axillary lymph node

腋窝淋巴结
  • 文章类型: Case Reports
    乳腺和腋窝的非乳腺转移很少见,孤立的腋窝淋巴结转移尤其罕见。我们介绍了原发性子宫内膜癌肉瘤的罕见左腋窝淋巴结转移病例。
    方法:我们报告了一例73岁女性,其表现为左侧乳房尾部明显肿块。X线摄影和乳腺MRI显示多个左侧腋窝淋巴结肿大(LN),显示出恶性标准,影像学上任一乳腺均无任何可疑恶性肿瘤。该患者接受了淋巴结切除活检,诊断为妇科腋窝淋巴结转移。补充腹盆腔CT显示可疑子宫内膜肿块,经MRI证实。她接受了D&C,病理显示子宫内膜癌肉瘤。
    乳腺原发灶的准确检测是至关重要的,因为它们的治疗和预后与原发性乳腺癌有显著差异。据我们所知,我们的病例可能是第一例报道的子宫癌肉瘤中孤立性转移性腋窝LN的病例,其最初症状为无盆腔或腹部LN受累。
    结论:对于这些患者,为了避免不必要的外科手术和治疗,由具有精确的放射学和病理学相关性的多学科团队做出正确的诊断至关重要.
    UNASSIGNED: Non-mammary metastases to the breast and axilla are rare instances, and isolated axillary lymph node metastases are especially rare. We present a rare case of left axillary lymph node metastasis from a primary endometrial carcinosarcoma.
    METHODS: We report a case of a 73-year-old woman who presented with a left breast tail palpable mass. Sonomammography and breast MRI revealed multiple enlarged left axillary lymph nodes (LN) showing malignant criteria without any suspected malignancy in either breast on imaging. The patient underwent a nodal excisional biopsy that diagnosed axillary lymph node metastasis from a gynecologic origin. Complementary abdominopelvic CT revealed a suspicious endometrial mass that was confirmed on MRI. She underwent D&C and the pathology revealed endometrial carcinosarcoma.
    UNASSIGNED: Accurate detection of extramammary primary sites is crucial as their management and outcome differ significantly from primary breast cancer. To the best of our knowledge, our case could be the first reported case of isolated metastatic axillary LN from uterine carcinosarcoma presenting as the initial symptom without pelvic or abdominal LN involvement.
    CONCLUSIONS: For these patients to avoid needless surgical procedures and therapies, a proper diagnosis made by a multidisciplinary team with precise radiologic and pathologic correlation is essential.
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  • 文章类型: Meta-Analysis
    目的:本系统评价磁共振成像(MRI)对乳腺癌患者新辅助化疗(NAC)后腋窝淋巴结状态(ALNS)的诊断价值。
    方法:我们搜索了PubMed,Embase,科克伦图书馆,和WebofScience确定相关研究,并使用QUADAS-2工具评估合格研究的方法学质量。我们使用STATA版本12.0来执行数据池,异质性测试,亚组分析,和敏感性分析。
    结果:对于21项注册研究,包括2875名患者,汇集的敏感性,特异性,正似然比,负似然比,和诊断比值比分别为0.63(95%CI:0.53-0.72),0.75(95%CI:0.68-0.81),2.52(95%CI:1.98-3.19),0.50(95%CI:0.39-0.63),和5.08(95%CI:3.38-7.63)。AUC为0.76(95%CI:0.72-0.79)。灵敏度(I2=94.41%)和特异度(I2=88.97%)的I2值均>50%。对于最初的ALN阳性患者,合并的敏感性和特异性分别为0.64(95%CI:0.53-0.75)和0.74(95%CI:0.64-0.82),分别。通过关注NAC后进行的MRI研究进行敏感性分析,使用DCE-MRI的研究,或偏倚风险较低的研究显示与主要分析相似的结果.
    结论:MRI在评估乳腺癌患者NAC后ALNS方面可能具有次优诊断价值。由于NAC方案的不一致,腋窝手术的变异性,磁共振成像和手术之间没有时间间隔,我们需要进一步的研究来证实我们的发现.
    结论:我们的研究为评估乳腺癌患者新辅助化疗后的腋窝淋巴结状态提供了诊断价值。
    结论:•MRI在评估普通乳腺癌患者NAC术后腋窝淋巴结状态方面可能具有次优诊断价值。•初始腋窝淋巴结状态对MRI的诊断效能影响不大。研究之间的实质性异质性突出了需要进一步的研究,以提供更多高质量的证据在这一领域。
    OBJECTIVE: This systematic review examined the diagnostic performance of magnetic resonance imaging (MRI) for assessing axillary lymph node status (ALNS) after neoadjuvant chemotherapy (NAC) in breast cancer patients.
    METHODS: We searched PubMed, Embase, Cochrane Library, and Web of Science to identify relevant studies and used the QUADAS-2 tool to assess methodological quality of eligible studies. We used STATA version 12.0 to perform data pooling, heterogeneity testing, subgroup analysis, and sensitivity analysis.
    RESULTS: For the 21 enrolled studies, including 2875 patients, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were respectively 0.63 (95% CI: 0.53-0.72), 0.75 (95% CI: 0.68-0.81), 2.52 (95% CI: 1.98-3.19), 0.50 (95% CI: 0.39-0.63), and 5.08 (95% CI: 3.38-7.63). The AUC was 0.76 (95% CI: 0.72-0.79). I2 values of sensitivity (I2 = 94.41%) and specificity (I2 = 88.97%) were both > 50%. For the initial positive ALN patients, the pooled sensitivity and specificity were 0.64 (95% CI: 0.53-0.75) and 0.74 (95% CI: 0.64-0.82), respectively. Sensitivity analyses by focusing on studies with MRI performed post-NAC, studies using DCE-MRI, or studies with low risk of bias showed similar results to the primary analyses.
    CONCLUSIONS: MRI may have suboptimal diagnostic value in assessing ALNS after NAC for breast cancer patients. Due to the inconsistency of NAC regimens, the variability of axillary surgery, and the lack of time interval between MRI and surgery, further studies are needed to confirm our findings.
    CONCLUSIONS: Our study provided the diagnostic value of MRI in assessing axillary lymph node status after neoadjuvant chemotherapy for breast cancer patients.
    CONCLUSIONS: • MRI may have suboptimal diagnostic value in assessing axillary lymph node status after NAC for general breast cancer patients. • The initial axillary lymph node status has little impact on the diagnostic efficacy of MRI. • The substantial heterogeneity among studies highlights the need for further studies to provide more high-quality evidence in this field.
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  • 文章类型: Review
    淀粉样变很少表现为局部淋巴结病。各种研究已经阐明了这种有趣疾病的各种表现和表现。我们回顾了文献,发现以淋巴结肿大为表现的原发性淀粉样变性36例。36例中有17例(47%)参与了进一步的治疗.我们描述了一个孤立的右腋窝肿块的患者。临床检查和放射学表明淋巴结肿大,没有乳房或肺部恶性肿瘤的迹象。组织病理学检查指示淀粉样变性。进一步的工作包括血清,尿液生化,心脏工作,骨髓检查,肾脏活检显示系统性淀粉样变性。患者接受达雷妥单抗和CyBorD(环磷酰胺,硼替佐米,和地塞米松),然后进行干细胞移植。患者缓解1年,在提交本报告时。因此,我们的结论是(1)系统性淀粉样变性表现为孤立的淋巴结肿大是罕见的,(2)结构化的系统工作是必要的早期诊断和适当的治疗淀粉样变性,当有怀疑的时候,(3)使用新的治疗方案,如CD38+抗体(daratumumab)和干细胞移植对疾病结局有积极影响.
    Amyloidosis rarely presents as localized lymphadenopathy. Various studies have elucidated the varied presentation and manifestations of this interesting disease. We reviewed the literature and found 36 cases of primary amyloidosis with lymph node enlargement as a presentation, and 17 of the 36 cases (47%) had systemic involvement on further work up. We describe a patient who presented with an isolated right axillary mass. Clinical examination and radiology were indicative of a lymph node enlargement with no evidence of malignancy in the breasts or lungs. Histopathological examination was indicative of amyloidosis. A further work up including serum, urine biochemistry, cardiac work up, bone marrow examination, and a kidney biopsy revealed systemic amyloidosis. Patient was treated with daratumumab and CyBorD (cyclophosphamide, bortezomib, and dexamethasone) followed by a stem cell transplantation. Patient is in remission for 1 year, at the time of submission of this report. Therefore, we conclude (1) systemic amyloidosis presenting as an isolated lymph node enlargement is rare, (2) a structured systemic work up is imperative for early diagnosis and proper management of amyloidosis, when there is an index of suspicion, and (3) use of novel therapeutic options such as CD38 + antibody (daratumumab) and stem cell transplant have positive impact on disease outcomes.
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  • 文章类型: Journal Article
    背景:乳腺癌可以在健康生活十年后复发。这项研究的目的是描述一例完全康复27年后罕见的乳腺癌复发病例。
    方法:一名67岁已婚未产(G1P0A1)女性,表现为左腋窝肿胀几周。她是一个已知的左乳腺癌病例,于1994年被发现并接受了标准的乳房切除术,没有腋窝干预。超声和乳房X线照相术成像显示正常的右乳房和清晰的左乳房床。细针穿刺细胞学检查(FNAC)显示乳腺导管转移癌。患者接受了I级和II级腋窝淋巴结组的全身麻醉和腋窝清扫术。
    结论:乳腺癌患者切除原发肿瘤后腋窝淋巴结的复发率因手术方式而异。从0.8%到8.6%不等。雌激素受体阳性的乳腺癌患者延迟复发的风险较高。
    结论:乳腺癌在诊断和治疗27年后仍可复发。这证明了在诊断为乳腺癌的患者一生中继续随访的重要性。
    BACKGROUND: Breast cancer can recur after a decade of healthy life. The purpose of this study is to describe a rare case of breast cancer recurrence after 27 years of full recovery.
    METHODS: A 67-year-old married nulliparous (G1P0A1) female presented with a few weeks of left axillary swelling. She is a known case of left breast cancer that was identified and treated in 1994 with a standard mastectomy without axillary intervention. An ultrasound and mammography imaging revealed a normal right breast and a clear left breast bed. Fine needle aspiration cytology (FNAC) revealed metastasized ductal carcinoma of the breast. The patient underwent general anesthesia and axillary dissection for level I and II axillary lymph node groups.
    CONCLUSIONS: The incidence of recurrence in axillary lymph nodes following excision of the original tumor in breast cancer patients varies according to the surgical approach, ranging from 0.8% to 8.6%. Patients with breast cancer who have a positive estrogen receptor are at a higher risk of delayed recurrence.
    CONCLUSIONS: Breast cancer can recur even 27 years after being diagnosed and treated. This demonstrates the significance of continuing follow-up in patients diagnosed with breast cancer throughout their lives.
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  • 文章类型: Journal Article
    To elucidate whether (1) a posterior axillary boost (PAB) field is an optimal method to target axillary lymph nodes (LNs); and (2) the addition of a PAB increases the incidence of lymphedema, a systematic review was undertaken. A literature search was performed in the PubMed database. A total of 16 studies were evaluated. There were no randomized studies. Seven articles have investigated dosimetric aspects of a PAB. The remaining 9 articles have determined the effect of a PAB field on the risk of lymphedema. Only 2 of 9 articles have prospectively reported the impact of a PAB on the risk of lymphedema development. There are conflicting reports on the necessity of a PAB. The PAB field provides a good coverage of level I/II axillary LNs because these nodes are usually at a greater depth. The main concern regarding a PAB is that it produces a hot spot in the anterior region of the axilla. Planning studies optimized a traditional PAB field. Prospective studies and the vast majority of retrospective studies have reported the use of a PAB field does not result in increasing the risk of lymphedema development over supraclavicular-only field. The controversies in the incidence of lymphedema suggest that field design may be more important than field arrangement. A key factor regarding the use of a PAB is the depth of axillary LNs. The PAB field should not be used unless there is an absolute indication for its application. Clinicians should weigh lymphedema risk in individual patients against the limited benefit of a PAB, in particular after axillary dissection. The testing of the inclusion of upper arm lymphatics in the regional LN irradiation target volume, and universal methodology measuring lymphedema are all areas for possible future studies.
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  • 文章类型: Case Reports
    Thyroid carcinoma has an excellent long-term outcome for locoregional disease if adequately treated, but the outcome declines sharply if distant metastatic disease is present. Axillary lymph nodal metastases are unusual in thyroid carcinoma and have a poorer outcome, as they are usually associated with aggressive histopathologies, extensive locoregional disease, and distant metastatic disease. We report 2 cases of thyroid carcinoma with axillary lymph nodal metastases and their management, and we review the literature on such cases.
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