Biliary Tract Cancer
Pat Price, Karol Sikora in Treatment of Cancer, 2020
The difficult tumors at the confluence of the right and left ducts are sometimes eponymously referred to as Klatskin tumors, after Klatskin’s report of 13 cases in 1965.31 Intra-hepatic cholangiocarcinomas could be histologically classified as mass-forming, periductal infiltrating, intraductal, or mixed, which may be related to their prognosis as well as getting a R0 resection.32 Bile duct tumors spread to the lymph node groups along the proper and common hepatic arteries; coeliac nodes; and, for distally placed lesions, retropancreatic and superior mesenteric nodes. It is important to sample lymph nodes when considering curative resection and when resecting tumors to skeletonize the hepatic artery and remove all lymphatic tissues and associated neural tissue. These tumors have a propensity for spread along the sub-epithelial planes and for longitudinal perineural and lympho-vascular invasion, both proximally and distally. Such invasion has a negative impact on survival.32,33 This histological feature presents challenges in pre- and intra-operative diagnosis, as choledochoscopic biopsies may underestimate the extent of tumor. Bile duct cancer may give rise to very well-differentiated nests of biliary epithelial cells within lymph nodes. Lymph node metastases have been seen to the left supraclavicular lymph nodes (Virchow’s sign).
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.
Breast cancer
Peter Hoskin, Peter Ostler in Clinical Oncology, 2020
The lump is usually non-tender, well-defined and most likely located in the upper outer quadrant, which contains the majority of the breast tissue. Breast discomfort is occasionally a presenting symptom. In advanced cases, the overlying skin can be dimpled or frankly invaded by tumour leading to reddening, induration and nodular irregularity. Fixation to the skin or chest wall with limited mobility of the lump should be sought by the clinician during physical examination. A very large lump will lead to obvious asymmetry of the breasts. There may be enlargement of the ipsilateral axillary lymph nodes, the mobility of which should be assessed as part of the clinical staging, and less frequently enlargement of the supraclavicular lymph nodes. Hepatomegaly could suggest metastatic infiltration while intrathoracic signs of collapse, consolidation or pleural effusion could suggest pulmonary or pleural metastases. Bone metastases are most frequent in the thoracic and lumbar spine and can lead to tenderness when pressure is applied to the affected vertebrae.
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].
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).
Into the gray-zone: update on the diagnosis and classification of a rare lymphoma
Published in Expert Review of Hematology, 2020
Caoimhe Egan, Stefania Pittaluga
Although established entities with well-delineated pathological features, certain commonalities and associations between CHL and PMBL are well recognized. As well as overlap on morphologic and immunophenotypic grounds in the form of GZL, both entities have been encountered as a composite lymphoma or as sequential lymphomas in the same patient [6]. Clinically, both tumors usually involve the anterior mediastinum or supraclavicular lymph nodes [1,9]. Seminal gene expression profiling studies performed by Rosenwald [10] and Savage [11] have shown that PMBL is distinct from other types of DLBCL and related to CHL. Furthermore, both PMBL and CHL have been shown to share similar genetic aberrations including amplification of 9p24.1 (JAK2/CD274/PDCD1LG2), rearrangements of CIITA at 16p13.13 and gains at the REL locus at 2p.16.1. Other mechanisms of NFκB and JAK-STAT pathway dysregulation found in both PMBL and CHL include point mutations in TNFAIP3 and SOCS1 genes [9,12].
Related Knowledge Centers
- Lymph Node
- Lymphatic Vessel
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- Sentinel Lymph Node
- Stomach Cancer
- Abdominal Cavity
- Cancer
- Clavicle
- Supraclavicular Fossa
- Asymptomatic