Background This study evaluated the usefulness of judgment of central lymph node (LN) metastasis by surgeon’s palpation in papillary thyroid cancer.
Methods This study included 127 patients who underwent thyroidectomy and central compartment node dissection between October 2014 and February 2015. The criterion for suspicious LNs was hardness.
Results Of the 20.5% (28/127) of suspicious for metastatic LNs according to surgeon determination, 92.8% (26/28) were confirmed to be metastatic in the final pathological examinations. Metastatic LNs were found in 38 (38.3%) of 99 patients without suspicious LNs, 29 of whom (76.3%) had micrometastases. The sensitivity, specificity, and positive and negative predictive values for the determination of LN metastasis by a surgeon were 40.6%, 96.8%, 92.9%, and 61.6%, respectively.
Conclusion Determination of central LN metastasis by a surgeon’s palpation may be useful to evaluate LNs owing to the high specificity and positive predictive values, especially in macrometastasis or high-risk LN disease.
Background Prophylactic central neck dissection (CND) in clinically node-negative (cN0) papillary thyroid carcinoma (PTC) remains controversial. The purpose of this study was to evaluate the benefits of prophylactic ipsilateral CND compared with bilateral CND in total thyroidectomy for cN0 unilateral PTC.
Methods We retrospectively enrolled 174 patients who underwent total thyroidectomies with prophylactic CND for cN0 unilateral PTC between January 2009 and May 2010. The prophylactic CND patients were divided into group 1, the ipsilateral CND group (n=74), and group 2, the bilateral CND group (n=100). The incidence of central lymph node metastasis (CLNM) and postoperative complications, such as hypoparathyroidism, recurrent laryngeal nerve injury, and recurrence were assessed.
Results CLNM was found in 22 (29.8%) in group 1 and 69 (69%) in group 2. The incidence of postoperative severe hypocalcemia less than 7.0 was also significantly different (six patients [8.1%] in group 1 and 23 [23%] in group 2; p=0.009). Permanent hypoparathyroidism was significantly more frequent in group 2 (4.1% vs. 19%; p=0.005). However, the incidence of transient hypoparathyroidism, recurrence, and recurrent laryngeal nerve injury was not significantly different.
Conclusion Prophylactic ipsilateral CND has advantage not only to reduce incidence of some complications but also to have similar recurrence rate compared with bilateral CND. We suggest that prophylactic ipsilateral CND may be safe and effective for selected patients undergoing total thyroidectomy for cN0 unilateral PTC.
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Comparison of prophylactic ipsilateral and bilateral central lymph node dissection in papillary thyroid carcinoma: a meta-analysis Yujie Li, Lingling Lao Brazilian Journal of Otorhinolaryngology.2023; 89(6): 101318. CrossRef
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Background This study aimed to assess the in-field lymph node (LN) failure rate according to LN size and to investigate effect of LN size on the survival outcome of patients with locally advanced cervical carcinoma treated with concurrent chemoradiotherapy (CCRT).
Methods A total of 310 patients with locally advanced cervical carcinoma treated with CCRT were enrolled in retrospective study. LN status was evaluated by magnetic resonance imaging. All patients received conventional external beam irradiation and high-dose rate brachytherapy, and concurrent cisplatin-based chemotherapy. In-field LN failure rate according to LN size was analyzed.
Results The median follow-up period was 83 months (range, 3-201 months). In-field LN failure rate in patients with pelvic LN size more than 10 mm was significantly higher than that in patients with pelvic LN size less than 10 mm (p<0.001). A similar finding was observed in the in-field para-aortic LN failure rate (p=0.024). The pelvic and para-aortic LN size (≥10 mm) was a significant prognostic factor of overall-survival (OS) and disease-free survival rate in univariate and multivariate analyses. The OS rate was significantly different between groups according to LN size (<10 mm vs. ≥10 mm).
Conclusion A LN of less than 10 mm in size in an imaging study is controlled by CCRT. On the other hand, in LN of more than 10 mm in size, the in-field LN failure rate increase and the prognosis deteriorate. Therefore, a more aggressive treatment strategy is needed.
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Giant lymph node hyperplasia (Castleman's disease) is a rare disease, which represents a peculiar form of lymph node hyperplasia. Generally, it has been considered as benign and localized disease but recently, revealed malignant transformation in some cases of multicentric form. It usually occurs on the mediastinum and occasionally neck, lung, axilla, mesentery, broad ligament, retroperitoneum or soft tissue of extremities. Histopathologically, it is divided into hyaline vascular or plasma cell type and the former is characterized with prominent vascular proliferation and hyalinization in the central portion and tight concentric layering of lymphocytes at the periphery of the follicles (mantle zone) and the latter is characterized by a diffuse plasma cell proliferation in the interfollicular area. From the point of view of clinical presentation, it has been divided into solitary form, which presents as a localized mass located most commonly in the mediastinum, and multicentric form, which occurs multiple location and has systemic manifestation and transformation into malignancy. Herein we report a case of Giant lymph node hyperplasia occurring in the left spermatic cord in a 58-year old male with brief review of literatures.
Supraclavicular lymph nodes are unique in that they can attract metastases from almost anywhere in the body and most common sites of metastasis from an unknown primary source. 125 cases which had been diagnosed as metastatic supraclavicular lymph node during the period between May 1983 and August 1991, were analyzed pathologically, and following distinctive characteristics could be outlined: 1) The most frequent sites of metastasis from primary lesions are lung (43%), stomach (23%), lymphoreticular (6%), biliary (5%), esophagus (2%), and pancreas (2%). 2) Histologic examination of metastatic supraclavicular lymph node revealed adenocarcinoma (57%), squamous cell carcinoma (12%), undifferentiated carcinoma (9%), small cell carcinoma (7%), malignant lymphoma (6%), malignant melanoma (1%) and undetermined carcinoma (8%). 3) In cases that histologic types were squamous cell carcinoma, undifferentiated carcinoma, small cell carcinoma and undetermined carcinoma, the most frequent primary site was lung.