Ultrasonographic and histopathological features of cervical lymph node metastases

Vol. 55 No. 2 Suppl., 2014
This supplement was not sponsored by Outside Organizations.


Ionela Genes, Carmen Aurelia Mogoanta, Gabriel Lostun, Alexandra Lostun, Huba Mozes, Gheorghe Muhlfay

Objectives: Different approaches have been made to differentiate benignant from malignant cervical lymphadenopathy using ultrasound examination. Assessment of nodal status is essential in patients with head and neck carcinomas as it predicts prognosis and helps in the selection of treatment options. The present study was designed to evaluate the role of ultrasound in the assessment of malignant cervical lymph nodes using the histological gold standard results. Gray-scale ultrasound assesses the nodal size, shape, border, internal architecture and color Doppler ultrasound evaluate the vascular pattern of lymph nodes. Materials and Methods: 158 cervical lymphadenopathies evaluated by ultrasound in 100 patients over a period of 36 months (between January 2010 and December 2012) were evaluated for the presence of intranodal vascular pattern, which was considered benignant when it traversed through the node without disruption. Results: Of the 158 cervical tumors evaluated, 114 (72.2%) were found to be malignant on pathologic review. Malignant vascular markings were present in 133/158 lymph nodes evaluated. The presence of malignant vascular pattern had a sensitivity of 97.37% and a positive predictive value of 82.84%. Malignant gray-scale ultrasound markings had a sensitivity of 23.3% and a positive predictive value of 100%. Conclusions: The presence of normal intranodal blood flow was associated with a benignant diagnosis in 87.5% of the masses evaluated. The addition of this color Doppler ultrasound finding improves the ability of ultrasound exam to predict the likelihood of malignant involvement.

Corresponding author: Ionela Genes, University Assistant, MD, PhD; e-mail: ionela_genes@yahoo.com

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Simona Gurzu, Ioan Jung, Tivadar Bara, Tivadar Bara Jr., Orsolya Serester

An 82-year-old male was hospitalized with rectal carcinoma that was confirmed endoscopically. Surgical resection of the rectum was performed. Intraoperative examination showed a solitary hepatic metastasis; metastasectomy was also performed. Histological examination of the surgical specimen showed mainly a trabecular arrangement of the tumor cells, alternating with tubuloglandular areas, the tumor being diagnosed in stage IV. The high-power-view examination showed that the tumor cells presented clear cytoplasm, and were diffusely marked by AE1/AE3 keratin, carcinoembryonic antigen (CEA), and CD10. A focal immunostain was also observed for keratins 7/20, vascular endothelial growth factor (VEGF), and its receptor (VEGF-R2). The tumor was proved to be microsatellite stable, presenting K-ras mutation. Based on the immunoprofile and computer scanning, metastases from clear cell renal cell carcinoma and adrenocortical carcinoma have been excluded. Based on these characteristics and the tumor stage, the final diagnosis was primary clear cell adenocarcinoma (CCA). Bevacizumab-based antiangiogenic therapy was indicated. This is the 12th primary CCA of the colorectum ever reported, and the first from Eastern Europe.

Corresponding author: Ioan Jung, Professor, MD, PhD; e-mail: jungjanos@studium.ro, simonagurzu@yahoo.com

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