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Esophageal Cancer Initially Thought to be Accompanied by a Solitary Metastasis to an Intrathoracic Paraaortic Lymph Node
Horio,Takuya,Ogata,Sho,Tsujimoto,Hironori,Akase,Takayoshi
Acta Medica Okayama , 2012,
Abstract: Esophageal cancers usually exhibit lymph-node metastases. Although a solitary lymph-node metastasis is occasionally found, the involvement of an intrathoracic paraaortic node is rare. We present here an intrathoracic mid-esophageal cancer case in which an accompanying solitary retroaortic mass was found within the posterior mediastinum by integrated positron emission tomography/computed tomography. For diagnosis, thoracoscopic resection of the mass was performed from a left thoracic approach, and histology revealed it to be a squamous cell carcinoma metastasized from the esophageal cancer. Upon radical esophagectomy after neoadjuvant therapy as a T3N1M0 Stage IIIa (AJCC/UICC) cancer, the esophageal cancer was found to have invaded unexpectedly deeply in the vicinity of the descending aorta. Another lymph node within the paraaortic region was also involved (T4N1M0 Stage IIIc). The present case and other cases we review here inform our understanding of metastasis to intrathoracic paraaortic nodes as follows:1) its existence may indicate extensive lymph-node metastasis or direct tumor invasion nearby, and 2) it may be accompanied by other lymph-node involvements in this region, even if it appears solitary upon preoperative investigation. Thus, for radical esophagectomy, sufficient lymph-node dissection is required, even at locations not reached by the usual right thoracic approach. Definitive chemoradiotherapy may be a better choice for preoperatively recognized T3 esophageal cancer when the cancer is accompanied by paraaortic lymph node metastasis.
Comparison of DWI and PET/CT in evaluation of lymph node metastasis in uterine cancer  [cached]
Kazuhiro Kitajima,Erena Yamasaki,Yasushi Kaji,Koji Murakami
World Journal of Radiology , 2012, DOI: 10.4329/wjr.v4.i5.207
Abstract: AIM: To investigate diffusion-weighted imaging (DWI) and positron emission tomography and computed tomography (PET/CT) with IV contrast for the preoperative evaluation of pelvic lymph node (LN) metastasis in uterine cancer. METHODS: Twenty-five patients with endometrial or cervical cancer who underwent both DWI and PET/CT before pelvic lymphadenectomy were included in this study. For area specific analysis, LNs were divided into eight regions: both common iliac, external iliac, internal iliac areas, and obturator areas. The classification for malignancy on DWI was a focally abnormal signal intensity in a location that corresponded to the LN chains on the T1WI and T2WI. The criterion for malignancy on PET/CT images was increased tracer uptake by the LN. RESULTS: A total of 36 pathologically positive LN areas were found in 9 patients. With DWI, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy for detecting metastatic LNs on an LN area-by-area analysis were 83.3%, 51.2%, 27.3%, 93.3% and 57.0%, respectively, while the corresponding values for PET/CT were 38.9%, 96.3%, 70.0%, 87.8% and 86.0%. Differences in sensitivity, specificity and accuracy were significant (P < 0.0005). CONCLUSION: DWI showed higher sensitivity and lower specificity than PET/CT. Neither DWI nor PET/CT were sufficiently accurate to replace lymphadenectomy.
Clinical Outcomes of Patients with Oral Cavity Squamous Cell Carcinoma and Retropharyngeal Lymph Node Metastasis Identified by FDG PET/CT  [PDF]
Jing-Ren Tseng, Tsung-Ying Ho, Chien-Yu Lin, Li-Yu Lee, Hung-Ming Wang, Chun-Ta Liao, Tzu-Chen Yen
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0079766
Abstract: Purpose Retropharyngeal lymph node (RPLN) metastasis is an uncommon finding in patients with oral cavity squamous carcinoma (OSCC). We sought to investigate the clinical outcomes, clinicopathological characteristics, and the priority of treatment with curative intent in OSCC patients with RPLN involvement. Methods and Materials Between January 2007 and January 2011, we identified 36 patients with primary RPLN metastases (n = 10) or RPLN relapse (n = 26). The follow-up continued until June 2013. Disease-specific survival (DSS), disease-free survival (DFS), and the potential benefits of salvage therapy served as the main outcome measures. Results The 2-year DSS and DFS rates of untreated patients with RPLN involvement were 20% and 24%, respectively. Level IV/V neck lymph node involvement was an adverse prognostic factor for DSS (P = 0.048) and DFS (P = 0.018). All of the patients presenting with neck lymph node involvement at level IV/V died within 6 months. Among patients who were treated for RPLN relapse, the 2-year DSS and DFS rates from the relapse day were 12.8% and 9.6%, respectively. Concomitant contralateral neck lymph node metastases (N2c) were associated with lower 2-year DSS (P = 0.005) and DFS (P = 0.011) rates. Moreover, five (55%) of the nine patients with recurrent disease in the contralateral RPLN had distant metastases within 6 months. Salvage therapy yielded the maximum survival benefit in patients without N2c disease and ipsilateral RPLN involvement alone (P = 0.005). Conclusion OSCC patients with RPLN involvement have poor outcomes. The risk factor for definitive treatment in OSCC patients with FDG PET/CT defined RPLN disease in primary disease was neck lymph node involvement at level IV/V and N2c and/or contralateral RPLN disease in recurrent disease. Treatment efforts with curative intent should be tailored according to individual risk factors.
Density and SUV Ratios from PET/CT in the Detection of Mediastinal Lymph Node Metastasis in Non-small Cell Lung Cancer  [PDF]
Tingting SHAO, Lijuan YU, Yingci LI, Munan CHEN
- , 2015, DOI: : 10.3779/j.issn.1009-3419.2015.03.05
Abstract: Background and objective Mediastinal involvement in lung cancer is a highly significant prognostic factor for survival, and accurate staging of the mediastinum will correctly identify patients who will benefit the most from surgery. Positron emission tomography/computed tomography (PET/CT) has become the standard imaging modality for the staging of patients with lung cancer. The aim of this study is to investigate 18-fluoro-2-deoxy-glucose (18F-FDG) PET/CT imaging in the detection of mediastinal disease in lung cancer. Methods A total of 72 patients newly diagnosed with non-small cell lung cancer (NSCLC) who underwent preoperative whole-body 18F-FDG PET/CT were retrospectively included. All patients underwent radical surgery and mediastinal lymph node dissection. Mediastinal disease was histologically confirmed in 45 of 413 lymph nodes. PET/CT doctors analyzed patients’ visual images and evaluated lymph node’s short axis, lymph node’s maximum standardized uptake value (SUVmax), node/aorta density ratio, node/aorta SUV ratio, and other parameters using the histopathological results as the reference standard. The optimal cutoff value for each ratio was determined by receiver operator characteristic curve analysis. Results Using a threshold of 0.9 for density ratio and 1.2 for SUV ratio yielded high accuracy for the detection of mediastinal disease. The lymph node’s short axis, lymph node’s SUVmax, density ratio, and SUV ratio of integrated PET/CT for the accuracy of diagnosing mediastinal lymph node was 95.2%. The diagnostic accuracy of mediastinal lymph node with conventional PET/CT was 89.8%, whereas that of PET/CT comprehensive analysis was 90.8%. Conclusion Node/aorta density ratio and SUV ratio may be complimentary to conventional visual interpretation and SUVmax measurement. The use of lymph node’s short axis, lymph node’s SUVmax, and both ratios in combination is better than either conventional PET/CT analysis or PET/CT comprehensive analysis in the assessment of mediastinal disease in NSCLC patients.
PET in uterine malignancies  [PDF]
Valeria Pirro, Andrea Skanjeti, Ettore Pelosi
Health (Health) , 2010, DOI: 10.4236/health.2010.27099
Abstract: Positron Emission Tomography (PET) or integrated PET/Computed Tomography (PET/CT) with 18F-Fluoro-Deoxy-Glucose (18F-FDG) is a functional imaging modality, useful in the characterization of undetermined morphological findings, and in the staging/re-staging of a large number of malignancies. Although its use in uterine malignancies has been poorly investigated, in recent years the employment of this technique has constantly increased. In this review, we evaluate the role of PET (/CT) with 18FFDG in uterine malignancies (cervical and endometrial cancers as well as uterine sarcomas), underlying its advantages and discussing its limitations. Metabolic and anatomic information given by PET/CT with 18F-FDG could be useful in the evaluation of local and distant disease involvement at the staging, in the detection of disease recurrence, and in the evaluation of the response after chemotherapy and/or radio-therapy.
The role of laparoscopy in diagnosing metastasis of upper gastrointestinal tract malignancies
F. Eshghi,M. Jamshidi,M. Jamshidi
Journal of Mazandaran University of Medical Sciences , 2006,
Abstract: Background and purpose: Upper gastrointestinal tract cancers are important malignancies in the entire world. Many Diagnostic procedures are frequently used for staging gastrointestinal malignancies. Laparoscopy has emerged as a good staging modality for most gastrointestinal cancers than many other preoperative modalities.Materials and Methods: Patients with gastrointestinal tract malignancies were selected for evaluation from 2000 to 2001. After complete physical examination and paraclinical evaluations, all patients underwent laparoscopy with general anesthesia and biopsies prepared from metastasis followed by laparotomy. Data were analyzed by statistical tests.Results: Fourty three patients, 41%female and 59% male with a mean age of 61.25±14 years were studied. Sensitivity and specifity of laparoscopy in diagnosing lymph node metastasis of upper gastrointestinal tract malignancies were 83.33% , 100% respectively. These indices were 75% and 100% in liver metastasis. Positive and negative predictive values of lymph node metastasis were 100% and 89.3% respectively and 100% and 20% in liver metastasis.Conclusion: Preoperative laparoscopy is an effective method for diagnosing metastasis in patients with gastrointestinal tract cancers and can prevent many unnecessary laparotomies.
Lymph node metastasis in grossly apparent clinical stage Ia epithelial ovarian cancer: Hacettepe experience and review of literature
Guldeniz Desteli, Murat Gultekin, Alp Usubutun, Kunter Yuce, Ali Ayhan
World Journal of Surgical Oncology , 2010, DOI: 10.1186/1477-7819-8-106
Abstract: A prospective study of clinical stage I ovarian cancer patients is presented. Patient's characteristics and tumor histopathology were the variables evaluated.Thirty three ovarian cancer patients with intact ovarian capsule were evaluated. Intraoperatively, neither of the patients had surface involvement, adhesions, ascites or palpable lymph nodes (supposed to be clinical stage Ia). The mean age of the study group was 55.3 ± 11.8. All patients were surgically staged and have undergone a systematic pelvic and paraaortic lymphadenectomy. Final surgicopathologic reports revealed capsular involvement in seven patients (21.2%), contralateral ovarian involvement in two (6%) and omental metastasis in one (3%) patient. There were two patients (6%) with lymph node involvement. One of the two lymph node metastasis was solely in paraaortic node and the other metastasis was in ipsilateral pelvic lymph node. Ovarian capsule was intact in all of the patients with lymph node involvement and the tumor was grade 3.In clinical stage Ia ovarian cancer patients, there may be a risk of paraaortic and pelvic lymph node metastasis. Further studies with larger sample size are needed for an exact conclusion.Epithelial ovarian carcinoma (EOC) is a lethal genital malignancy [1]. Only one third of cases are diagnosed in the early stages of the disease. Lymphadenectomy is an integral part of surgical staging and treatment for ovarian cancers, and they have a potential role in both staging and retroperitoneal debulking. Lymphatic node metastasis results in a change from stage I to stage IIIC. 5-year survival decreases from more than 90% to 20% to 60% if there lymphatic node metastasis is present and adjuvant therapy is needed [2-4]. However, there is debate on the extent of lymphadenectomy, particularly in early staged unilateral tumors (confined to only one ovary) [5,6]. Despite a detailed history of lymphadenectomies in scientific literature, there are only a limited number of reports analyzing
Stereotactic body radiotherapy for isolated paraaortic lymph node recurrence from colorectal cancer  [cached]
Mi-Sook Kim, Chul Koo Cho, Kwang Mo Yang, Dong Han Lee, Sun Mi Moon, Young Joo Shin
World Journal of Gastroenterology , 2009,
Abstract: AIM: To evaluate the efficacy and complications of stereotactic body radiotherapy in localized paraaortic lymph node recurrence from colorectal cancer.METHODS: From 2003 to 2009, 7 patients with paraaortic lymph node recurrence (1-3 lesions) from colorectal cancer were treated with stereotactic body radiotherapy. Total gross tumor volumes ranged from 4 to 40 mL. The doses were escalated from 36 Gy/patient to 51 Gy/patient and were delivered in 3 fractions.RESULTS: One and 3 year overall survival rates were 100% and 71.4%, respectively, and median survival was 37 mo. Grade IV intestinal obstruction was reported in 1 of 7 patients. This patient received 48 Gy in 3 fractions with a maximum point dose to the intestine of 53 Gy and V45Gy = 3.6 mL. However, 6 patients received an intestinal maximum point dose of < 51 Gy and V45Gy of < 1 mL, and did not develop any severe complications.CONCLUSION: This pilot study suggests selected paraaortic lymph node recurrence (1-3 closed lesions) that failed to respond to chemotherapy can be potentially salvaged by stereotactic body radiotherapy.
Comparison of CT and MRI for presurgical characterization of paraaortic lymph nodes in patients with pancreatico-biliary carcinoma  [cached]
Young Chul Kim, Mi-Suk Park, Seung-Whan Cha, Yong Eun Chung, Joon Suk Lim, Kyung Sik Kim, Myeong-Jin Kim, Ki Whang Kim
World Journal of Gastroenterology , 2008,
Abstract: AIM: To determine the accuracy of computed tomography (CT) and magnetic resonance (MR) for presurgical characterization of paraaortic lymph nodes in patients with pancreatico-biliary carcinoma.METHODS: Two radiologists independently evaluated CT and MR imaging of 31 patients who had undergone lymphadenectomy (9 metastatic and 22 non-metastatic paraaortic nodes). Receiver operating characteristic (ROC) curve analysis was performed using a five point scale to compare CT with MRI. To re-define the morphologic features of metastatic nodes, we evaluated CT scans from 70 patients with 23 metastatic paraaortic nodes and 47 non-metastatic ones. The short axis diameter, ratio of the short to long axis, shape, and presence of necrosis were compared between metastatic and non-metastatic nodes by independent samples t-test and Fisher’s exact test. P < 0.05 was considered statistically significant.RESULTS: The mean area under the ROC curve for CT (0.732 and 0.646, respectively) was slightly higher than that for MRI (0.725 and 0.598, respectively) without statistical significance (P = 0.940 and 0.716, respectively). The short axis diameter of the metastatic lymph nodes (mean = 9.2 mm) was significantly larger than that of non-metastatic ones (mean = 5.17 mm, P < 0.05). Metastatic nodes had more irregular margins (44.4%) and central necrosis (22.2%) than non-metastatic ones (9% and 0%, respectively), with statistical significance (P < 0.05).CONCLUSION: The accuracy of CT scan for the characterization of paraaortic nodes is not different from that of MRI. A short axis-diameter (> 5.3 mm), irregular margin, and presence of central necrosis are the suggestive morphologic features of metastatic paraaortic nodes.
Metastasis to the Male Breast from Squamous Cell Lung Carcinoma  [PDF]
Berhan Gen?,Aynur Solak,Neslin ?ahin,A?k?n Gül?en
Case Reports in Oncological Medicine , 2013, DOI: 10.1155/2013/593970
Abstract: Metastasis to breast from extra mammarian organs is quite rare with an incidence of 0.5–3%. Malignancies that most commonly metastasize to breast are lymphomas, leukemias, and malignant melanoma. Metastasis of lung cancer to breast is a very rare condition. We present here a case with squamous cell lung cancer that metastasized to breast. A 65-year-old man presented with cough in addition to a mass in the left breast, which had been noted 3 weeks ago and grown gradually since then. A histopathological diagnosis of metastasis of squamous lung cancer was made for the mass in the left breast. PET/CT scan showed no distant metastasis. Chemoradiation therapy was applied for lung cancer. As the prognosis of such patients is extremely poor, it is of a great importance to distinguish a primary breast cancer from a metastatic breast lesion in order to determine the appropriate treatment modality. 1. Introduction Although breast cancer is prevalent among adult females, metastasis to breast tissue from an extra mammarian malignancy is quite rare. The incidence has been reported to be 0.5–3% [1, 2]. Despite its rare occurrence, breast metastasis is treated way differently than primary breast cancer. Although malignancies metastasizing to breast vary considerably, diseases that most commonly metastasize to breast are melanoma, leukemia, lymphoma, and renal adenocarcinoma [1, 3]. Patients are usually females. Malignancies metastasizing to breast from extra mammarian organs are extremely uncommon in men. PET/CT is highly useful for detection of metastatic lesion. Definite diagnosis is made by histopathological examination. In this case report, a primary lung cancer that metastasized to the breast was presented with imaging findings. To our knowledge, this case is the first male patient diagnosed with simultaneous squamous cell lung cancer and breast metastasis presented by PET/CT. 2. Case Presentation A 65-year-old male patient presented with firm nodule in the left breast and cough for 3 weeks. On chest examination, respiratory sounds diminished in the left hemithorax. Physical examination revealed a painless, well-bordered, and firm mass lesion at the upper middle quadrant of the left breast. No palpable lymph nodes were present in the left axilla. Breast ultrasonography revealed a well-bordered, solid mass lesion. Color Doppler interrogation showed a high-resistance arterial vascular flow inside the mass. Mammography revealed a ?cm mass lesion at the upper middle quadrant of the left breast (Figure 1). Chest X-ray was notable for pleural effusion involving the
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