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Rao JH, Zha CP, Zhang WD, Cheng LH, Lei Q, Xie T, Peng W, Ye PJ, Zhang MY, Xing YJ, Sun CZ, Li L. Cervical Lymph Nodes Metastasis From Non-head and Neck Primary Carcinomas: A Retrospective Analysis of 1448 Patients. Head Neck 2025; 47:400-409. [PMID: 39545349 DOI: 10.1002/hed.28002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 10/21/2024] [Accepted: 11/04/2024] [Indexed: 11/17/2024] Open
Abstract
OBJECTIVE To investigate the clinicopathological features of individuals who have cervical lymph node metastasis (CLNM) from non-head and neck primary carcinomas. METHODS The data of 1448 patients diagnosed with CLNM from non-head and neck primary carcinomas at the Yunnan Cancer Hospital, Third Affiliated Hospital of Kunming Medical University, China, from January 2013 to December 2023 were collected. The patients' general information, imaging data, and pathological information were retrospectively analyzed. RESULTS There were 780 men and 668 women among the 1448 patients, for a male-to-female ratio of 1.17:1. The median age was 56 years (range 21-81 years). The most prevalent primary sites in males were the lung (n = 508, 65.1%) and, in females, the breast (n = 276, 41.3%). The most prevalent pathological kind (n = 949), or 65.5% of cases, was adenocarcinoma. There was a significant difference in the proportion of adenocarcinoma between males (n = 385, 49.4%) and females (n = 564, 84.4%). The common sites of CLNM from non-head and neck primary carcinomas were level V (1,236 cases, 85.4%). In a subgroup of 1133 patients with primary cancer located in symmetrical or unilateral organs, 60.3% exhibited ipsilateral lymph node metastasis, 27.6% had bilateral lymph node metastasis, and 12.1% showed contralateral lymph node metastasis exclusively. CONCLUSION For patients with CLNM, especially those with metastasis to cervical areas IV-V and those with adenocarcinoma pathology, it is particularly important to screen for primary foci in the lungs, breast, urogenital system, and digestive system after excluding head and neck primary cancers.
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Affiliation(s)
- Jin-Hui Rao
- Department of Head and Neck Surgery Section II, the Yunnan Cancer Hospital, Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Cheng-Peng Zha
- Department of Head and Neck Surgery Section II, the Yunnan Cancer Hospital, Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Wen-Da Zhang
- Department of Head and Neck Surgery Section II, the Yunnan Cancer Hospital, Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Liu-Han Cheng
- Department of Head and Neck Surgery Section II, the Yunnan Cancer Hospital, Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Qian Lei
- Department of Head and Neck Surgery Section II, the Yunnan Cancer Hospital, Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Tao Xie
- Department of Head and Neck Surgery Section II, the Yunnan Cancer Hospital, Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Wen Peng
- Department of Head and Neck Surgery Section II, the Yunnan Cancer Hospital, Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Pei-Jing Ye
- Department of Head and Neck Surgery Section II, the Yunnan Cancer Hospital, Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Min-Yue Zhang
- Department of Head and Neck Surgery Section II, the Yunnan Cancer Hospital, Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yu-Jie Xing
- Department of Head and Neck Surgery Section II, the Yunnan Cancer Hospital, Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Chuan-Zheng Sun
- Department of Head and Neck Surgery Section II, the Yunnan Cancer Hospital, Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Lei Li
- Department of Head and Neck Surgery Section II, the Yunnan Cancer Hospital, Third Affiliated Hospital of Kunming Medical University, Kunming, China
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Husnain A, Aadam AA, Reiland A, Salem R, Baker J, Nemcek AA, Green J, Ganger D, De Freitas RA, Riaz A. Combined Percutaneous Transhepatic Lymphatic Embolization and Peroral Duodenal Mucosal Radiofrequency Ablation to Manage Protein-Losing Enteropathy. J Vasc Interv Radiol 2024; 35:1351-1356.e1. [PMID: 38901491 DOI: 10.1016/j.jvir.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 06/07/2024] [Accepted: 06/13/2024] [Indexed: 06/22/2024] Open
Abstract
Percutaneous transhepatic lymphatic embolization (PTLE) and peroral esophagogastroduodenoscopy (EGD) duodenal mucosal radiofrequency (RF) ablation were performed to manage protein-losing enteropathy (PLE) in patients with congenital heart disease. Five procedures were performed in 4 patients (3 men and 1 woman; median age, 49 years; range, 31-71 years). Transhepatic lymphangiography demonstrated abnormal periduodenal lymphatic channels. After methylene blue injection through transhepatic access, subsequent EGD evaluation showed methylene blue extravasation at various sites in the duodenal mucosa. Endoscopic RF ablation of the leakage sites followed by PTLE using 3:1 ethiodized oil-to-n-butyl cyanoacrylate glue ratio resulted in improved symptoms and serum albumin levels (before procedure, 2.6 g/dL [SD ± 0.2]; after procedure, 3.5 g/dL [SD ± 0.4]; P = .004) over a median follow-up of 16 months (range, 5-20 months). Transhepatic lymphangiography and methylene blue injection with EGD evaluation of the duodenal mucosa can help diagnose PLE. Combined PTLE and EGD-RF ablation is an option to treat patients with PLE.
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Affiliation(s)
- Ali Husnain
- Section of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Abdul Aziz Aadam
- Section of Gastroenterology and Hepatology, Department of Medicine, Northwestern Memorial Hospital, Chicago, Illinois
| | - Allison Reiland
- Section of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Riad Salem
- Section of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Joe Baker
- Section of Interventional Radiology, Department of Radiology, Lurie Children's Hospital, Chicago, Illinois
| | - Albert A Nemcek
- Section of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Jared Green
- Department of Radiology, Memorial Healthcare System, Miami, Florida
| | - Daniel Ganger
- Section of Gastroenterology and Hepatology, Department of Medicine, Northwestern Memorial Hospital, Chicago, Illinois
| | - Roger Andrew De Freitas
- Section of Cardiology, Department of Medicine, Northwestern Memorial Hospital, Chicago, Illinois
| | - Ahsun Riaz
- Section of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois.
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Ellebrecht DB, Hoge M, von Weihe S. [Chylothorax]. Zentralbl Chir 2024; 149:133-147. [PMID: 38442889 DOI: 10.1055/a-1990-4896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Chylothorax is a serious and potentially life-threatening condition of diverse etiology. This article provides a detailed overview of anatomy, physiology, etiology, diagnosis, and therapeutic options in the context of chylothorax.
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Bauer C, Scala M, Rome JJ, Tulzer G, Dori Y. Lymphatic Imaging and Intervention in Congenital Heart Disease. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101174. [PMID: 39131972 PMCID: PMC11308220 DOI: 10.1016/j.jscai.2023.101174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 08/13/2024]
Abstract
The lymphatic system plays a central role in some of the most devastating complications associated with congenital heart defects. Diseases like protein-losing enteropathy, plastic bronchitis, postoperative chylothorax, and chylous ascites are now proven to be lymphatic in origin. Novel imaging modalities, most notably, noncontrast magnetic resonance lymphangiography and dynamic contrast-enhanced magnetic resonance lymphangiography, can now depict lymphatic anatomy and function in all major lymphatic compartments and are essential for modern therapy planning. Based on the new pathophysiologic understanding of lymphatic flow disorders, innovative minimally invasive procedures have been invented during the last few years with promising results. Abnormal lymphatic flow can now be redirected with catheter-based interventions like thoracic duct embolization, selective lymphatic duct embolization, and liver lymphatic embolization. Lymphatic drainage can be improved through surgical or interventional techniques such as thoracic duct decompression or lympho-venous anastomosis.
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Affiliation(s)
- Christoph Bauer
- Department of Paediatric Cardiology, Kepler University Hospital GmbH, Linz, Austria
- Johannes Kepler University Linz, Linz, Austria
| | - Mario Scala
- Johannes Kepler University Linz, Linz, Austria
- Central Radiology Institute, Kepler University Hospital GmbH, Linz, Austria
| | - Jonathan J. Rome
- Department of Cardiology, Jill and Mark Fishman Center for Lymphatic Disorders, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Gerald Tulzer
- Department of Paediatric Cardiology, Kepler University Hospital GmbH, Linz, Austria
- Johannes Kepler University Linz, Linz, Austria
| | - Yoav Dori
- Department of Cardiology, Jill and Mark Fishman Center for Lymphatic Disorders, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Pieper CC. Back to the Future II-A Comprehensive Update on the Rapidly Evolving Field of Lymphatic Imaging and Interventions. Invest Radiol 2023; 58:610-640. [PMID: 37058335 DOI: 10.1097/rli.0000000000000966] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
ABSTRACT Lymphatic imaging and interventional therapies of disorders affecting the lymphatic vascular system have evolved rapidly in recent years. Although x-ray lymphangiography had been all but replaced by the advent of cross-sectional imaging and the scientific focus shifted to lymph node imaging (eg, for detection of metastatic disease), interest in lymph vessel imaging was rekindled by the introduction of lymphatic interventional treatments in the late 1990s. Although x-ray lymphangiography is still the mainstay imaging technique to guide interventional procedures, several other, often less invasive, techniques have been developed more recently to evaluate the lymphatic vascular system and associated pathologies. Especially the introduction of magnetic resonance, and even more recently computed tomography, lymphangiography with water-soluble iodinated contrast agent has furthered our understanding of complex pathophysiological backgrounds of lymphatic diseases. This has led to an improvement of treatment approaches, especially of nontraumatic disorders caused by lymphatic flow abnormalities including plastic bronchitis, protein-losing enteropathy, and nontraumatic chylolymphatic leakages. The therapeutic armamentarium has also constantly grown and diversified in recent years with the introduction of more complex catheter-based and interstitial embolization techniques, lymph vessel stenting, lymphovenous anastomoses, as well as (targeted) medical treatment options. The aim of this article is to review the relevant spectrum of lymphatic disorders with currently available radiological imaging and interventional techniques, as well as the application of these methods in specific, individual clinical situations.
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Affiliation(s)
- Claus C Pieper
- From the Division for Minimally Invasive Lymphatic Therapy, Department of Diagnostic and Interventional Radiology, University Hospital Bonn; and Center for Rare Congenital Lymphatic Diseases, Center of Rare Diseases Bonn, Bonn, Germany
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Saito T, Muro S, Fujiwara H, Umebayashi Y, Sato Y, Tokunaga M, Akita K, Kinugasa Y. Histological study of the structural layers around the esophagus in the lower mediastinum. World J Gastrointest Surg 2023; 15:1331-1339. [PMID: 37555123 PMCID: PMC10405116 DOI: 10.4240/wjgs.v15.i7.1331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/20/2023] [Accepted: 05/22/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND In Japan, the transhiatal approach, including lower mediastinal lymph node dissection, is widely performed for Siewert type II esophagogastric junction adenocarcinoma. This procedure is generally performed in a magnified view using laparoscopy or a robotic system, therefore, the microanatomy of the lower mediastinum is important. However, mediastinal microanatomy is still unclear and classification of lower mediastinal lymph nodes is not currently based on fascia or other microanatomical structures. AIM To clarify the fascia and layer structures of the lower mediastinum and classify the lower mediastinal tissue. METHODS We dissected the esophagus and surrounding organs en-bloc from seven cadavers fixed in 10% formalin. Organs and tissues were then cut at the level of the lower thoracic esophagus, embedded in paraffin, and serially sectioned. Tissue sections were stained with Hematoxylin-Eosin (all cadavers) and immunostained for the lymphatic endothelial marker D2-40 (three cadavers). We observed the periesophageal fasciae and layers, and defined lymph node boundaries based on the fasciae. Lymphatic vessels around the esophagus were observed on immunostained tissue sections. RESULTS We identified two fasciae, A and B. We then classified lower mediastinal tissue into three areas, paraesophageal, paraaortic, and intermediate, using these fasciae as boundaries. Lymph nodes were found to be present and were counted in each area. The dorsal part of the intermediate area was thicker on the caudal side than on the cranial side in all cadavers. On the dorsal side, no blood vessels penetrated the fasciae in six of the seven cadavers, whereas the proper esophageal artery penetrated fascia B in one cadaver. D2-40 immunostaining showed lymphatic vessel connections between the paraesophageal and intermediate areas on the lateral and ventral sides of the esophagus, but no lymphatic connection between areas on the dorsal side of the esophagus. CONCLUSION Histological studies identified two fasciae surrounding the esophagus in the lower mediastinum and the layers separated by these fasciae were used to classify the lower mediastinal tissues.
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Affiliation(s)
- Toshifumi Saito
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Bunkyo-ku 113-8519, Tokyo, Japan
| | - Satoru Muro
- Department of Clinical Anatomy, Tokyo Medical and Dental University, Bunkyo-ku 113-8519, Tokyo, Japan
| | - Hisashi Fujiwara
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Bunkyo-ku 113-8519, Tokyo, Japan
| | - Yuya Umebayashi
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Bunkyo-ku 113-8519, Tokyo, Japan
| | - Yuya Sato
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Bunkyo-ku 113-8519, Tokyo, Japan
| | - Masanori Tokunaga
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Bunkyo-ku 113-8519, Tokyo, Japan
| | - Keiichi Akita
- Department of Clinical Anatomy, Tokyo Medical and Dental University, Bunkyo-ku 113-8519, Tokyo, Japan
| | - Yusuke Kinugasa
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Bunkyo-ku 113-8519, Tokyo, Japan
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Hsu PK, Lee YY, Chuang LC, Wu YC. Lymph Node Dissection for Esophageal Squamous Cell Carcinoma. Thorac Surg Clin 2022; 32:497-510. [DOI: 10.1016/j.thorsurg.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Lee E, Biko DM, Sherk W, Masch WR, Ladino-Torres M, Agarwal PP. Understanding Lymphatic Anatomy and Abnormalities at Imaging. Radiographics 2022; 42:487-505. [PMID: 35179984 DOI: 10.1148/rg.210104] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Lymphatic abnormalities encompass a wide range of disorders spanning solitary common cystic lymphatic malformations (LMs) to entities involving multiple organ systems such as lymphangioleiomyomatosis. Many of these disorders are rare, yet some, such as secondary lymphedema from the treatment of malignancy (radiation therapy and/or lymph node dissection), affect millions of patients worldwide. Owing to complex and variable anatomy, the lymphatics are not as well understood as other organ systems. Further complicating this is the variability in the description of lymphatic disease processes and their nomenclature in the medical literature. In recent years, medical imaging has begun to facilitate a deeper understanding of the physiology and pathologic processes that involve the lymphatic system. Radiology is playing an important and growing role in the diagnosis and treatment of many lymphatic conditions. The authors describe both normal and common variant lymphatic anatomy. Various imaging modalities including nuclear medicine lymphoscintigraphy, conventional lymphangiography, and MR lymphangiography used in the diagnosis and treatment of lymphatic disorders are highlighted. The authors discuss imaging many of the common and uncommon lymphatic disorders, including primary LMs described by the International Society for the Study of Vascular Anomalies 2018 classification system (microcystic, mixed, and macrocystic LMs; primary lymphedema). Secondary central lymphatic disorders are also detailed, including secondary lymphedema and chylous leaks, as well as lymphatic disorders not otherwise easily classified. The authors aim to provide the reader with an overview of the anatomy, pathology, imaging findings, and treatment of a wide variety of lymphatic conditions. ©RSNA, 2022.
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Affiliation(s)
- Elizabeth Lee
- From the Department of Radiology, Divisions of Cardiothoracic Imaging (E.L., P.P.A.), Interventional Radiology (W.S.), and Body Imaging (W.R.M.), University of Michigan, University Hospital Floor B1, Reception C, 1500 E Medical Center Dr, SPC 5030, Ann Arbor, MI 48109; University of Pennsylvania Perelman School of Medicine, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (D.M.B.); and Department of Radiology, Division of Pediatric Radiology, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, Mich (M.L.T.)
| | - David M Biko
- From the Department of Radiology, Divisions of Cardiothoracic Imaging (E.L., P.P.A.), Interventional Radiology (W.S.), and Body Imaging (W.R.M.), University of Michigan, University Hospital Floor B1, Reception C, 1500 E Medical Center Dr, SPC 5030, Ann Arbor, MI 48109; University of Pennsylvania Perelman School of Medicine, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (D.M.B.); and Department of Radiology, Division of Pediatric Radiology, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, Mich (M.L.T.)
| | - William Sherk
- From the Department of Radiology, Divisions of Cardiothoracic Imaging (E.L., P.P.A.), Interventional Radiology (W.S.), and Body Imaging (W.R.M.), University of Michigan, University Hospital Floor B1, Reception C, 1500 E Medical Center Dr, SPC 5030, Ann Arbor, MI 48109; University of Pennsylvania Perelman School of Medicine, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (D.M.B.); and Department of Radiology, Division of Pediatric Radiology, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, Mich (M.L.T.)
| | - William R Masch
- From the Department of Radiology, Divisions of Cardiothoracic Imaging (E.L., P.P.A.), Interventional Radiology (W.S.), and Body Imaging (W.R.M.), University of Michigan, University Hospital Floor B1, Reception C, 1500 E Medical Center Dr, SPC 5030, Ann Arbor, MI 48109; University of Pennsylvania Perelman School of Medicine, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (D.M.B.); and Department of Radiology, Division of Pediatric Radiology, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, Mich (M.L.T.)
| | - Maria Ladino-Torres
- From the Department of Radiology, Divisions of Cardiothoracic Imaging (E.L., P.P.A.), Interventional Radiology (W.S.), and Body Imaging (W.R.M.), University of Michigan, University Hospital Floor B1, Reception C, 1500 E Medical Center Dr, SPC 5030, Ann Arbor, MI 48109; University of Pennsylvania Perelman School of Medicine, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (D.M.B.); and Department of Radiology, Division of Pediatric Radiology, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, Mich (M.L.T.)
| | - Prachi P Agarwal
- From the Department of Radiology, Divisions of Cardiothoracic Imaging (E.L., P.P.A.), Interventional Radiology (W.S.), and Body Imaging (W.R.M.), University of Michigan, University Hospital Floor B1, Reception C, 1500 E Medical Center Dr, SPC 5030, Ann Arbor, MI 48109; University of Pennsylvania Perelman School of Medicine, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (D.M.B.); and Department of Radiology, Division of Pediatric Radiology, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, Mich (M.L.T.)
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Ovadia M. Pulmonary Arterial 18F-FDG Uptake in Sarcoidosis: A Novel Biosignal for Subclinical Pulmonary Hypertension. JACC Cardiovasc Imaging 2021; 15:121-125. [PMID: 34801464 DOI: 10.1016/j.jcmg.2021.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/12/2021] [Accepted: 08/12/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Marc Ovadia
- Cardiac Catheterization Laboratory, Swedish-American Hospital (A Division of University of Wisconsin Health), Rockford, Illinois, USA; Department of Internal Medicine, Chicago Medical School, Rosalind Franklin University, North Chicago, Illinois, USA; Lutheran General Hospital, Park Ridge, Illinois and Illinois Masonic Hospital, Chicago, Illinois, USA; University of Illinois College of Medicine, Rockford, Illinois, USA.
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Ishida H, Nakazawa K, Yanagihara A, Umesaki T, Taguchi R, Yamada A, Nitanda H, Sakaguchi H. Chylothorax associated with lymphatic reflux in a thoracic duct tributary after lung cancer surgery. Thorac Cancer 2021; 12:2221-2224. [PMID: 34152082 PMCID: PMC8327699 DOI: 10.1111/1759-7714.14062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/05/2021] [Accepted: 06/09/2021] [Indexed: 12/25/2022] Open
Abstract
Chyle leaks are attributed to damage to the thoracic duct itself or its tributaries during surgery. Chylothorax after lung cancer surgery can occur due to damaged thoracic duct tributaries; however, little is known of the mechanism involved. A 71-year-old female underwent a left upper lobectomy with hilar and mediastinal lymphadenectomy for a 1.8-cm primary squamous cell carcinoma, and developed a chylothorax a day later. Catheter lymphangiography revealed high-flow chyle leaks from a damaged thoracic duct tributary, known as a bronchomediastinal lymph trunk, due to a lymphatic reflex from the thoracic duct. Subsequently, catheter embolization of the tributary repaired the chylothorax. The potential for persistent chylothorax after lung cancer surgery and successful lymphatic intervention should be noted.
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Affiliation(s)
- Hironori Ishida
- Department of General Thoracic SurgerySaitama Medical University International Medical CenterSaitamaJapan
| | - Ken Nakazawa
- Department of Diagnostic RadiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Akitoshi Yanagihara
- Department of General Thoracic SurgerySaitama Medical University International Medical CenterSaitamaJapan
| | - Tetsuya Umesaki
- Department of General Thoracic SurgerySaitama Medical University International Medical CenterSaitamaJapan
| | - Ryo Taguchi
- Department of General Thoracic SurgerySaitama Medical University International Medical CenterSaitamaJapan
| | - Akiko Yamada
- Department of General Thoracic SurgerySaitama Medical University International Medical CenterSaitamaJapan
| | - Hiroyuki Nitanda
- Department of General Thoracic SurgerySaitama Medical University International Medical CenterSaitamaJapan
| | - Hirozo Sakaguchi
- Department of General Thoracic SurgerySaitama Medical University International Medical CenterSaitamaJapan
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Rabattu PY, Sole Cruz E, El Housseini N, El Housseini A, Bellier A, Verot PL, Cassiba J, Quillot C, Faguet R, Chaffanjon P, Piolat C, Robert Y. Anatomical study of the thoracic duct and its clinical implications in thoracic and pediatric surgery, a 70 cases cadaveric study. Surg Radiol Anat 2021; 43:1481-1489. [PMID: 34050781 DOI: 10.1007/s00276-021-02764-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/04/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Given the high variability and fragility of the thoracic duct, good knowledge of its anatomy is essential for its repair or to prevent iatrogenic postoperative chylothorax. The objective of this study was to define a site where the thoracic duct is consistently found for its ligation. The second objective was to define an anatomically safe surgical pathway to prevent iatrogenic chylothorax in surgery for aortic arch anomalies with vascular ring, through better knowledge of the anatomical relationships of the thoracic duct. METHODS Seventy adult formalin-fixed cadavers were dissected. The anatomical relationships of the thoracic duct were reported at the postero-inferior mediastinum, at levels T3 and T4. RESULTS The thoracic duct was consistently situated between the left anterolateral border of the azygos vein and the right border of the aorta between levels T9 and T10, whether it was simple, double, or plexiform. It was located medially, anteromedially, or posteriorly to the left subclavian artery in 51%, 21%, and 28% of the cases, respectively, at the level of T3. At T4, it was posteromedial in 27% of the cases or had no direct relationship with the aortic arch. CONCLUSION These results favor mass ligation of the thoracic duct at levels T9-T10 between the right border of the aorta and the azygos vein, eventually including the latter. To prevent iatrogenic postoperative chylothorax in aortic arch anomalies with vascular ring surgery, we recommend remaining strictly lateral to the left subclavian artery at the level of T3 to reach the aortic arch anomalies with vascular ring at T4.
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Affiliation(s)
- P Y Rabattu
- LADAF, Anatomical Laboratory, Univ. Grenoble Alpes, Grenoble University Hospital, 38000, Grenoble, France
- Department of Pediatric Surgery, Children's Hospital, University Hospital of Grenoble, 38000, Grenoble, France
| | - E Sole Cruz
- LADAF, Anatomical Laboratory, Univ. Grenoble Alpes, Grenoble University Hospital, 38000, Grenoble, France
- Department of Pediatric Surgery, Children's Hospital, University Hospital of Grenoble, 38000, Grenoble, France
- ID17 Biomedical Beamline, European Synchrotron Radiation Facility, 38000, Grenoble, France
| | - N El Housseini
- LADAF, Anatomical Laboratory, Univ. Grenoble Alpes, Grenoble University Hospital, 38000, Grenoble, France
| | - A El Housseini
- LADAF, Anatomical Laboratory, Univ. Grenoble Alpes, Grenoble University Hospital, 38000, Grenoble, France
| | - A Bellier
- LADAF, Anatomical Laboratory, Univ. Grenoble Alpes, Grenoble University Hospital, 38000, Grenoble, France
| | - P L Verot
- Department of Pediatric Surgery, Children's Hospital, University Hospital of Grenoble, 38000, Grenoble, France
| | - J Cassiba
- Department of Pediatric Reanimation, Children's Hospital, University Hospital of Grenoble, 38000, Grenoble, France
| | - C Quillot
- Department of Digestive Surgery, Nantes University Hospital, 44000, Nantes, France
| | - R Faguet
- Department of Pediatric Surgery, Children's Hospital, University Hospital of Grenoble, 38000, Grenoble, France
| | - P Chaffanjon
- LADAF, Anatomical Laboratory, Univ. Grenoble Alpes, Grenoble University Hospital, 38000, Grenoble, France
- GIPSA-Lab, Univ. Grenoble Alpes, CNRS, Grenoble INP, 38000, Grenoble, France
| | - C Piolat
- Department of Pediatric Surgery, Children's Hospital, University Hospital of Grenoble, 38000, Grenoble, France
| | - Y Robert
- LADAF, Anatomical Laboratory, Univ. Grenoble Alpes, Grenoble University Hospital, 38000, Grenoble, France.
- Department of Pediatric Surgery, Children's Hospital, University Hospital of Grenoble, 38000, Grenoble, France.
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Yadav A, Jain Y, Narkhede A, KM M, Gupta A. Lymphangiography and Lymphatic Interventions. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2021. [DOI: 10.1055/s-0041-1726165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AbstractCompared with the traditional pedal lymphangiography, intranodal lymphangiography and MR lymphangiography have made imaging of the lymphatic system less challenging. Improvements in imaging and availability of newer catheters have allowed embolization of lymphatic system much more feasible that previously envisioned. In this article, we briefly review the anatomy, imaging, and current and future of lymphatic interventions.
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Affiliation(s)
- Ajit Yadav
- Department of Interventional Radiology, Sir Ganga Ram Hospital, Sir Ganga Ram Hospital, New Delhi, India
| | - Yajush Jain
- Department of Interventional Radiology, Sir Ganga Ram Hospital, Sir Ganga Ram Hospital, New Delhi, India
| | - Amey Narkhede
- Department of Interventional Radiology, Sir Ganga Ram Hospital, Sir Ganga Ram Hospital, New Delhi, India
| | - Mahendra KM
- Department of Interventional Radiology, Sir Ganga Ram Hospital, Sir Ganga Ram Hospital, New Delhi, India
| | - Arun Gupta
- Department of Interventional Radiology, Sir Ganga Ram Hospital, Sir Ganga Ram Hospital, New Delhi, India
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13
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Park S, Yoon WS, Jang MH, Rim CH. Clinical Impact of Supraclavicular Lymph Node Involvement of Stage IIIC Non-Small Cell Lung Cancer Patients. ACTA ACUST UNITED AC 2021; 57:medicina57030301. [PMID: 33807016 PMCID: PMC8004859 DOI: 10.3390/medicina57030301] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 12/29/2022]
Abstract
Background and Objective: Investigations on the clinical impact of supraclavicular lymph node (SCN) involvement in stage IIIC non-small cell lung cancer (NSCLC) remain scarce. We evaluated the oncological outcomes of definitive radiochemotherapy and the clinical significance of SCN involvement. Materials and Methods: Between November 2009 and June 2019, a total of 40 patients with N3-positivity and NSCLC were evaluated. Most patients received concomitant chemotherapy, but six patients who received radiotherapy (RT) alone were also included. Twenty-one patients (52.5%) received 3D-conformal RT (3DCRT), and the remainder received intensity-modulated RT (IMRT). Results: The median follow-up duration was 10.7 months (range: 1.7-120.6 months). Median overall survival (OS) and cause-specific survival (CSS) times were 10.8 months and 16.3 months, respectively. Among the 40 patients, 17 (42.5%) had SCN involvement. SCN involvement negatively affected progression-free survival (hazard ratio (HR): 2.08, 95% confidence interval (CI): 1.04-4.17, p = 0.039) and local control (HR: 3.05, 95% CI: 1.09-8.50, p = 0.034). However, IMRT use was correlated with higher local control (HR: 0.28, 95% CI: 0.09-0.86, p = 0.027). Grade ≥3 esophagitis and pneumonitis accounted for 7.5% and 15.0% of all cases, respectively. A higher RT dose (mean dose: 66.6 vs. 61.7 Gy) was significantly correlated with grade ≥3 pneumonitis (p = 0.001). RT modality was a significant factor (p = 0.042, five of six cases occurred in the IMRT group). Conclusions: SCN involvement could negatively affect oncologic outcomes of stage IIIC NSCLC patients. High-dose irradiation with IMRT could increase local control but may cause lung toxicities.
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14
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Abstract
OBJECTIVE. This article reviews thoracic lymphatic pathways and tributaries, discusses lymphatic anatomic variants and their clinical implications, and emphasizes common patterns of thoracic lymphadenopathy from extrapulmonary malignancies. CONCLUSION. Recognition of common patterns and pathways of thoracic lymphatic drainage can help identify the site of tumor origin and allow a more focused examination of disease extent, both of which are important for disease prognosis and management.
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15
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Cholet C, Delalandre C, Monnier-Cholley L, Le Pimpec-Barthes F, El Mouhadi S, Arrivé L. Nontraumatic Chylothorax: Nonenhanced MR Lymphography. Radiographics 2020; 40:1554-1573. [PMID: 33001788 DOI: 10.1148/rg.2020200044] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Chylothorax is a rare cause of pleural effusion, secondary to accumulation of lymph in the pleural space. Diagnosis is based on the triglyceride and cholesterol content of pleural fluid obtained with thoracentesis. Because the lymphatic system plays an essential role in fat absorption and immune response, lymphatic leak associated with chylothorax may cause life-threatening malnutrition and immunodeficiency. Chylothorax is usually described as traumatic or nontraumatic. The main cause of chylothorax is traumatic, typically postsurgical, secondary to iatrogenic direct puncture of the thoracic duct during thoracic surgery. Causes of nontraumatic chylothorax include a wide range of differential diagnoses. Lymphoma and thoracic malignancies are the most common causes and are responsible for chylothorax by extrinsic compression or invasion of the thoracic duct. Other rare causes include primary and secondary diffuse lymphatic diseases, responsible for chylothorax by lymphatic vessel wall dysfunction. Imaging the lymphatic system remains a challenge in the days of modern imaging. Nonenhanced MR lymphography is a noninvasive technique based on heavily T2-weighted sequences, thus enabling visualization of the lymphatic circulation. This technique allows diagnosis and differential diagnosis, evaluation of disease severity, and guidance of therapeutic management in nontraumatic chylothorax. Furthermore, it may offer radiologic classification of primary lymphatic diseases on the basis of morphologic features of lymphatic vessels. The authors describe the anatomy and physiology of the thoracic lymphatic system, present the technique of nonenhanced MR lymphography, and discuss pathophysiologic mechanisms and imaging features in different causes of nontraumatic chylothorax. ©RSNA, 2020.
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Affiliation(s)
- Clément Cholet
- From the Department of Radiology, Saint-Antoine Hospital (AP-HP), 184 Rue du Faubourg Saint-Antoine, 75012 Paris, France (C.C., C.D., L.M.C., S.E.M., L.A.); Médecine Sorbonne University, Paris, France (C.C., L.A.); and Department of Thoracic and Pulmonary Surgery, Georges Pompidou European Hospital (AP-HP), Paris, France (F.L.P.B.)
| | - Coline Delalandre
- From the Department of Radiology, Saint-Antoine Hospital (AP-HP), 184 Rue du Faubourg Saint-Antoine, 75012 Paris, France (C.C., C.D., L.M.C., S.E.M., L.A.); Médecine Sorbonne University, Paris, France (C.C., L.A.); and Department of Thoracic and Pulmonary Surgery, Georges Pompidou European Hospital (AP-HP), Paris, France (F.L.P.B.)
| | - Laurence Monnier-Cholley
- From the Department of Radiology, Saint-Antoine Hospital (AP-HP), 184 Rue du Faubourg Saint-Antoine, 75012 Paris, France (C.C., C.D., L.M.C., S.E.M., L.A.); Médecine Sorbonne University, Paris, France (C.C., L.A.); and Department of Thoracic and Pulmonary Surgery, Georges Pompidou European Hospital (AP-HP), Paris, France (F.L.P.B.)
| | - Françoise Le Pimpec-Barthes
- From the Department of Radiology, Saint-Antoine Hospital (AP-HP), 184 Rue du Faubourg Saint-Antoine, 75012 Paris, France (C.C., C.D., L.M.C., S.E.M., L.A.); Médecine Sorbonne University, Paris, France (C.C., L.A.); and Department of Thoracic and Pulmonary Surgery, Georges Pompidou European Hospital (AP-HP), Paris, France (F.L.P.B.)
| | - Sanaâ El Mouhadi
- From the Department of Radiology, Saint-Antoine Hospital (AP-HP), 184 Rue du Faubourg Saint-Antoine, 75012 Paris, France (C.C., C.D., L.M.C., S.E.M., L.A.); Médecine Sorbonne University, Paris, France (C.C., L.A.); and Department of Thoracic and Pulmonary Surgery, Georges Pompidou European Hospital (AP-HP), Paris, France (F.L.P.B.)
| | - Lionel Arrivé
- From the Department of Radiology, Saint-Antoine Hospital (AP-HP), 184 Rue du Faubourg Saint-Antoine, 75012 Paris, France (C.C., C.D., L.M.C., S.E.M., L.A.); Médecine Sorbonne University, Paris, France (C.C., L.A.); and Department of Thoracic and Pulmonary Surgery, Georges Pompidou European Hospital (AP-HP), Paris, France (F.L.P.B.)
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16
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Schreuder A, Jacobs C, Scholten ET, van Ginneken B, Schaefer-Prokop CM, Prokop M. Typical CT Features of Intrapulmonary Lymph Nodes: A Review. Radiol Cardiothorac Imaging 2020; 2:e190159. [PMID: 33778597 DOI: 10.1148/ryct.2020190159] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 04/02/2020] [Accepted: 04/28/2020] [Indexed: 12/26/2022]
Abstract
Several studies investigated the appearance of intrapulmonary lymph nodes (IPLNs) at CT with pathologic correlation. IPLNs are benign lesions and do not require follow-up after initial detection. There are indications that IPLNs represent a considerable portion of incidentally found pulmonary nodules seen at high-resolution CT. The reliable and accurate identification of IPLNs as benign nodules may substantially reduce the number of unnecessary follow-up CT examinations. Typical CT features of IPLNs are a noncalcified solid nodule with sharp margins; a round, oval, or polygonal shape; distanced 15 mm or less from the pleura; and most being located below the level of the carina. The term perifissural nodule (PFN) was coined based on some of these characteristics. Standardization of those CT criteria are a prerequisite for accurate nodule classification. However, four different definitions of PFNs can currently be found in the literature. Furthermore, there is considerable variation in the reported interobserver agreement, malignancy rate, and prevalence of PFNs. The purpose of this review was to provide an overview of what is known about PFNs. In addition, knowledge gaps in defining PFNs will be discussed. A decision tree to guide clinicians in classifying nodules as PFNs is provided. Supplemental material is available for this article. © RSNA, 2020 See also the commentary by White and Rubin in this issue.
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Affiliation(s)
- Anton Schreuder
- Diagnostic Image Analysis Group, Department of Radiology, Nuclear Medicine, and Anatomy, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands (A.S., C.J., E.T.S., B.v.G., C.M.S.P., M.P.); Fraunhofer MEVIS, Bremen, Germany (C.J., B.v.G.); and Department of Radiology, Meander Medisch Centrum, Amersfoort, the Netherlands (C.M.S.P.)
| | - Colin Jacobs
- Diagnostic Image Analysis Group, Department of Radiology, Nuclear Medicine, and Anatomy, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands (A.S., C.J., E.T.S., B.v.G., C.M.S.P., M.P.); Fraunhofer MEVIS, Bremen, Germany (C.J., B.v.G.); and Department of Radiology, Meander Medisch Centrum, Amersfoort, the Netherlands (C.M.S.P.)
| | - Ernst T Scholten
- Diagnostic Image Analysis Group, Department of Radiology, Nuclear Medicine, and Anatomy, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands (A.S., C.J., E.T.S., B.v.G., C.M.S.P., M.P.); Fraunhofer MEVIS, Bremen, Germany (C.J., B.v.G.); and Department of Radiology, Meander Medisch Centrum, Amersfoort, the Netherlands (C.M.S.P.)
| | - Bram van Ginneken
- Diagnostic Image Analysis Group, Department of Radiology, Nuclear Medicine, and Anatomy, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands (A.S., C.J., E.T.S., B.v.G., C.M.S.P., M.P.); Fraunhofer MEVIS, Bremen, Germany (C.J., B.v.G.); and Department of Radiology, Meander Medisch Centrum, Amersfoort, the Netherlands (C.M.S.P.)
| | - Cornelia M Schaefer-Prokop
- Diagnostic Image Analysis Group, Department of Radiology, Nuclear Medicine, and Anatomy, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands (A.S., C.J., E.T.S., B.v.G., C.M.S.P., M.P.); Fraunhofer MEVIS, Bremen, Germany (C.J., B.v.G.); and Department of Radiology, Meander Medisch Centrum, Amersfoort, the Netherlands (C.M.S.P.)
| | - Mathias Prokop
- Diagnostic Image Analysis Group, Department of Radiology, Nuclear Medicine, and Anatomy, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands (A.S., C.J., E.T.S., B.v.G., C.M.S.P., M.P.); Fraunhofer MEVIS, Bremen, Germany (C.J., B.v.G.); and Department of Radiology, Meander Medisch Centrum, Amersfoort, the Netherlands (C.M.S.P.)
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17
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Bellier A, Pardo Vargas JS, Cassiba J, Desbrest P, Guigui A, Chaffanjon P. Anatomical variations in distal portion of the thoracic duct-A systematic review. Clin Anat 2019; 33:99-107. [PMID: 31576619 DOI: 10.1002/ca.23476] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/27/2019] [Accepted: 09/14/2019] [Indexed: 12/22/2022]
Abstract
The objective of this study was to identify and analyze the anatomical variations in the termination of the thoracic duct (TD) in cadavers or patients by anatomical dissections and surgical or radiological procedures for better knowledge of the interindividual variations through a systematic review. The search strategy included PubMed and reference tracking. Studies were identified by searching the electronic Medline databases. The search terms included "TD," "Jugular Vein," "Subclavian Vein," or "Cervical," and the protocol used is reported herein. These search results yielded 20 qualitative review articles out of the 275 articles consulted. We collected all the important data from these 20 articles with 1,352 TD analyzed by varying sources in our search. Regarding the characteristics of the studies and the anatomy of the TD, the results were heterogeneous. The TD most commonly terminates in the internal jugular vein in 54.05% of cases (95% confidence interval [CI]: 54.03; 54.07), in the jugular-venous angle in 25.79% (95% CI: 25.77; 25.81), and in the subclavian vein in 8.16% of cases (95% CI: 8.14;8.18). Other terminations were found in 12% of cases. This systematic review provided an overview of the variations in the distal portion of the TD. This study can be helpful for surgeons in selecting the most appropriate methods to achieve successful surgical results and avoid complications, such as chylothorax; it also offers detailed information on the cervical termination of the TD in new diagnostic and therapeutic methods involving the TD. Clin. Anat. 32:99-107, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Alexandre Bellier
- Grenoble Alpes University Hospital, Boulevard de la Chantourne, INSERM CIC1406, 38700, La Tronche, France.,Laboratoire d'Anatomie Des Alpes Françaises, Grenoble Alpes University, Place du commandant Nal, Domaine de La Merci, 38700, La Tronche, France
| | - Juan Sebastian Pardo Vargas
- Laboratoire d'Anatomie Des Alpes Françaises, Grenoble Alpes University, Place du commandant Nal, Domaine de La Merci, 38700, La Tronche, France
| | - Julie Cassiba
- Laboratoire d'Anatomie Des Alpes Françaises, Grenoble Alpes University, Place du commandant Nal, Domaine de La Merci, 38700, La Tronche, France
| | - Paul Desbrest
- Laboratoire d'Anatomie Des Alpes Françaises, Grenoble Alpes University, Place du commandant Nal, Domaine de La Merci, 38700, La Tronche, France
| | - Alicia Guigui
- Grenoble Alpes University Hospital, Boulevard de la Chantourne, INSERM CIC1406, 38700, La Tronche, France
| | - Philippe Chaffanjon
- Laboratoire d'Anatomie Des Alpes Françaises, Grenoble Alpes University, Place du commandant Nal, Domaine de La Merci, 38700, La Tronche, France.,GIPSA-Lab-Department of Parole et Cognition, UMR 5216, Grenoble Campus, 11 rue des Mathématiques, BP46, 38402, Saint Martin d'Hères Cedex, France
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18
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Maleux G, Storme E, Cools B, Heying R, Boshoff D, Louw JJ, Frerich S, Malekzadeh‐Milanii S, Hubrechts J, Brown SC, Gewillig M. Percutaneous embolization of lymphatic fistulae as treatment for protein‐losing enteropathy and plastic bronchitis in patients with failing Fontan circulation. Catheter Cardiovasc Interv 2019; 94:996-1002. [DOI: 10.1002/ccd.28501] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 09/04/2019] [Accepted: 09/07/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Geert Maleux
- Interventional RadiologyUniversity Hospitals Leuven Leuven Belgium
| | - Emma Storme
- Department of Paediatric and Congenital CardiologyUniversity Hospitals Leuven Leuven Belgium
| | - Bjorn Cools
- Department of Paediatric and Congenital CardiologyUniversity Hospitals Leuven Leuven Belgium
| | - Ruth Heying
- Department of Paediatric and Congenital CardiologyUniversity Hospitals Leuven Leuven Belgium
| | - Derize Boshoff
- Department of Paediatric and Congenital CardiologyUniversity Hospitals Leuven Leuven Belgium
| | - Jacoba J. Louw
- Paediatric CardiologyUniversity Hospital Maastricht Maastricht the Netherlands
| | - Stefan Frerich
- Paediatric CardiologyUniversity Hospital Maastricht Maastricht the Netherlands
| | | | - Jelena Hubrechts
- Department of Paediatric and Congenital CardiologyUniversity Hospitals Leuven Leuven Belgium
| | - Stephen C. Brown
- Department of Paediatric and Congenital CardiologyUniversity Hospitals Leuven Leuven Belgium
- Paediatric CardiologyUniversity of the Free State Bloemfontein South Africa
| | - Marc Gewillig
- Department of Paediatric and Congenital CardiologyUniversity Hospitals Leuven Leuven Belgium
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19
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Lin Z, Chen W, Chen Y, Peng X, Yan S, He F, Fu R, Jiang Y, Hu Z. Achieving adequate lymph node dissection in treating esophageal squamous cell carcinomas by radical lymphadenectomy: Beyond the scope of numbers of harvested lymph nodes. Oncol Lett 2019; 18:1617-1630. [PMID: 31423229 PMCID: PMC6607061 DOI: 10.3892/ol.2019.10465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 04/15/2019] [Indexed: 12/26/2022] Open
Abstract
Previous studies have recommended harvesting a large number of lymph nodes (LNs) to improve the survival of patients with esophageal squamous cell carcinoma (ESCC). These studies or clinical guidelines focus on the total harvested LNs during lymphadenectomy; however, the extent of LN dissection (LND) required in patients with ESCCs remains controversial. The present study proposed a novel individualized adequate LND (ALND) strategy to compliment current guidelines to improve individualized therapeutic efficacy. For N0 cases, ALND was defined as an LN harvest of >55% of the LNs from nodal zones adjacent to the tumor location; and for N+ cases, ALND was defined as 8, 8, 8, 8 or 16 LNs dissected from the involved cervical, upper, middle, lower and celiac zones, respectively. Retrospective analysis of the ESCC cohort revealed that the ALND was associated with improved patient survival [hazard ratio (HR)=0.45 and 95% CI=0.30–0.66)]. Stratified analyses revealed that the protective role of ALND was prominent, with the exception of higher pN+ staged (pN2-3) cases (HR=0.52, 95% CI=0.23–1.18). Furthermore, ALND was associated with improved survival in local diseases (T1-3/N0-1; HR=0.50, 95% CI=0.30–0.84) and locally advanced diseases (T4/Nany or T1-3/N2-3; HR=0.32, 95% CI=0.15–0.68). These findings suggested that the proposed ALND strategy may effectively improve the survival of patients with ESCC.
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Affiliation(s)
- Zheng Lin
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, Fujian 350108, P.R. China.,Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian 350108, P.R. China
| | - Weilin Chen
- Department of Radiation Oncology, Affiliated Zhangzhou Hospital of Fujian Medical University, Zhangzhou, Fujian 363000, P.R. China
| | - Yuanmei Chen
- Department of Thoracic Surgery, Fujian Provincial Cancer Hospital, Fuzhou, Fujian 350014, P.R. China
| | - Xiane Peng
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, Fujian 350108, P.R. China.,Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian 350108, P.R. China
| | - Siyou Yan
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, Fujian 350108, P.R. China
| | - Fei He
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, Fujian 350108, P.R. China.,Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian 350108, P.R. China
| | - Rong Fu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, Fujian 350108, P.R. China
| | - Yixian Jiang
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, Fujian 350108, P.R. China
| | - Zhijian Hu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, Fujian 350108, P.R. China.,Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian 350108, P.R. China
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20
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Shin JW, Cho DG, Choi SY, Park JK, Lee KY, Moon Y. Prognostic Factors in Stage IIB Non-Small Cell Lung Cancer according to the 8th Edition of TNM Staging System. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 52:131-140. [PMID: 31236372 PMCID: PMC6559194 DOI: 10.5090/kjtcs.2019.52.3.131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 12/27/2018] [Accepted: 12/31/2018] [Indexed: 12/25/2022]
Abstract
Background The purposes of this study were to evaluate the appropriateness of the stage migration of stage IIA non-small cell lung cancer (NSCLC) in the seventh edition of the tumor, node, and metastasis classification for lung cancer to stage IIB lung cancer in the eighth edition, and to identify prognostic factors in patients with eighth-edition stage IIB disease. Methods Patients with eighth-edition stage IIB disease were subclassified into those with seventh-edition stage IIA disease and those with seventh-edition stage IIB disease, and their recurrence-free survival and disease-specific survival rates were compared. Risk factors for recurrence after curative resection were identified in all included patients. Results Of 122 patients with eighth-edition stage IIB NSCLC, 101 (82.8%) had seventh-edition stage IIA disease and 21 (17.2%) had seventh-edition stage IIB disease. Nonsignificant differences were observed in the 5-year recurrence-free survival rate and the 5-year disease-specific survival rate between the patients with seventh-edition stage IIA disease and those with seventh-edition stage IIB disease. Visceral pleural invasion was a significant risk factor for recurrence in patients with eighth-edition stage IIB NSCLC. Conclusion The stage migration from seventh-edition stage IIA NSCLC to eighth-edition stage IIB NSCLC was appropriate in terms of oncological outcomes. Visceral pleural invasion was the only prognostic factor in patients with eighth-edition stage IIB NSCLC.
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Affiliation(s)
- Jin Won Shin
- Department of Thoracic and Cardiovascular Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Deog Gon Cho
- Department of Thoracic and Cardiovascular Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Si Young Choi
- Department of Thoracic and Cardiovascular Surgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Kil Park
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyo Young Lee
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Youngkyu Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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21
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McKleroy W, Lyn-Kew K. 500 Million Alveoli from 30,000 Feet: A Brief Primer on Lung Anatomy. Methods Mol Biol 2019; 1809:3-15. [PMID: 29987778 DOI: 10.1007/978-1-4939-8570-8_1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The lungs are a complex organ that fulfill multiple life-sustaining roles including transfer of oxygen and carbon dioxide between the ambient environment and the bloodstream, host defense, and immune homeostasis. As in any biological system, an understanding of the underlying anatomy is prerequisite for successful experimental design and appropriate interpretation of data, regardless of the precise experimental model or procedure in use. This chapter provides an overview of human lung anatomy focused on the airways, the ultrastructure or parenchyma of the lung, the pulmonary vasculature, the innervation of the lungs, and the pulmonary lymphatic system. We will also discuss notable anatomic differences between mouse and human lungs.
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Affiliation(s)
- William McKleroy
- Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, CO, USA.,Department of Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kenneth Lyn-Kew
- Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, CO, USA.
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22
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Wang Y, Zhu L, Xia W, Wang F. Anatomy of lymphatic drainage of the esophagus and lymph node metastasis of thoracic esophageal cancer. Cancer Manag Res 2018; 10:6295-6303. [PMID: 30568491 PMCID: PMC6267772 DOI: 10.2147/cmar.s182436] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The lymphatic drainage of the inner layers (mucosa and submucosa) and the outer layers (muscularispropria and adventitia) of the thoracic esophagus is different. Longitudinal lymphatic vessels and long drainage territory in the submucosa and lamina propria should be the bases for bidirectional drainage and direct drainage to thoracic duct and extramural lymph nodes (LN). The submucosal vessels for direct extramural drainage are usually thick while lymphatic communication between the submucosa and intermuscular area is usually not clearly found, which does not facilitate transversal drainage to paraesophageal LN from submucosa. The right paratracheal lymphatic chain (PLC) is well developed while the left PLC is poorly developed. Direct drainage to the right recurrent laryngeal nerve LN and subcarinal LN from submucosa has been verified. Clinical data show that lymph node metastasis (LNM) is frequently present in the lower neck, upper mediastinum, and perigastric area, even for early-stage thoracic esophageal cancer (EC). The lymph node metastasis rate (LNMR) varies mainly according to the tumor location and depth of tumor invasion. However, there are some crucial LN for extramural relay which have a high LNMR, such as cervical paraesophageal LN, recurrent laryngeal nerve LN, subcarinal LN, LN along the left gastric artery, lesser curvature LN, and paracardial LN. Metastasis of thoracic paraesophageal LN seems to be a sign of more advanced EC. This review gives us a better understanding about the LNM and provides more information for treatments of thoracic EC.
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Affiliation(s)
- Yichun Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, P.R. China, ;
| | - Liyang Zhu
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, P.R. China, ;
| | - Wanli Xia
- Department of Thoracic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, P.R. China
| | - Fan Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, P.R. China, ;
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Lin Z, Chen W, Chen Y, Peng X, Zhu K, Lin Y, Lin Q, Hu Z. A new classification of lymph node metastases according to the lymph node stations for predicting prognosis in surgical patients with esophageal squamous cell carcinoma. Oncotarget 2018; 7:76261-76273. [PMID: 27788489 PMCID: PMC5342812 DOI: 10.18632/oncotarget.12842] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 10/12/2016] [Indexed: 01/02/2023] Open
Abstract
Lymph node metastasis (LNM) is one of the major prognostic factors for esophageal squamous cell carcinoma (ESCC). However there is no consensus regarding the prognostic significance of the location of LNM. Therefore, a novel classification was proposed to identify the lymph node (LN) stations which may be useful in predicting prognosis. A total of 260 ESCC patients were enrolled in this prospective study. The prognostic values of LNM in different lymph node (LN) stations were evaluated by random survival forests (RSF). Their prognostic significance was examined by Cox regression and receiver operating characteristic curve (ROC). The three most frequently involved LN stations were station 16 (24.49%), station 1 (22.22%) and station 2 (21.05%). Stations 1, 2, 8M, 8L and 16 were grouped as dominant LN stations (DLNS) which showed higher values in predicting overall survival (OS) and disease-free survival (DFS) than the remaining LN stations, which we define as non-dominant LN stations (N-DLNS). LNM features of DLNS (number of positive LN stations, number of positive LNs and LN ratio), but not those from N-DLNS, served as independent prognostic factors (P<0.05) whenever used alone or when combined with factors from N-DLNS. Furthermore, the area under ROC indicated that DLNS is a more accurate prediction than N-DLNS (P<0.05). This study demonstrated the value of LNM in DLNS in predicting prognosis in surgical ESCC patients, which outperformed those from N-DLNS. Therefore, the method of dominant and non-dominant classification may serve as an additional parameter to improve individualized therapeutic strategies.
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Affiliation(s)
- Zheng Lin
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350108, China
| | - Weilin Chen
- Department of Radiation Oncology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China
| | - Yuanmei Chen
- Department of Thoracic Surgery, Fujian Provincial Cancer Hospital Affiliated to Fujian Medical University, Fuzhou 350014, China
| | - Xiane Peng
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350108, China.,Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Minhou, Fuzhou 350108, China
| | - Kunshou Zhu
- Department of Thoracic Surgery, Fujian Provincial Cancer Hospital Affiliated to Fujian Medical University, Fuzhou 350014, China
| | - Yimin Lin
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350108, China
| | - Qiaokuang Lin
- Department of Radiation Oncology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China
| | - Zhijian Hu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350108, China.,Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Minhou, Fuzhou 350108, China
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24
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Jejelava N, Kaufman S, Krieger JP, Terra MM, Langhans W, Arnold M. Intestinal lymph as a readout of meal-induced GLP-1 release in an unrestrained rat model. Am J Physiol Regul Integr Comp Physiol 2018; 314:R724-R733. [PMID: 29341824 DOI: 10.1152/ajpregu.00120.2017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Intestinal lymph supposedly provides a readout for the secretion of intestinal peptides. We here assessed how mesenteric lymph duct (MLD) lymph levels of glucagon-like peptide (GLP-1), insulin, and metabolites [glucose and triglycerides (TG)] evolve after isocaloric high- and low-fat diet (HFD and LFD) meals and how they compare with hepatic portal vein (HPV) plasma levels. Moreover, we examined the effects of intraperitoneally administered GLP-1 (1 or 10 nmol/kg) on these parameters. At 20 min after the HFD meal onset, GLP-1 levels were higher in MLD lymph than in HPV plasma. No such difference occurred with the LFD meal. Intraperitoneal injections of 10 nmol/kg GLP-1 before meals enhanced the meal-induced increases in MLD lymph and HPV plasma GLP-1 levels except for the MLD lymph levels after the HFD meal. Intraperitoneal injection of 1 nmol/kg GLP-1 only increased HPV plasma GLP-1 levels at 60 min after the HFD meal. GLP-1 injections did not increase the MLD lymph or HPV plasma GLP-1 concentrations beyond the physiological range, suggesting that intraperitoneal GLP-1 injections can recapitulate the short-term effects of endogenous GLP-1. Dipeptidyl peptidase IV (DPP-IV) activity in MLD lymph was lower than in HPV plasma, which presumably contributed to the higher levels of GLP-1 in lymph than in plasma. Insulin and glucose showed similar profiles in MLD lymph and HPV plasma, whereas TG levels were higher in lymph than in plasma. These results indicate that intestinal lymph provides a sensitive readout of intestinal peptide release and potential action, in particular when fat-rich diets are consumed.
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Affiliation(s)
- Nino Jejelava
- Physiology and Behavior Laboratory, Institute of Food, Nutrition, and Health, Swiss Federal Institute of Technology, ETH Zurich, Switzerland
| | - Sharon Kaufman
- Physiology and Behavior Laboratory, Institute of Food, Nutrition, and Health, Swiss Federal Institute of Technology, ETH Zurich, Switzerland
| | - Jean-Philippe Krieger
- Physiology and Behavior Laboratory, Institute of Food, Nutrition, and Health, Swiss Federal Institute of Technology, ETH Zurich, Switzerland
| | | | - Wolfgang Langhans
- Physiology and Behavior Laboratory, Institute of Food, Nutrition, and Health, Swiss Federal Institute of Technology, ETH Zurich, Switzerland
| | - Myrtha Arnold
- Physiology and Behavior Laboratory, Institute of Food, Nutrition, and Health, Swiss Federal Institute of Technology, ETH Zurich, Switzerland
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25
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Huang L, Li W, Zhao L, Li B, Chai Y. Risk factors of lymph node metastasis in lung squamous cell carcinoma of 3 cm or less in diameter. Medicine (Baltimore) 2017; 96:e7563. [PMID: 28723786 PMCID: PMC5521926 DOI: 10.1097/md.0000000000007563] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Through literature review we cannot find an efficient risk factor of lymph node metastasis in lung squamous cell carcinoma (SCC). This study aimed to investigate the risk factors of pathological lymph node status in patients with lung SCC of 3 cm or less in diameter, to provide some reference for the fellow surgeons in the decision of operative option.In total, we analyzed 154 patients with lung SCC of 3 cm or less in diameter who underwent lobectomy or bilobectomy or pneumonectomy with systematic lymph node dissection. The relationship between lymph node status and clinical characteristics were examined.Lymph node metastases were present in 48 patients (31.2%) of the study subjects. Multivariate analysis indicated that, age <60 years old (P = .007), tumor location of central-type (P = .003), tumor long axis >2 cm but ≤3 cm (P = .047) were associated with lymph node metastasis, and their odd ratios (OR) were 3.120, 3.359, and 5.196, respectively. Group analysis of the 74 peripheral lung SCC showed that those with the tumor long axis ≤2 cm had a lower rate of lymph node metastasis (7.9% vs 27.8%, P = .025).Age <60 years old, tumor location of central-type, and tumor long axis >2 cm but ≤3 cm are risk factors of lymph node metastasis in lung SCC. Systematic lymph node dissection or sampling is recommended when tumor central-type location and/or long axis >2 cm in lung SCC are present.
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Affiliation(s)
| | | | | | - Baizhou Li
- Pathology Department, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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26
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Lama VN, Belperio JA, Christie JD, El-Chemaly S, Fishbein MC, Gelman AE, Hancock WW, Keshavjee S, Kreisel D, Laubach VE, Looney MR, McDyer JF, Mohanakumar T, Shilling RA, Panoskaltsis-Mortari A, Wilkes DS, Eu JP, Nicolls MR. Models of Lung Transplant Research: a consensus statement from the National Heart, Lung, and Blood Institute workshop. JCI Insight 2017; 2:93121. [PMID: 28469087 DOI: 10.1172/jci.insight.93121] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Lung transplantation, a cure for a number of end-stage lung diseases, continues to have the worst long-term outcomes when compared with other solid organ transplants. Preclinical modeling of the most common and serious lung transplantation complications are essential to better understand and mitigate the pathophysiological processes that lead to these complications. Various animal and in vitro models of lung transplant complications now exist and each of these models has unique strengths. However, significant issues, such as the required technical expertise as well as the robustness and clinical usefulness of these models, remain to be overcome or clarified. The National Heart, Lung, and Blood Institute (NHLBI) convened a workshop in March 2016 to review the state of preclinical science addressing the three most important complications of lung transplantation: primary graft dysfunction (PGD), acute rejection (AR), and chronic lung allograft dysfunction (CLAD). In addition, the participants of the workshop were tasked to make consensus recommendations on the best use of these complimentary models to close our knowledge gaps in PGD, AR, and CLAD. Their reviews and recommendations are summarized in this report. Furthermore, the participants outlined opportunities to collaborate and directions to accelerate research using these preclinical models.
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Affiliation(s)
- Vibha N Lama
- Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - John A Belperio
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jason D Christie
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Souheil El-Chemaly
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael C Fishbein
- Department of Pathology and Laboratory Medicine, UCLA Center for the Health Sciences, Los Angeles, California, USA
| | - Andrew E Gelman
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Wayne W Hancock
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Shaf Keshavjee
- Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Kreisel
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Victor E Laubach
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Mark R Looney
- Department of Medicine, UCSF School of Medicine, San Francisco, California, USA
| | - John F McDyer
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Rebecca A Shilling
- Department of Medicine, University of Illinois College of Medicine at Chicago, Illinois, USA
| | - Angela Panoskaltsis-Mortari
- Departments of Pediatrics, and Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - David S Wilkes
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Jerry P Eu
- National Heart, Lung and Blood Institute, NIH, Bethesda, Maryland, USA
| | - Mark R Nicolls
- Department of Medicine, Stanford University School of Medicine/VA Palo Alto Health Care System, Stanford, California, USA
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Kreutzer J, Kreutzer C. Lymphodynamics in Congenital Heart Disease. J Am Coll Cardiol 2017; 69:2423-2427. [DOI: 10.1016/j.jacc.2017.03.559] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 03/22/2017] [Indexed: 10/19/2022]
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28
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Biological voyage of solid lipid nanoparticles: a proficient carrier in nanomedicine. Ther Deliv 2016; 7:691-709. [DOI: 10.4155/tde-2016-0038] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
This review projects the prospects and issues faced by solid lipid nanoparticles (SLNs) in current scenarios, specially related to its clinical implementation and effectiveness. We re-examine the basic concept of biobehavior and movement of SLNs as a nanomedicine carrier. The extensive survey of the uptake and absorption mechanism from different routes, distribution pattern, targeting efficiency, effect of surface functionalization on biodistribution, elimination pathways and toxic effects have been documented. In general, the objective of this review is to boost our knowledge about the interaction of SLNs with the bioenvironment, their movement in, and effect on, a living system and future prospects.
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30
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Encinas de la Iglesia J, Corral de la Calle MA, Fernández Pérez GC, Ruano Pérez R, Álvarez Delgado A. Esophageal cancer: anatomic particularities, staging, and imaging techniques. RADIOLOGIA 2016; 58:352-65. [PMID: 27469407 DOI: 10.1016/j.rx.2016.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/30/2016] [Accepted: 06/09/2016] [Indexed: 02/07/2023]
Abstract
Cancer of the esophagus is a tumor with aggressive behavior that is usually diagnosed in advanced stages. The absence of serosa allows it to spread quickly to neighboring mediastinal structures, and an extensive lymphatic drainage network facilitates tumor spread even in early stages. The current TNM classification, harmonized with the classification for gastric cancer, provides new definitions for the anatomic classification, adds non-anatomic characteristics of the tumor, and includes tumors of the gastroesophageal junction. Combining endoscopic ultrasound, computed tomography, positron emission tomography, and magnetic resonance imaging provides greater accuracy in determining the initial clinical stage, and these imaging techniques play an essential role in the selection, planning, and evaluation of treatment. In this article, we review some particularities that explain the behavior of this tumor and we describe the current TNM staging system; furthermore, we discuss the different imaging tests available for its evaluation and include a diagnostic algorithm.
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Affiliation(s)
| | | | - G C Fernández Pérez
- Servicio de Radiodiagnóstico, Hospital Universitario Río Hortega, Valladolid, España
| | - R Ruano Pérez
- Servicio de Medicina Nuclear, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | - A Álvarez Delgado
- Servicio de Aparato Digestivo, Complejo Asistencial Universitario de Salamanca, Salamanca, España
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31
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Bang JH, Kim SH, Park CS, Park JJ, Yun TJ. Anatomic variability of the thoracic duct in pediatric patients with complex congenital heart disease. J Thorac Cardiovasc Surg 2015; 150:490-5. [DOI: 10.1016/j.jtcvs.2015.06.078] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 06/15/2015] [Accepted: 06/21/2015] [Indexed: 11/25/2022]
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32
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Oshiro H, Miura M, Iobe H, Kudo T, Shimazu Y, Aoba T, Okudela K, Nagahama K, Sakamaki K, Yoshida M, Nagao T, Nakaya T, Kurata A, Ohtani O. Lymphatic Stomata in the Adult Human Pulmonary Ligament. Lymphat Res Biol 2014; 13:137-45. [PMID: 25526320 DOI: 10.1089/lrb.2014.0009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Lymphatic stomata are small lymphatic openings in the serosal membrane that communicate with the serosal cavity. Although these stomata have primarily been studied in experimental mammals, little is known concerning the presence and properties of lymphatic stomata in the adult human pleura. Thus, adult human pleurae were examined for the presence or absence of lymphatic stomata. METHODS AND RESULTS A total of 26 pulmonary ligaments (13 left and 13 right) were obtained from 15 adult human autopsy cases and examined using electron and light microscopy. The microscopic studies revealed the presence of apertures fringed with D2-40-positive, CD31-positive, and cytokeratin-negative endothelial cells directly communicating with submesothelial lymphatics in all of the pulmonary ligaments. The apertures' sizes and densities varied from case to case according to the serial tissue section. The medians of these aperture sizes ranged from 2.25 to 8.75 μm in the left pulmonary ligaments and from 2.50 to 12.50 μm in the right pulmonary ligaments. The densities of the apertures ranged from 2 to 9 per mm(2) in the left pulmonary ligaments and from 2 to 18 per mm(2) in the right pulmonary ligaments. However, no significant differences were found regarding the aperture size (p=0.359) and density (p=0.438) between the left and the right pulmonary ligaments. CONCLUSIONS Our study revealed that apertures exhibit structural adequacy as lymphatic stomata on the surface of the pulmonary ligament, thereby providing evidence that lymphatic stomata are present in the adult human pleura.
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Affiliation(s)
- Hisashi Oshiro
- 1 Department of Anatomic Pathology, Tokyo Medical University , Tokyo, Japan .,5 Department of Pathology, Yokohama City University Graduate School of Medicine , Yokohama, Japan
| | - Masahiro Miura
- 2 Department of Human Anatomy, Oita University , Oita, Japan
| | - Hiroaki Iobe
- 1 Department of Anatomic Pathology, Tokyo Medical University , Tokyo, Japan
| | - Tomoo Kudo
- 4 Department of Pathology, Nippon Dental University , Tokyo, Japan
| | | | - Takaaki Aoba
- 4 Department of Pathology, Nippon Dental University , Tokyo, Japan
| | - Koji Okudela
- 5 Department of Pathology, Yokohama City University Graduate School of Medicine , Yokohama, Japan
| | - Kiyotaka Nagahama
- 5 Department of Pathology, Yokohama City University Graduate School of Medicine , Yokohama, Japan
| | - Kentaro Sakamaki
- 6 Department of Biostatistics and Epidemiology, Yokohama City University Graduate School of Medicine , Yokohama, Japan
| | - Maki Yoshida
- 1 Department of Anatomic Pathology, Tokyo Medical University , Tokyo, Japan
| | - Toshitaka Nagao
- 1 Department of Anatomic Pathology, Tokyo Medical University , Tokyo, Japan
| | - Takeo Nakaya
- 3 Department of Molecular Pathology, Tokyo Medical University , Tokyo, Japan
| | - Atsushi Kurata
- 3 Department of Molecular Pathology, Tokyo Medical University , Tokyo, Japan
| | - Osamu Ohtani
- 7 Department of Anatomy, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences , Toyama, Japan
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Steliga MA, Rice DC. Extended Resections for Lung Cancer. Lung Cancer 2014. [DOI: 10.1002/9781118468791.ch15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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