Objective: Background: Rare disease An epithelial inclusion cyst within a lymph node denotes a heterotopic phenomenon. Nodal epithelial inclusion cysts have been reported in a variety of anatomical locations including pelvic, abdominal, mediastinal, and axillary regions. While nodal melanocytic nevus (also known as nevus cell aggregates) is the most common heterotopic phenomena involving the axillary lymph nodes, the presence of benign epithelial inclusion cysts in axillary lymph nodes is a rare but well-reported finding. Such documentation is in part due to assessment of sentinel lymph nodes in breast cancer becoming standard of care. These epithelial inclusion cysts offer a diagnostic pitfall in evaluation of sentinel lymph node in the setting of breast carcinoma. They also complicate assessment of sentinel lymph node during intraoperative frozen sections analysis. Case Report: We report a case of co-existent of benign squamous-type and glandular-type epithelial inclusions cysts in 2 sentinel lymph nodes in a patient with grade III invasive ductal carcinoma involving the left breast. There have been at least 4 cases reported in literature in which benign epithelial inclusion cysts in sentinel lymph nodes were first mistakenly diagnosed as metastatic carcinoma both during intraoperative frozen section analysis and during review of permanent sections. The missed diagnosis could potentially occur intraoperatively during frozen section sentinel lymph node analysis secondarily due to lack of availability of the primary tumor for comparison and inability to use immunohistochemical stains. Conclusions: Pathologists should be aware of this pitfall especially in frozen section analysis of sentinel lymph node to avoid misdiagnosis and its associated potential grave consequences.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24281号 / 医博第4897号 / 新制||医||1061(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 森田 智視, 教授 妹尾 浩, 教授 波多野 悦朗 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Prostate cancer (PCa) is the most common non-skin malignancy of men in developed countries. In spite of treatment with curative intent up to 30-40% of patients have disease recurrence after treatment, resulting from any combination of lymphatic, hematogenous, or contiguous local spread. The concept of early detection of PCa offer benefits in terms of reduced mortality, but at the cost of over-diagnosis and overtreatment of indolent disease. This is largely due to the random nature of conventional biopsies, with a risk of missing significant cancer and randomly hitting indolent disease. In the present thesis, diagnostic performance of MRI DWI and 11C Acetate PET/CT lymph node staging of intermediate and high risk PCa, was investigated, and additionally, predictive factors of regional lymph node metastases were evaluated. Further, additional value of targeted biopsies to conventional biopsies, for detection of clinically significant PCa, was investigated. In paper one and two, 53 and 40 patients with predominantly high risk PCa underwent 11C Acetate PET/CT and 3T MRI DWI, respectively, for lymph node staging, before extended pelvic lymph node dissection (ePLND). The sensitivity and specificity for PET/CT was 38% and 96% respectively. The sensitivity and specificity for MRI DWI was 55% and 90% respectively. In paper three, 53 patients with newly diagnosed PCa were included. All patients underwent multi-parametric MRI, followed by two cognitive targeted biopsies. Five more clinically significant cancers were detected by adding targeted biopsies to conventional biopsies. In paper four the value of quantitative and qualitative MRI DWI and 11C Acetate PET/CT parameters, alone and in combination, in predicting regional lymph node metastases were examined. ADCmean in lymph nodes and T-stage on MRI were independent predictors of lymph node metastases in multiple logistic regression analysis. In conclusion the specificity of diffusion weighted MRI and 11C Acetate PET/CT for lymph node staging was high, although the sensitivity was low. Predictive factors of regional lymph node metastases could be retrieved from diffusion weighted MRI and 11C Acetate PET/CT. By combining targeted biopsies with conventional biopsies the detection rate of clinically significant PCa could be increased.

BACKGROUND:The aim of the study is to assess the effectiveness of intensity-modulated radiotherapy (IMRT) or image-guided radiotherapy (IGRT) for the prevention of retropharyngeal nodal recurrences in locally advanced head and neck cancer.METHODS:A retrospective review of 76 patients with head and neck cancer undergoing concurrent chemoradiation or postoperative radiotherapy with IMRT or IGRT who were at risk for retropharyngeal nodal recurrences because of anatomic site (hypopharynx, nasopharynx, oropharynx) and/or the presence of nodal metastases was undertaken.The prevalence of retropharyngeal nodal recurrences was assessed on follow-up positron emission tomography (PET)-CT scans.RESULTS:At a median follow-up of 22months (4-53months), no patient developed retropharyngeal nodal recurrences.CONCLUSION:Prophylactic irradiation of retropharyngeal lymph nodes with IMRT or IGRT provides effective regional control for individuals at risk for recurrence in these nodes.

Einteilung:Das Lungenkarzinom ist eine der häufigsten Krebstodesursachen der Welt. Die chirurgische Therapie mit onkologischer Resektion des Tumors bietet bessere Chancen für einen dauerhaften Therapieerfolg. Die Bedeutung der systematischen Lymphadenektomie im Sinne eines akkuraten Stagings und einer besseren Lokalkontrolle des Tumors ist unumstritten. In der Literatur wurden verschiedene LK-Befallsmuster bei den operierten NSCLC anhand verschiedener histomorphologischer Parameter beschrieben, um letztendlich eine passende Technik der Lymphadenektomie zu entwickeln. Patienten und Methoden: In unserer retrospektiven Studie wurde ein Kollektiv von 111 Patienten mit operierten nicht kleinzelligen Lungenkarzinome zwischen 2008 und 2013 untersucht. Das LK-Metastasierungsmuster wurde anhand verschiedener histomorphologischer Parameter untersucht. Ergebnisse: Eine zentrale Tumorlage, L1-Kategorie, sowie die zunehmende Tumorgröße zeigten eine signifikante Neigung zur LK-Metastasierung. Anhand der Tumorlokalisation im Lungenlappen ließ sich jedoch kein bestimmtes LK- Befallmuster sichern. Schlussfolgerung: Diese Daten unterstützen die Angaben der Literatur, in der eine systematische Lymphadenektomie unabhängig von den anderen Parametern weiter gefordert wird, um ein akkurates Staging zur erreichen und so eine optimale Therapie durchzuführen.fi

Teladorsagia circumcincta is a major financial burden on the UK sheep farming industry. Disease control is becoming increasingly difficult due to the rapid emergence of anthelmintic resistance. This has prompted the search for alternative, sustainable control measures, including vaccination. Vaccine design would be aided by a thorough knowledge of the mechanisms involved in immunity to T.circumcincta. Most research has focussed on humoral and cellular responses to infection with this nematode. This thesis focuses on the impact of infection with regards to the proteins found locally within the abomasum. Using a well established infection model, proteomic analysis of lymph draining the abomasum was carried out by means of 2-dimensional electrophoresis (2-DE). The identity of many of the proteins in gastric lymph was revealed by means of MALDI-TOF analysis. The relative quantities of the lymph proteins were monitored over time using gel analysis software in both primary infection and immune challenged infection models. This study revealed a number of proteins of interest, including the acute phase proteins serum amyloid A, alpha-1 acid glycoprotein and haptoglobin, as well as the actin depolymerising protein, gelsolin. The effect of infection and immunity to T.circumcincta on these proteins was investigated further by means of biochemical assays, western blotting and real-time PCR. The impact of infection on the permeability of the abomasal mucosa will affect the resultant gastric lymph proteome. This “leak lesion” phenomenon is well documented in T.circumcincta infection but the underlying cause is unknown. Tight junction proteins in the abomasum were studied, using immunofluorescence techniques, in an attempt to define the role of these proteins in this important immunological/pathological event. The aim of this thesis is to contribute to the knowledge of innate immune responses and local pathology occurring within the abomasum during T.circumcincta infection.

At least 50% of people will develop cancer at some point during their lifetime and half these will end in fatality. Improving patients’ prognosis relies on early and accurate diagnosis and treatment. Current diagnostic methods are based on histopathological analysis and are time-consuming, expensive and require biopsy. Raman spectroscopy can measure subtle biochemical changes and provides a rapid, non-destructive and objective technique that can be used in vivo for identifying pathological changes in tissue samples. This study investigates both a standard Raman spectrometer system and also a Raman needle probe for their use as diagnostic techniques and clinical tools. Oesophageal, femoral and head and neck lymph nodes were analysed in this study. Metastatic lymph nodes from the three areas could be identified from the non-cancer lymph nodes with a sensitivity of 71% and specificity of 89%. Lymphoma was identified from non-cancer lymph nodes with a sensitivity of 64% and specificity of 86%. It was observed that oesophageal nodes often contained carbon particles, clinically diagnosed as anthracosis. These nodes were much harder to study than the femoral or head and neck, due to strong Raman signal detected from the carbon particles. Lymph nodes are embedded in adipose tissue and as a consequence, very strong lipid peaks were frequently observed in spectra. Spectral differences were exhibited in the measurements of the lymph nodes from the three different anatomical regions. A comparison of the point measurements and mapped data showed no difference in classification. Therefore, indicating that just a few measurements can be sufficient enough sampling to represent a specimen, and demonstrates the practicability of Raman use in vivo for rapid analysis. The Raman needle probe feasibility study showed its potential for in vivo use for real-time diagnosis and as a surgical tool to support biopsy. A sensitivity and specificity of 80% and 79% for the identification of non-cancer head and neck lymph nodes from non-cancer provides similar accuracies to the standard Raman approach, therefore supports its viability for use as a diagnostic tool.

The quantitative assessment of lymph node size plays an important role in treatment of diseases like cancer. In current clinical practice, lymph nodes are analyzed manually based on very rough measures of long and/or short axis length, which is error prone. In this paper we present a graph-based lymph node segmentation method to enable the computer-aided three-dimensional (3D) assessment of lymph node size. Our method has been validated on 111 cases of enlarged lymph nodes imaged with X-ray computed tomography (CT). For unsigned surface positioning error, Hausdorff distance and Dice coefficient, the mean was around 0.5 mm, under 3.26 mm and above 0.77 respectively. On average, 5.3 seconds were required by our algorithm for the segmentation of a lymph node.

No description available.

Staging is critical in the management of cancer. Sentinel lymph node (SLN) biopsy is one method used in the assessment of cancer spread. SLN procedures are standard practice in the management of some cancers although; these procedures have only recently been developed and refined. SLN procedures are commonly used in the management of melanomas and breast cancers in patients with no evidence of metastatic disease on clinical exam. SLN procedures include detection, localization, and assessment of SLNs. The detection/localization components vary in technique and rates of success. The procedures with the least number of detection/localization techniques generally include the use of blue dye or the use of a radiotracer with intraoperative gamma counting. The most complex procedures involve the use of blue dye, the use of a radiotracer with preoperative gamma imaging and preoperative gamma counting, intraoperative gamma counting, or some combination of these techniques. The ideal procedure for SLN would include all the listed techniques however; all facilities do not incorporate the most complete procedure, for different reasons. An investigation using a small FOV (5 in x 5 in) gamma camera intraoperatively for SLN procedures in melanoma and breast cancer patients was performed. A smaller FOV camera is capable of obtaining some of the same information as a conventional gamma camera. It is possible that centers, which do not or are not able to take advantage of preoperative imaging, may find the use of a smaller FOV gamma camera in the operating room useful. The investigation consisted of a total of 41 patients; it was split into two studies, Study 1: melanoma and study 2: breast cancer. The melanoma study found the added use of a smaller FOV camera under the parameters of this study to be minimal. Study 2 was broken into two branches; branch 1: camera/probe/dye and branch 2: probe/dye, for a comparison study. Comparing the two branches did not show the smaller FOV camera to reduce the time spent in the operating room versus using the probe and blue dye.