INTRODUCTION: Detection and examination of proper number of lymph nodes in patients after rectal resection is important for next treatment and management of patients with rectal carcinoma. There are no clear guideliness for minimal count of lymph nodes, variant recommendations agree on the number of 12 (1014) nodes. There are situations, when is not easy to reach this count, mainly in older age groups and in patients after neoadjuvant, especially radiation therapy. As a modality for improvement of lymph nodes harvesting seems to be establishing of defined protocols originally designed for mesorectal excision quality evaluation. METHODS: The investigation group was formed by patients examined in 2 three-years intervals before and after implementation of the protocol. Elevation in count of harvested lymph nodes was rated generaly and in relation to age groups and gender. RESULTS: The average count of lymph nodes increased from 10 to 15 nodes, in subset of patients whose received neoadjuvant therapy from 7 to almost 14 nodes. The recommended number of lymph nodes was obtained in all investigated age groups. By the increased number of lymph nodes, rises also possibility of positive nodes found, that can lead to upstaging of the disease, in subset of patients whose received neoadjuvant therapy it is more than 4%. CONCLUSION: Our conclusions show, that forming of multidisciplinary cooperative groups (chiefly surgeon-pathologist), implementation of defined protocol of surgery, specimen manipulation and investigation by detached specialists lead to benefit consequences for further management and treatment of the patients with colorectal cancer.

• Klíčová slova
• circumferential resection margin (CRM), colorectal carcinoma, lymph nodes identiffication and harvesting and examination, mesorectal excision, stage according to TNM classification and Dukes classification,
• MeSH
• lidé MeSH
• lymfadenektomie * MeSH
• lymfatické uzliny MeSH
• nádory rekta * chirurgie   MeSH
• neoadjuvantní terapie MeSH
• senioři MeSH
• staging nádorů MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVES: To assess the diagnostic performance of ultrasonography in pre-operative assessment of lymph nodes in patients with cervical cancer, to compare the outcomes for pelvic and para-aortic regions, and to detect macrometastases and micrometastases separately. METHODS: Patients were retrospectively included if they met the following inclusion criteria: pathologically verified cervical cancer; ultrasonography performed by one of four experienced sonographers; surgical lymph node staging, at least in the pelvic region-sentinel lymph node biopsy or systematic pelvic lymphadenectomy or debulking. The final pathological examination was the reference standard. RESULTS: 390 patients met the inclusion criteria between 2009 and 2019. Pelvic node macrometastases (≥2 mm) were confirmed in 54 patients (13.8%), and micrometastases (≥0.2 mm and <2 mm) in another 21 patients (5.4%). Ultrasonography had sensitivity 72.2%, specificity 94.0%, and area under the curve (AUC) 0.831 to detect pelvic macrometastases, while sensitivity 53.3%, specificity 94.0%, and AUC 0.737 to detect both pelvic macrometastases and micrometastases (pN1). Ultrasonography failed to detect pelvic micrometastases, with sensitivity 19.2%, specificity 85.2%, and AUC 0.522. There was no significant impact of body mass index on diagnostic accuracy. Metastases in para-aortic nodes (macrometastases only) were confirmed in 16 of 71 patients who underwent para-aortic lymphadenectomy. Ultrasonography yielded sensitivity 56.3%, specificity 98.2%, and AUC 0.772 to identify para-aortic node macrometastases. CONCLUSION: Ultrasonography performed by an experienced sonographer can be considered a sufficient diagnostic tool for pre-operative assessment of lymph nodes in patients with cervical cancer, showing similar diagnostic accuracy in detection of pelvic macrometastases as reported for other imaging methods (18F-fluorodeoxyglucose positron emission tomography/CT or diffusion-weighted imaging/MRI). It had low sensitivity for detection of small-volume macrometastases (largest diameter <5 mm) and micrometastases. The accuracy of para-aortic assessment was comparable to that for pelvic lymph nodes, and assessment of the para-aortic region should be an inseparable part of the examination protocol.

• Klíčová slova
• Area Under Curve, Cervical Cancer, Lymph Nodes, Lymphatic Metastasis,
• MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• lymfadenektomie MeSH
• lymfatické metastázy * diagnostické zobrazování   MeSH
• lymfatické uzliny * diagnostické zobrazování   patologie   chirurgie   MeSH
• mikrometastázy diagnostické zobrazování   MeSH
• nádory děložního čípku * diagnostické zobrazování   patologie   chirurgie   MeSH
• předoperační péče metody   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• ultrasonografie * metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• Klíčová slova
• LYMPH NODES/pathology *,
• MeSH
• lidé MeSH
• lymfatické nemoci * MeSH
• lymfatické uzliny patologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

The lymphatic pathway is an important route of metastasis in gynecological malignancy. Therefore, the examination of lymph nodes is an essential part of the ultrasound evaluation in patients with known or suspected gynecological malignancy. The lymph nodes most frequently involved in gynecological malignancy (apart from vulvar cancer) are parietal (retroperitoneal) and visceral abdominopelvic lymph nodes. In advanced disease, more distant lymph-node regions, such as the inguinal, axillary and supraclavicular lymph nodes, can also be involved. The standardized description of lymph nodes has been published previously by the Vulvar International Tumor Analysis (VITA) collaborative group. Herein, a collaborative group of gynecologists and gynecological oncologists with extensive ultrasound experience presents a systematic methodology for ultrasonographic lymph-node assessment performed as part of the locoregional and distant work-up to assess the extent of gynecological malignancy. The aim of this consensus opinion is also to describe the anatomical classification and drainage pathways of the lymphatic system as relevant to the gynecological organs. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

• Klíčová slova
• anatomy, clinical cases, gynecological malignancy, lymph nodes, lymphatic drainage, ultrasonography,
• MeSH
• konsensus MeSH
• lidé MeSH
• lymfatické metastázy * diagnostické zobrazování   patologie   MeSH
• lymfatické uzliny * diagnostické zobrazování   patologie   MeSH
• nádory ženských pohlavních orgánů * patologie   diagnostické zobrazování   MeSH
• staging nádorů metody   MeSH
• terminologie jako téma MeSH
• ultrasonografie metody   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Sentinel node biopsy in vulvar cancer is associated with much less morbidity than inguinofemoral node dissection. Our study focused on describing the morphology of superficial lymphatic drainage of the vulva and its relationship to regional nodes, which may facilitate orientation during surgery. MATERIALS AND METHODS: In 24 female cadavers, injections of patent blue (at various localisations medially, unilaterally and bilaterally) were used to visualise the lymphatic drainage of the vulva. After dissection of lymphatic vessels and nodes, their course was documented by photograph and then analysed. Subsequently, a map of vulvar superficial lymphatics was created. RESULTS: The cutaneous and subcutaneous tissue of the vulva primarily drained to superficial inguinal nodes. There was no evidence of a solitary lymph node that drained the unilateral vulva. Each area of the vulva drained to its own lymph node, which was variably localised in the subcutaneous groin around the great saphenous vein. Anastomoses between individual inguinal superficial lymph nodes are likely. Right-left symmetry in the course of lymphatic collectors was not detected. Natural drainage of the medial and paramedial areas to contralateral inguinal nodes was also not detected. The drainage pattern to ipsilateral inguinal nodes was consistent in cadavers without evidence of vulvar disease and may be applicable in the early stages of vulvar cancer. CONCLUSIONS: There was no evidence of a solitary node that drained the unilateral vulva. Each part of the vulva may drain to a corresponding lymph node in a different localisation of the groin. The surgeon should take this variability into account.

• Klíčová slova
• anatomy, cancer, lymphatic mapping, sentinel node, vulva,
• MeSH
• biopsie sentinelové lymfatické uzliny MeSH
• lidé MeSH
• lymfatické cévy * patologie   MeSH
• lymfatické uzliny patologie   MeSH
• nádory vulvy * patologie   MeSH
• třísla patologie   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

A middle-aged man in his 50s, active smoker, presented to the pulmonary office for lung cancer evaluation. On a low-dose computed tomography for lung cancer screening, he was found to have an 8 mm endobronchial lesion in the right main stem bronchus. A PET-CT revealed no endobronchial lesion, but incidentally, fluorodeoxyglucose (FDG) avidity was present in the right hilar (SUV 13.2) and paratracheal lymph nodes (LNs). He underwent bronchoscopy and EBUS-TBNA of station 7 and 10 R LNs. The fine needle aspiration (FNA) revealed necrotizing epithelioid granuloma. The acid-fast bacilli (AFB) and Grocott methenamine silver (GMS) stains were negative. He had suffered from pneumonic tularemia 13 months ago and immunohistochemical staining for Francisella tularensis on FNA samples at Center for Disease Control and Prevention was negative. The intense positron emission tomography (PET) avidity was attributed to prior tularemic intrathoracic lymphadenitis without active tularemia, a rare occurrence. To the best of our knowledge, PET-positive intrathoracic lymph node beyond one year without evidence of active tularemia has not been previously reported.

• Klíčová slova
• Lymph nodes, PET-CT, Pneumonia, Tularemia,
• MeSH
• biopsie tenkou jehlou pod endosonografickou kontrolou metody   MeSH
• časná detekce nádoru MeSH
• fluorodeoxyglukosa F18 MeSH
• lidé středního věku MeSH
• lidé MeSH
• lymfatické uzliny diagnostické zobrazování   patologie   MeSH
• nádory plic * diagnóza   patologie   MeSH
• PET/CT metody   MeSH
• retrospektivní studie MeSH
• staging nádorů MeSH
• tularemie * diagnóza   patologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• fluorodeoxyglukosa F18 MeSH

• Klíčová slova
• VIRUS DISEASES/case reports *,
• MeSH
• chorobopisy * MeSH
• infekce vyvolané poxviry * MeSH
• virové nemoci * MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

The survey is given of the actual knowledge of mononuclear phagocyte system which is involved in reactive changes of regional lymph nodes in experimental and human tumors. The practical aspects of their role in the development of tumors are discussed.

• MeSH
• experimentální nádory patologie   MeSH
• lidé MeSH
• lymfatické uzliny patologie   MeSH
• makrofágy patologie   MeSH
• nádory patologie   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

• Klíčová slova
• LYMPH NODES/physiology *, SKIN TRANSPLANTATION/experimental *,
• MeSH
• lidé MeSH
• lymfatické uzliny fyziologie   MeSH
• transplantace kůže * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Sentinel lymph node biopsy (SLNB) has emerged as an alternative to axillary lymph node dissection during breast cancer surgery during the last 2 decades. However, there are several controversies regarding the indication of the sentinel node biopsy after neoadjuvant chemotherapy which can convert positive lymph nodes to negative. The false-negative rate after neoadjuvant chemotherapy is unacceptably high. This high false-negative rate can be decreased by marking of the positive lymph nodes and removal during sentinel lymph node biopsy procedure in addition to the sentinel lymph nodes. The aim of this study was to investigate the possibility of carbon tattooing of the positive sentinel lymph nodes before neoadjuvant chemotherapy. In 2016, a prospective protocol was launched investigating the black carbon tattooing procedure of the suspective and positive axillary lymph nodes by injecting 0.1-0.5 carbon ink in normal saline under ultrasound guidance. All patients underwent black carbon tattooing of the suspected or positive axillary lymph nodes before the chemotherapy or one week before the primary surgery when chemotherapy was not indicated in the neoadjuvant setting. Sentinel lymph nodes together with lymph nodes marked by the black carbon ink were removed and histologically evaluated. So far 27 patients were treated under this protocol. Breast saving surgery was performed in 22 cases and mastectomy in 5 cases. All patients had invasive ductal carcinoma. In 20 patients neoadjuvant chemotherapy was indicated and in 7 patients primary surgery was performed. All lymph nodes marked by black carbon ink were successfully identified and removed. Sentinel lymph node biopsy was performed in 8 cases and sentinel lymph node biopsy followed by axillary dissection in 15 cases. Axillary dissection alone was performed in 4 cases. In 19 cases, the black carbon ink was present in the sentinel lymph node at the same time and in 4 cases carbon dye was present in other lymph nodes than the lymph node identified during SLNB, which corresponds to 17.4%. In the group of patients undergoing primary surgery, in one case from six, the sentinel lymph node was negative and the lymph node marked with carbon ink positive which represents false-negative lymph node and failure of the SLNB procedure. After neoadjuvant chemotherapy, there was no false-negative lymph node identified, but the conversion of the positive lymph nodes to negative was present in 10 cases (50%). There were no complications attributed to carbon ink tattooing. The results of positive sentinel lymph nodes tattooing have confirmed that this method is safe and allows a decrease in the false negativity rate during the sentinel node biopsy procedure.

• MeSH
• axila patologie   MeSH
• biopsie sentinelové lymfatické uzliny MeSH
• disekce MeSH
• lidé MeSH
• lymfadenektomie * MeSH
• lymfatické uzliny patologie   chirurgie   MeSH
• mastektomie MeSH
• nádory prsu * farmakoterapie   patologie   chirurgie   MeSH
• neoadjuvantní terapie MeSH
• prospektivní studie MeSH
• staging nádorů MeSH
• tetování * MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH