Clinical Features of Colorectal Adenoma and Adenocarcinoma
Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams in Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Abdominal distension due to flatus may be present in patients whose growths are responsible for subacute intestinal obstruction. The tumour itself may be palpable; right-sided lesions are stated to be palpable more often than left-sided ones, although this is not the authors’ experience. Palpable left-sided lesions can be differentiated from inspissated faeces by the fact that they fail to indent on pressure with the finger. Carcinomas at the splenic and hepatic flexures may be palpable, but in order for them to be felt, the clinician must purposefully perform a bimanual palpation of both loins during full inspiration and expiration. Examination of the inguinal regions for the presence of palpable lymph nodes is rarely helpful in rectal cancer. Spread to these nodes is unusual in rectal cancer only and occurs in anal margin tumours or if the tumour has invaded distally into the anal canal. Supraclavicular lymph nodes may occasionally be enlarged in advanced cases.
Gastrointestinal cancer
Peter Hoskin, Peter Ostler in Clinical Oncology, 2020
There is often evidence of malnutrition, the degree of which is dependent on the duration and severity of dysphagia and whether there has been a history of alcoholism. In cases of oesophageal obstruction the patient could even be dehydrated owing to poor fluid intake. Women with Plummer–Vinson syndrome can appear anaemic and have koilonychia, while alcoholics may have stigmata of chronic liver disease. There is usually no palpable evidence of disease although an epigastric mass is sometimes palpable in tumours of the lower third of the oesophagus and if there are large intra-abdominal lymph nodes. The cervical and supraclavicular lymph nodes should be palpated carefully. Hepatomegaly suggests metastatic disease but also fatty infiltration or cirrhosis in heavy drinkers.
Lymphatic anatomy: microanatomy and physiology
Charles F. Levenback, Ate G.J. van der Zee, Robert L. Coleman in Clinical Lymphatic Mapping in Gynecologic Cancers, 2022
Afferent lymphatics transport lymphatic fluid into lymph nodes, which enters the medullary sinus – a common site for small metastases. The lymph fluid flows through the medulla and germinal centers of the lymph node and then exits the efferent channel. The lymphatics of the lower extremities and pelvis coalesce into large collecting ducts and ultimately form the thoracic duct. The thoracic duct and right lymphatic duct join the venous system at the junction of the left subclavian and jugular veins (Figure 2.3). Consequently, the left supraclavicular lymph nodes represent a common site for metastases from gynecologic cancers.
Melanoma and mantle cell lymphoma in a single collision tumor
Published in Baylor University Medical Center Proceedings, 2019
Madhuri Badrinath, Ajay Tambe, Poornima Ramadas, Melissa Mahajan, Adham Jurdi
A healthy 61-year-old man presented with a growing lesion over the nape of his neck for the past year associated with fatigue and unintentional weight loss. Physical examination showed a 1-cm pigmented lesion over the posterior neck with palpable submandibular and supraclavicular lymph nodes. Complete blood counts were unremarkable. Initial punch biopsy revealed melanoma with a Breslow thickness of 0.92 mm (Figure 1a). Wide surgical excision of the skin lesion revealed a superficial spreading type of melanoma, Breslow thickness of 1.2 cm, with infiltration of small to medium-sized CD 20+ lymphoid cells. A sentinel lymph node biopsy of the left supraclavicular node showed effacement of nodular architecture by sheets of B lymphocytes diffusely positive for CD20, CD5, and BCL2 and partially positive for cyclin D1 and CD43; no involvement with melanoma was shown. A Ki67 stain showed 40% positivity. Fluorescent in situ hybridization showed the presence of t(11;14) (q13;q32) between the IGH gene and the CCND1 gene, consistent with MCL. Bone marrow biopsy revealed extensive involvement with MCL (Figures 1b, 1c). Cytogenetics showed 25% to 33% of cells with an interstitial deletion of 13q, 11;14 rearrangement and 10% of cells with deletion of 17p (TP53 locus). A positron emission tomography–computed tomography scan showed diffuse lymphadenopathy involving the cervical, supraclavicular, mediastinal, hilar, internal and external iliac, and inguinal lymph nodes and uptake in the palatine tonsils (Figure 2a).
Clinical prognostic risk analysis and progression factor exploration of primary breast lymphoma
Published in Hematology, 2022
Jili Deng, Lan Mi, Xiaopei Wang, Jun Zhu, Chen Zhang, Yuqin Song
In 1972, Wiseman and Liao[3] first defined PBL according to the following four criteria, which is the current standard definition: 1. The first pathogenic site was the breast, and the lymphoma tissue was adjacent to the anatomical structure of the breast; 2. There was no history of lymphoma orno extensive disease spread; 3. Only regional lymph nodes were involved (ipsilateral axillary and supraclavicular lymph nodes); and 4. Sufficient histological specimens were available for pathological confirmation. These criteria were too stringent to exclude diseases involving distant regional lymph nodes and other extranodal organs, and there have been no large-scale trials or studies verifying the mechanism. Usually, only patients with stage IE–IIE were included. Patients with bilateral involvement were classified as either stage II or IV. Thus, studies have confirmed that PBL has a better prognosis than secondary breast lymphoma (SBL)[4].
Upregulation of NUCKS1 in Lung Adenocarcinoma is Associated with a Poor Prognosis
Published in Cancer Investigation, 2021
Hongfei Ma, Jing Xu, Ruixia Zhao, Yongyun Qi, Yong Ji, Kai Ma
We analyzed the correlation between the clinicopathologic features of LA with NUCKS1 expression, and the results are shown in Table 1. There were 70 cases of LA (38 females and 32 males, with a median age of 61.5 years); and 28 cases exhibited lymph node metastasis (LNM). The tumor sizes ranged from 0.7 cm to 9 cm, with 33 cases of pT1 (≤3 cm), and 37 cases equal or greater than pT2 (>3 cm). The LA were all of mixed type with more than 1 component. Thirty-three cases showed low-to-intermediate differentiation, with lepidic, acinus, and/or papillary components; 37 cases were accompanied by high-grade components, such as with solid, micropapillary, and/or spread through air space (STAS) components, and 45 cases contained interstitial lymphocytes. At the 5-year postoperative follow-up, 35 patients remained disease-free, 31 patients progressed, and 4 patients were lost to follow-up. The tumor components metastasized to supraclavicular lymph nodes, lung, bone, brain, and liver. Seventeen patients died of the disease without other reasons, and 49 patients were alive at the 5-year follow-up.
Related Knowledge Centers
- Lymph Node
- Lymphatic Vessel
- Metastasis
- Sentinel Lymph Node
- Stomach Cancer
- Abdominal Cavity
- Cancer
- Clavicle
- Supraclavicular Fossa
- Asymptomatic