BACKGROUND: This anatomic study details the lymphatic drainage of the upper extremity (UE) and breast, as well as its course in the axilla and its relation to axillary reverse mapping. Two aspects important for breast cancer surgery were followed: connection between the lymphatics of the UE and breast, and the possible cause of lymphedema of the UE after sentinel node (SN) biopsy. METHODS: Patent blue dye was injected bilaterally in 23 cadavers with no history of breast carcinoma to simultaneously visualize the lymphatics of the UE and breast. After visualization and dissection of the lymphatic vessels and nodes, a record of their routes was made. A scheme of superficial UE and breast lymphatics was constructed. RESULTS: After application of color contrast to the UE, 2-4 main afferent collectors were shown. As opposed to cranial and medial collectors, caudal collectors diverged from the axillary vein and entered the caudal axilla. In five (10.8%) cases, the caudal collector entered a node, which was considered to be the SN of the breast. In six (13%) cases, the SN of the breast and SNs of the UE were found in close proximity (up to 1.5 cm). CONCLUSIONS: Lymphatic drainage of the UE and breast are closely related in the caudal part of the axilla. SN groups for the UE and breast share connections in 24% of cases, which could explain lymphedema after surgery if damaged. Additional studies are needed to further improve our understanding of the lymphatic drainage of the UE and breast.
- MeSH
- axila MeSH
- barvicí látky MeSH
- disekce MeSH
- horní končetina anatomie a histologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lymfatické cévy anatomie a histologie MeSH
- lymfatické uzliny anatomie a histologie MeSH
- mrtvola MeSH
- prsy anatomie a histologie MeSH
- rosanilinová barviva MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Názvy látek
- barvicí látky MeSH
- rosanilinová barviva MeSH
- sulfan blue MeSH Prohlížeč
OBJECTIVE: Lymphatic mapping is a method to find and preserve upper extremity lymphatics during axillary surgery (axilla clearance and sentinel node biopsy) in breast cancer patients. This may reduce the incidence of lymphedema. We examined on anatomical model, if the lymphatic drainage of the upper extremity is fully separable from the lymphatic drainage of the breast. We further endeavored to find an explanation as to why lymphedema occurs in the upper extremity after sentinel node biopsy in breast carcinoma. DESIGN: Pilot study. SETTING: Oncogynecologic Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague. METHODS: Patent blue dye was injected deep and superficially in arm and breast bilaterally in 9 cadavers. After visualization and precise dissection of the lymphatic vessels and nodes, a record of their routes was made. A scheme of arm and breast lymphatics was constructed. RESULTS: The lymph from arm is drained by 2-4 main afferent collectors. As opposed to cranial and medial collectors, caudal collectors diverged from the axillary vein and entered the caudal axilla. In one case the caudal collector entered a node, which was considered to be the sentinel node of the breast. The other important finding is the demonstration of lymphatic anastomoses that take place between imaged nodes in the caudal axilla, which is the most frequent localization of the breast sentinel lymph node. CONCLUSION: The relationship of lymphatic drainage of the arm and breast are closely related and share connections. These connections represent the main problem, which could explain lymphedema following surgery if damaged. Further studies are necessary to improve understanding of this method and to increase the number of observations.
- MeSH
- axila MeSH
- biopsie sentinelové lymfatické uzliny škodlivé účinky MeSH
- lidé MeSH
- lymfadenektomie MeSH
- lymfatické cévy anatomie a histologie MeSH
- lymfatické uzliny anatomie a histologie MeSH
- lymfedém etiologie prevence a kontrola MeSH
- nádory prsu patologie chirurgie MeSH
- paže MeSH
- prsy MeSH
- rosanilinová barviva * MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- rosanilinová barviva * MeSH
- sulfan blue MeSH Prohlížeč
BACKGROUND: Pelvic lymphadenectomy is an integral component of gynecologic cancer surgery, yet there is a lack of standardization in the terminology used, the extent of the procedure, and the definition of anatomic landmarks. This lack of standardization if corrected will likely facilitate a more clear communication and analysis of outcomes from various institutions, and reduce confusion to trainees about the procedure being performed. METHODS: We summarize the anatomic data concerning pelvic lymphatic drainage; describe the procedure based on clearly defined anatomic landmarks; and finally propose a new classification system to facilitate standardization, communication, and comparison of results. The accompanying video demonstrates the anatomic landmarks. RESULTS: We list and define four commonly used terms related to pelvic lymph node harvesting: sentinel node mapping, excision of bulky nodes, pelvic lymph node sampling, and systematic pelvic lymphadenectomy. We list the five specific anatomic regions of the pelvic lymphatic basin: external iliac, obturator, internal iliac, common iliac, and presacral. We highlight the important neural structures located in regions of the pelvic lymphadenectomy: genitofemoral nerve, obturator nerve, cranial part of the lumbosacral plexus, hypogastric plexus, and splanchnic nerves. Finally, we propose a new, four-part classification system of types of pelvic lymph node dissection. CONCLUSION: In this report and video, we demonstrate anatomy and offer a new classification system for pelvic lymphadenectomy.
- MeSH
- lidé MeSH
- lymfadenektomie klasifikace metody normy MeSH
- lymfatické uzliny anatomie a histologie patologie chirurgie MeSH
- nádory děložního čípku patologie chirurgie MeSH
- pánev anatomie a histologie chirurgie MeSH
- terminologie jako téma MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Quantification of microvessels in tumors is mostly based on counts of vessel profiles in tumor hot spots. Drawbacks of this method include low reproducibility and large interobserver variance, mainly as a result of individual differences in sampling of image fields for analysis. Our aim was to test an unbiased method for quantifying microvessels in healthy and tumorous lymph nodes of dogs. The endothelium of blood vessels was detected in paraffin sections by a combination of immunohistochemistry (von Willebrand factor) and lectin histochemistry (wheat germ agglutinin) in comparison with detection of basal laminae by laminin immunohistochemistry or silver impregnation. Systematic uniform random sampling of 50 image fields was performed during photo-documentation. An unbiased counting frame (area 113,600 microm(2)) was applied to each micrograph. The total area sampled from each node was 5.68 mm(2). Vessel profiles were counted according to stereological counting rules. Inter- and intraobserver variabilities were tested. The application of systematic uniform random sampling was compared with the counting of vessel profiles in hot spots. The unbiased estimate of the number of vessel profiles per unit area ranged from 100.5 +/- 44.0/mm(2) to 442.6 +/- 102.5/mm(2) in contrast to 264 +/- 72.2/mm(2) to 771.0 +/- 108.2/mm(2) in hot spots. The advantage of using systematic uniform random sampling is its reproducibility, with reasonable interobserver and low intraobserver variance. This method also allows for the possibility of using archival material, because staining quality is not limiting as it is for image analysis, and artifacts can easily be excluded. However, this method is comparatively time-consuming.
- MeSH
- barvení a značení MeSH
- biometrie metody MeSH
- cévní endotel MeSH
- cévy anatomie a histologie patologie MeSH
- imunohistochemie metody MeSH
- lymfatické uzliny anatomie a histologie patologie MeSH
- nádory patologie MeSH
- patologie metody MeSH
- psi MeSH
- reprodukovatelnost výsledků MeSH
- zvířata MeSH
- Check Tag
- psi MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- hodnotící studie MeSH
BACKGROUND: Sentinel node (SN) biopsy is associated with much less morbidity than axillary dissection. In patients with early breast cancer, lymphatic mapping and SN biopsy accurately stage the axillary nodes. Both currently available lymphatic mapping agents, radiocolloid and blue dye, have some limitations that may make perioperative or preoperative SN identification difficult. In such cases, exact knowledge of the topography of the axilla and the most probable location of the SN may be crucial. METHODS: In 12 fresh female cadavers with no history of breast carcinoma, injections of patent blue dye were used to visualize the SNs in the axillary quadrants and their lymphatic collectors from the upper outer quadrant of the breast, which is the most common location of breast cancer. The axilla was divided into quadrants with regard to the intersection of the thoracoepigastric vein and the third intercostobrachial nerve. RESULTS: All SNs were located within a circle of 2-cm radius of this intersection in the fatty tissue at the clavipectoral fascia. In most cases, the SN was located in the fatty tissue near the clavipectoral fascia in the lower ventral quadrant of the axilla (n = 14, 58%). In seven cases (29%), the SN was located in the upper ventral quadrant, in two cases (8%) in the upper dorsal quadrant, and in one case in the lower dorsal quadrant. CONCLUSIONS: The results of this anatomical study may facilitate SN biopsy in patients with breast cancer.
- MeSH
- axila anatomie a histologie MeSH
- biopsie sentinelové lymfatické uzliny metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- lymfatické cévy anatomie a histologie MeSH
- lymfatické uzliny anatomie a histologie MeSH
- mrtvola MeSH
- prsy anatomie a histologie MeSH
- rosanilinová barviva MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Názvy látek
- rosanilinová barviva MeSH
- sulfan blue MeSH Prohlížeč
The objective of the work was to assess the impact of the shift of gastric cancer in an oral direction in the mediastinal lymph nodes. For this purpose a new miniinvasive lower mediastinoscopy was used in 30 patients. The method is safe and can be used also in other situations. Mediastinal metastases may occur in cancer in the distal and medium third of the stomach. They need not be present when cancer is in the upper third. The shift of gastric carcinoma did not influence the mediastinal nodes.
- MeSH
- břicho MeSH
- dospělí MeSH
- karcinom sekundární chirurgie MeSH
- laparoskopie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lymfadenektomie * MeSH
- lymfatické metastázy MeSH
- lymfatické uzliny anatomie a histologie MeSH
- mediastinoskopie MeSH
- mediastinum MeSH
- nádory žaludku patologie chirurgie MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
In ten postmortem hearts of the Macaque monkey (M. mulatta), the coronary lymphatics were visualized using an India ink suspension in 2% gelatin. The left coronary lymphatic initially passed to the dorsal surface of the aortic arch. In five hearts, this lymphatic went directly to the cardiac lymph node, whereas in the others, it first ascended to the left superior tracheobronchial node and then interconnected with the cardiac lymph node. The right coronary lymphatic usually passed in front of the ascending aorta and common arterial (brachiocephalic) trunk and entered the cardiac lymph node. In two hearts, however, the right coronary lymphatic first ascended to an anterior transverse mediastinal node and from here lymphatics joined the cardiac lymph node. Those lymphatics that passed cephalad from the cardiac lymph node to the right anterior mediastinal nodes and the right paratracheal nodes ultimately emptied into the right venous angle. Those lymphatics that passed cephalad from the cardiac lymph node to the anterior transverse mediastinal nodes ultimately emptied into the left venous angle. In five other Macaque monkeys (M. mulatta and M. fascicularis) after marker injection (T1824 blue dye and micropulverized barium sulfate) into the living heart or pericardium, lymphatic drainage beyond the base of the heart could not be demonstrated. Whereas postmortem morphologic studies suggest that the monkey coronary lymphatic system is amenable to obstruction by removal of the cardiac lymph node and interruption of its adjacent lymphatic connections, effective methods for visualizing the mediastinal lymphatic collecting system in the living monkey must be developed before experimental cardiac lymphatic ablation can be accomplished in this species.
- MeSH
- lymfatické uzliny anatomie a histologie MeSH
- lymfatický systém anatomie a histologie MeSH
- Macaca fascicularis MeSH
- Macaca mulatta anatomie a histologie MeSH
- mediastinum anatomie a histologie MeSH
- srdce anatomie a histologie MeSH
- zvířata MeSH
- Check Tag
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
The majority of nodes of iliosacral lymphocenter are attached to the wall of a. iliaca communis dextra et sinistra from its origin to the rise of a. circumflexa ilium profunda. The total number of nodes of the lymphocenter ranges from 5 to 11, without any marked dextro-sinistral asymmetry. The size of nodes, as expressed by their length, showed a wide range from 1.5 to 20 mm and in more than one half of nodes it was 5 to 10 mm. The mass of individual nodes ranged from 1.7 to 98.9 mg and in one half of them was up to 20 mg. The total mass of all nodes of lymphocenter fluctuated individually from 131 to 340 mg with a slight asymmetry in favour of the right-hand side. Regarding a considerable positional variability of nodes the authors do not hold a further particularization of iliosacral lymphocenter for reliable and they consider the nodes under study to be a uniform topical group.
- MeSH
- balneologie * MeSH
- krysa rodu Rattus MeSH
- lymfatické uzliny anatomie a histologie MeSH
- zvířata MeSH
- Check Tag
- krysa rodu Rattus MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
The ds RNA, an inducer of interferon, displayed a marked modulatory action on damage induced in the lymphoid system of mice by a single injection of cyclophosphamide. Its action depended on the type of lymphoid tissue and on the time interval between injection of ds RNA and CY. The "unwanted" synergy between the action of ds RNA and CY was most pronounced in the thymus in which a further great decrease in weight and cellularity was observed at all time intervals. In the case of the spleen and lymph nodes, the undesirable synergy was manifest only when the ds RNA was injected prior to CY. Simultaneous injection of ds RNA and CY, or injection of ds RNA after CY, had beneficial effects on the weight and cellularity of lymphoid organs, possibly by accelerating the regeneration processes.
- MeSH
- cyklofosfamid farmakologie MeSH
- dvouvláknová RNA farmakologie MeSH
- interferony fyziologie MeSH
- játra anatomie a histologie MeSH
- lymfatické uzliny anatomie a histologie MeSH
- lymfatický systém anatomie a histologie účinky léků MeSH
- lymfoidní tkáň MeSH
- myši inbrední A MeSH
- myši inbrední C57BL MeSH
- myši MeSH
- slezina anatomie a histologie MeSH
- thymus anatomie a histologie MeSH
- velikost orgánu účinky léků MeSH
- zvířata MeSH
- Check Tag
- myši MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- cyklofosfamid MeSH
- dvouvláknová RNA MeSH
- interferony MeSH
