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Lymphatic anatomy: lymphatics of the uterus
Published in Charles F. Levenback, Ate G.J. van der Zee, Robert L. Coleman, Clinical Lymphatic Mapping in Gynecologic Cancers, 2022
Jennifer J. Mueller, Nadeem R. Abu-Rustum
Mariani et al. examined routes of lymphatic spread in 112 surgically staged patients with clinical stage I endometrial cancer and reported that external iliac lymph nodes, followed by obturator lymph nodes, were the most commonly involved nodes across all patients assessed.11 In patients with tumors involving the cervix, there was a significant increase in common iliac nodal metastases. The authors found paraaortic nodal metastases in 35 patients (31%), and all but 3 (9%) had concurrent pelvic nodal metastases. Based on their data, Mariani and colleagues concluded that paraaortic nodal dissemination occurs via the common iliac nodes when the cervix is involved. When the cervix is not involved, paraaortic nodal dissemination occurs via routes shared by the external iliac and obturator lymph nodes, an uncommon event.
Paper 2
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
You are asked to review the pelvic MRI of a 38 year old woman with chronic pelvic pain and suspected endometriosis. There is a well-defined, thin walled lesion located between the sacrum and rectum. It is multiloculated and demonstrates high T2 and intermediate T1 weighted signal. There is no evidence of high T1 signal in the pelvis on fat suppressed sequences. There is minimal wall enhancement following contrast administration. There is no distal ureteric dilatation. Appearances of the vagina, cervix, uterus and ovaries are within normal limits with a corpus luteum on the right. A few bilateral common and external iliac lymph nodes measure up to 5 mm in short axis. There is a trace of pelvic free fluid. The imaged bones have normal appearances.
The prostate and seminal vesicles
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Lymphatic spread may occur (1) via lymphatic vessels passing to the obturator fossa or along the sides of the rectum to the lymph nodes beside the internal iliac vein and in the hollow of the sacrum and (2) via lymphatics that pass over the seminal vesicles and follow the vas deferens for a short distance to drain into the external iliac lymph nodes. From retroperitoneal lymph nodes, the mediastinal nodes and occasionally the supraclavicular nodes may become implicated.
Is complete mesocolic excision or total mesorectal excision necessary during cytoreductive surgery in ovarian peritoneal carcinomatosis with colonic involvement?
Published in Acta Chirurgica Belgica, 2023
Kursat Karadayi, Ufuk Karabacak
Colon lymph nodes are divided into four groups [34]. Epicolic lymph nodes are associated with the serosal surface of the colon; paracolic lymph nodes run along the medial of the colon; and intermediate lymph nodes continue along with the ileocolic, right colic, middle colic, left colic, sigmoid, and superior rectal arteries. Later, the lymphatic flow drains into the para-aortic area through the principal lymph nodes, following the inferior and superior mesenteric arteries. Three ways have been detected for the lymphatic spread of ovarian cancer [35]. The first and most common route is para-aortic spread through the lymphatics and then by way of the ovarian vascular structures. The second path uses the para-aortic lymph nodes and then the internal and external iliac lymph nodes through the broad ligaments toward the lateral and posterior pelvic wall. The third, and rarest, is along the round ligament to the external iliac and inguinal region.
Evaluation of the stage classification of anal cancer by the TNM 8th version versus the TNM 7th version
Published in Acta Oncologica, 2020
Olav Dahl, Mette Pernille Myklebust, Jon Espen Dale, Otilia Leon, Eva Serup-Hansen, Anders Jakobsen, Per Pfeiffer, Inger Marie Løes, Frank Pfeffer, Karen-Lise Garm Spindler, Marianne Grønlie Guren, Bengt Glimelius, Anders Johnsson
The Union for International Cancer Control (UICC) TNM Classification of Malignant Tumours 8th edition (TNM8) published in 2016, introduced several changes in the lymph node classification for anal cancer [5]. Anal margin cancer within 5 cm from anal verge is now classified as anal cancer and not skin cancer. The T classification was unchanged. The external iliac lymph nodes are considered as a site of regional disease (N), previously they were not specified and could be classified as a site of distal metastasis (M). Lymph node status was previously recorded as N0 and N1–N3 in the TNM 7th edition (TNM7) [6]. It is now divided into two main cathegories: N0 and N1 as used by Ajani et al., however with a new subclassification into 1a, 1b, and 1c [5–7]. Note that N1a may include multiple malignant lymph nodes in several regional locations as long as the external iliac nodes are not involved. Furthermore, the TNM8 introduces additional stage sub-categories relative to TNM7: Stage II is divided into IIA and IIB depending on T stage, while stage III is grouped in three, IIIA, IIIB, and IIIC depending on T and N stage (Table 1). Subtle changes have also been made in which stage the different combinations of T and N status belong [5,6]. In general, the prognostic importance of nodal disease involvement has been downplayed, while T3 or T4 status is considered more severe. To our knowledge, the changes implemented in the TNM8 classification and staging have not been validated by any clinical prognostic data except the division of stage II [8].
Ocular adnexal marginal zone lymphoma arising in a patient with IgG4-related ophthalmic disease
Published in Modern Rheumatology, 2019
Kenji Nishida, Yuka Sogabe, Ayako Makihara, Akemi Senoo, Hisanori Morimoto, Mai Takeuchi, Yuka Gion, Tadashi Yoshino, Yasuharu Sato
Systemic CT showed enlargement of multiple lymph nodes (right intraparotid, right supraclavicular, both axillar, and left external iliac lymph nodes). F-18-fluorodeoxyglucose positron emission tomography (PET) demonstrated abnormal accumulation in the right eyelid only; the lacrimal gland, parotid gland, submandibular gland, lymph nodes, and other lesions (including left ocular lesions) did not show accumulation and were not histopathologically examined. Based on these investigations, the patient was diagnosed with MZL of clinical stage 2 or higher and was treated with six courses of R-THP-COP (rituximab, pirarubicin, cyclophosphamide, vincristine, and prednisolone). The right eyelid lesion rapidly improved after the first course of treatment; however, the left eyelid lesion did not show any significant change (Figure 1d). After the fourth course of R-THP-COP, F-18-fluorodeoxyglucose PET demonstrated no accumulation in both eyelids and in the lymph nodes. Accordingly, we finally diagnosed MZL clinical stage 1 localized to the right eyelid.