment should be performed in such cases.

口腔領域へん平上皮癌における頚部リンパ節転移の様態と予後

A clinical evaluation of lymphatic metastasis was carried out on previously-untreated 104 patients with squamous cell carcinoma in the oral region.Exact metastases, evaluated by microscopy, to the submandibular, middle cervical, upper cervical and submental nodes appeared in the above order of frequency. Few metastases were observed in the other parts of the cervical lymph nodes. Relatively higher frequency of metastasis to the cervical lymph nodes was detected in patients with primary lesions of the gingiva of the upper jaw, buccal mucosa, gingiva of the lower jaw, floor of the mouth and tongue.Later metastasis to the cervical lymph nodes after the primary treatment was observed at relatively low rates in patients with tumor of the maxillary sinus, gingiva of the lower jaw and oropharynx, as compared to tumors of the upper jaw, buccal mucosa, floor of the mouth and tongue. Patient's survival rate closely related to whether or not the later metastasis to the cervical lymph nodes occured while no significant correlation between the existence of metastatic lymph nodes before treatment and the patient's survical rate was detected. However, no definitive factor influencing the later metastasis could be found in the present study.

いわゆるミクリッツ病の３症例

Three cases with so-called Mikulicz's disease were studied clinically.Case 1 A 35-year-old woman was suffering from bilateral lacrimal and submandibular gland swelling. Biopsy of the submandibular gland and lacrimal gland showed severe atrophy of the glandular tissue and extensive lympoid infiltration accompanied by germinal center. It is five years since she first came to our clinic and has remained generally well without any treatment. The swelling of the gland is naturally decreasing.Case 2 A 62-year-old man was suffering from bilateral lacrimal and submandibular gland diffuse swelling. Histological examination revealed extensive infiltration with lymphocytes and plasma cells. Five months after his first visit, he showed significant changes in clinical and laboratory findings, that is to say, general lymphnode swelling, total protein 9.8 g/dl, hyper gamma globulinemia 50.1%, elevated ESR 119 mm/hr, etc. Steroid treatment resulted in gradual disappearance of the swelling.Case 3 A 69-year-old woman was referred to our clinic for evaluation regarding the enlargement of bilateral parotid gland, submandibular gland, right orbital region and submental lymphnode. This is a case of 45 years' duration and for a long time was treated as sarcoma. Steroid treatment resulted in gradual disappearance of the swelling.

Tuberculous osteomyelitis of the mandible

An unusual case of tuberculous involvement of the mandible in a 22-month-old African girl is presented. Other tissues involved included the small bones of the hands and feet and pulmonary, cervical, and submental lymph nodes. A short discussion of the pathogen involved is offered.

Reduced lymphatic drainage from hamster cheek pouch.

SummaryUsing a newly constructed, transparent isolation chamber preventing diffusion of India ink to adjacent tissues of the hamster mouth and neck, egression of dye to the regional, ipsilateral, submental lymph nodes takes place, but in a reduced fashion. It is suggested that the so-called “immunologically privileged” character of the hamster cheek pouch is related to a delayed and reduced lymphatic drainage from this site.

Lymphatics of the upper and lower lip: A clinical and experimental study

A number of experimental studies designed to determine lymphatic flow pattern from the upper and lower lip of the monkey, dog, and cat are described together with clinical observations on seventy-nine patients. The drainage was similar to that reported in anatomy books except for a few discrepancies; for example, the data presented indicate that the upper lip has as one of its primary lymphatic drainage sites the submental lymph nodes. These nodes also receive a large portion of the lymphatic flow from the central and lateral portions of the lower lip. Experimentally the lip lymphatics had a high incidence of contralateral flow after they passed through one or two lymph nodes on the epsilateral side. Clinically, however, contralateral metastasis occurred in only two patients.

Spindle and giant cell metaplasia in papillary carcinoma of the thyroid

The preceding discussion serves to re-emphasize that metaplasia to a highly lethal form of thyroid cancer can occur in the usually indolent papillary thyroid cancer. When this happens, these patients usually have the ominous signs previously elucidated. There is recent rapid growth in the thyroid or neck nodes, a large (over 5 cm.) tumor, and recurrent laryngeal nerve palsy. However, these signs are not always present. Furthermore, metaplasia may not be manifest in the first material examined histologically. There may be a long interval from the initial treatment to the appearance of large areas of metaplasia (twelve and ten years in two of these cases). Metaplasia may be present in either or both the primary tumor, cervical, or other metastases. Its absence in the primary lesion does not preclude its appearance in subsequent metastases. This was demonstrated in two patients in this review. There was metaplasia in a submental node in one (case IV) and an axillary node in the other (case V) with no evidence of metaplasia in the primary lesion in either. Once spindle or giant cell metaplasia is evident in large amounts, the prognosis is grave; the average time until death is five months.