Integrative hyperthermia treatments for different types of cancer
Clifford L. K. Pang, Kaiman Lee in Hyperthermia in Oncology, 2015
Breast mass is the most common manifestation of breast cancer. The symptom of nipple discharge mostly means benign change. But patients more than 50 years old with unilateral nipple discharge should be alerted to the possibility of breast cancer. Nipple retraction, nipple itching, scaling, erosion, ulceration, scab, and eczema-like changes are often clinical manifestations of mammary Paget’s disease. Some patients present breast skin and contour changes. For example, when the cancer invades the Cooper ligament of the skin a “dimple syndrome” can be formed, cancer cells blocking subcutaneous lymphatic capillaries can result in skin edema, and depressions at the hair follicles can form the “orange peel” syndrome. When the skin is widely invaded, many hard nodules or small cords are formed in the epidermis or even integrated into pieces. If lesions extend to the back and to contralateral chest wall, breathing can be restricted and corset cancer can be formed. Inflammatory breast cancer can present significantly enlarged breasts with skin congestion, redness, and swelling and with increased local skin temperature. In addition, advanced breast cancer can present skin ulceration and form cancerous ulcers. Some patients present with swollen lymph nodes: the ipsilateral axillary lymph nodes can undergo swelling. Advanced breast cancer can transfer to contralateral axillary lymph node metastasis and cause swelling; moreover, the ipsilateral and contralateral supraclavicular lymph nodes are palpable in some cases.
Malignancy following lung transplantation
Wickii T. Vigneswaran, Edward R. Garrity, John A. Odell in LUNG Transplantation, 2016
Two additional malignancies with skin involvement that are uncommon in transplant recipients are neuroendocrine skin (i.e., Merkel cell) carcinoma and cutaneous lymphoma. Merkel cell carcinoma is characterized by nonspecific nodular growths and high rates of lymph node metastases. Mohs surgery with wide excisional margins is the first step in therapy. Chemotherapy with possible radiation treatment is implemented when evidence of lymph node involvement is present. The prognosis is poor, with a mortality rate of 56% at 2 years as opposed to 25% to 35% in nonimmunosuppressed patients.30 Cutaneous lymphoma can be of B- or T-cell origin. B-cell variants appear as single or multiple papules that may be ulcerated. Clinical manifestations of T-cell lymphoma are heterogeneous and can include mycosis fungoides, erythroderma, or hemorrhagic lesions, often with generalized lymphadenopathy. As for other cutaneous malignancy, the mainstays of treatment are surgical excision, radiotherapy, chemotherapy, and reduction in immunosuppression.69 Because many B-cell tumors are positive for EBV, the use of IFN-a and acyclovir has also been attempted but shown limited success.69 Overall survival outcomes are worse for T-cell lymphoma.
HIV/AIDS
Patricia G. Melloy in Viruses and Society, 2023
There are three stages to HIV/AIDS. The acute stage, the chronic or asymptomatic stage, and the AIDS stage (CDC 2021a) (Figure 5.2). In the weeks immediately following infection with HIV (acute stage), no symptoms or general flu-like symptoms might arise. Fever, coughing, and diarrhea may occur. However, lymph node swelling, called lymphadenopathy, may indicate something is happening with the immune system. When the immune system is severely weakened, it can allow susceptibility to other diseases such as tuberculosis or even cancers like lymphoma or Kaposi’s sarcoma (KS), called opportunistic infections (WHO 2021b; Zimmer 2011). Before HIV was discovered, swollen lymph nodes and other symptoms were mysteriously seen in people who were otherwise healthy (Shilts 1987).
Drug delivery to the intestinal lymph by oral formulations
Published in Pharmaceutical Development and Technology, 2022
Takayuki Yoshida, Hiroyuki Kojima, Kazuhiro Sako, Hiromu Kondo
Lymph nodes are small, oval glands that contain T cells, B cells, and macrophages (Thomas and Schudel 2015). Certain lymphatic vessels connect to a lymph node and deliver lymph fluid to the nodes that filter pathogens, viruses, and bacteria through phagocytosis or via an immune response (Fanous et al. 2007). Lymphocytes circulate through the blood and lymphatic vessels where they are trapped in lymph nodes. T cells in the cortical zone are activated by dendritic cells in the nodes, and subsequently, T cells promote antibody production by B cells in the nodular cortex and medulla of the nodes (Thomas and Schudel 2015). Therefore, lymph nodes are crucial sites for mounting and maintaining immune responses and therefore serve as the main target sites for the delivery of vaccines or immunosuppressive drugs.
Utility of 18-fluorodeoxyglucose positron emission tomography in children with relapsed/refractory leukemia
Published in Pediatric Hematology and Oncology, 2018
Zühre Kaya, Ozgür Umit Akdemir, Ozlem Lütfiye Atay, Nalan Akyürek, Faruk Güçlü Pınarlı, İdil Yenicesu, Ülker Koçak
Of the 28 total patients, six (21%) were FDG-PET/CT negative, four (14%) were positive at only one location, eight (29%) were positive at two locations, and 10 (36%) were positive at three or more sites. In total, 72 extramedullary lesion sites were detected, including 48 in ALL patients and 24 in AML patients. The most commonly involved sites of extramedullary leukemia were lymph nodes (n = 30), spleen (n = 8), soft tissues (n = 6), bone (n = 6), liver (n = 5), and thymus (n = 4). Rarely involved sites were the kidney (n = 3), central nervous system (CNS) (n = 2), joints (n = 2), muscle (n = 2), testis (n = 1), lung (n = 1), pancreas (n = 1), and eye (n = 1). The involvement of the kidney, CNS, eye, testis, and lung was only detected in patients with ALL. The involvement of the pancreas was only detected in patients with AML. The most common lymph node sites affected were the cervical, supraclavicular, abdominal, and axillary lymph regions. On FDG-PET/CT, the involved lymph nodes were mildly to moderately FDG avid, with a median SUVmax of 4.5 (range, 1.5–10.5). For those with splenic involvement, the median spleen SUVmax was 3.6 (range, 2.3–5.0). Four patients showed pulmonary, joint, tonsil, and bone FDG uptake, and these findings were consistent with infectious etiologies as opposed to leukemia.
Mediastinal lymphadenopathy: a practical approach
Published in Expert Review of Respiratory Medicine, 2021
Hariharan Iyer, Abhishek Anand, PB Sryma, Kartik Gupta, Priyanka Naranje, Nishikant Damle, Saurabh Mittal, Neha Kawatra Madan, Anant Mohan, Vijay Hadda, Pawan Tiwari, Randeep Guleria, Karan Madan
The International Thymic Malignancy Interest group (ITMIG) classification divides the mediastinum into three compartments viz. prevascular, visceral, and paravertebral. The prevascular space has the same boundaries as the anterior part of inferior mediastinum, but it extends superiorly to the thoracic outlet level. It consists of the thymus, left brachiocephalic vein and lymph nodes. The visceral compartment is behind the anterior fibrous pericardium. It extends posteriorly till an imaginary plane passing from each thoracic vertebra at a point 1 cm behind the anterior border of the central body of the vertebra. It contains heart, ascending aorta, arch of the aorta and descending aorta, superior vena cava, pulmonary arteries, trachea, esophagus, thoracic duct and lymph nodes. Posterior to this imaginary vertical plane lies the paravertebral compartment. This compartment contains the thoracic spine and paravertebral soft tissue [6]. The intra-thoracic lymph nodes are distributed in all of these compartments (Figure 1A).