OBJECTIVEWe analyzed the lymph node (MLNs) metastasis of thoracic esophageal squamous cell carcinoma (ESCC) to explore the patterns of lymphatic spread and the rational surgical procedure and extent of lymph node dissection for ESCC.

METHODSWe retrospectively evaluated 313 consecutive patients treated in our hospital between January 2010 and May 2014 who underwent minimally invasive esophagectomy (MIE) for ESCC. The information of lymph node status was obtained and the features of lymph node metastasis were analyzed.

RESULTSOf the 313 cases, 122 (39.0%) were found to have lymph node metastasis. In the 4461 dissected lymph nodes, metastasis was identified in 294 (6.6%) lymph nodes. The recurrent laryngeal nerve lymph nodes were the most frequent metastatic nodes with a metastasis rate of 25.2%, followed by the paracardiac and left gastric artery lymph nodes (18.2%). Chi-square test showed that the lymph node metastasis is associated with tumor invasion and tumor differentiation (P<0.001 for both). Metastases were more frequently found in the recurrent laryngeal nerve lymph nodes in patients with tumors in the upper third esophagus and with histologically poor differentiation (P<0.05 for both). The metastasis rate of para-cardiac and left gastric artery lymph nodes was associated with tumor in the lower third of esophagus, T stage and differentiation (all P<0.05). Logistic regression analysis showed that tumor differentiation and location are independent factors affecting the metastasis of recurrent laryngeal nerve lymph nodes (P<0.05 for all). T stage, tumor differentiation and location were independent factors associated with metastasis of para-cardiac and left gastric artery lymph nodes (P<0.05 for all).

CONCLUSIONS(1) Metastases of thoracic esophageal carcinoma are often found in the recurrent laryngeal nerve lymph nodes, para-cardiac and left gastric artery lymph nodes. (2) Extensive lymph node dissection should be performed for ESCC with poor differentiation and deep tumor invasion.

Carcinoma, Squamous Cell ; secondary ; surgery ; Esophageal Neoplasms ; pathology ; surgery ; Esophagectomy ; Humans ; Lymph Node Excision ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Lymphatic Vessels ; Recurrent Laryngeal Nerve ; Retrospective Studies

Sclerosing mucoepidermoid carcinoma with eosinophilia (SMECE) is a recently recognized malignant neoplasm of the thyroid gland. About 14 cases of SMECE have been reported and this is the first reported case in Korea. A 57-year-old woman presented with right neck mass for 20 years. Total thyroidectomy was performed under the impression of thyroid carcinoma. The resected thyroid gland showed a poorly circumscribed hard mass. Histologically, the tumor consisted of solid nests of large atypical cells with dense fibrous stroma. The tumor cells showed squamoid appearance with abundant eosinophilic cytoplasm. There were also rare mucin-containing cells within the nests. Within the hyalinized stroma, numerous eosinophils were found. The surrounding thyroid parenchyma displayed Hashimoto's thyroiditis. There was metastasis in a regional lymph node. Two years after initial surgery, she underwent a modified radical neck dissection due to recurrent neck mass. After the radiation therapy for eight weeks, laryngectomy and esophagectomy were performed due to a recurrent carcinoma in the esophageal wall. We report an additional case of SMECE, with metastasis to regional lymph nodes and esophagus. The tumor appears to be more aggressive than previously reported and a correct diagnosis can be rendered by just examining the metastatic lesions.
Carcinoma, Mucoepidermoid/surgery ; Carcinoma, Mucoepidermoid/secondary* ; Carcinoma, Mucoepidermoid/pathology* ; Carcinoma, Mucoepidermoid/complications ; Case Report ; Eosinophilia/pathology ; Eosinophilia/complications* ; Esophageal Neoplasms/surgery ; Esophageal Neoplasms/secondary* ; Female ; Human ; Laryngectomy ; Lymph Nodes ; Middle Age ; Recurrence ; Sclerosis ; Thyroid Gland/pathology* ; Thyroid Neoplasms/surgery ; Thyroid Neoplasms/pathology* ; Thyroid Neoplasms/complications ; Thyroiditis, Autoimmune/complications

OBJECTIVETo review the experience of different surgical construction methods for hypopharyngeal cancer with cervical esophageal invasion.

METHODSFrom 1989 to 2000,forty-eight patients with advanced hypopharyngeal cancer and cervical esophageal invasion were retrospectively reviewed, including 38 males and 10 females. The median age was 54. 3 years old, ranged from 26 to 71 years old. According to UICC 1997 criteria, all the tumors were T4 stage and originated from the pyriform sinus (33), posterior pharyngeal wall (14), postcricoid area (1), there were 28 patients in cN0, 15 in cN1, 5 in cN2 and no distant metastasis. Precise preoperative evaluation was performed with computed tomography scan, barium swallow perspective and biopsy. All the patients received modified neck dissection, including both unilateral (38 patients) and bilateral (10 patients). Pharyngoesophageal defect reconstruction methods were: laryngotracheal flap in 11 patients, pectoralis major musculocutaneous flap in 13, laryngotracheal flap combined with pectoralis major musculocutaneous flap in 6, pectoralis major musculocutaneous flap combined with the split graft in 10, stomach pulling-up in 3, colon interposition in 5 patients. Total laryngectomy was carried out in 8 patients. All patients received radiotherapy postoperatively (dose 55 - 75 Gy).

RESULTSThe cervical lymph node metastasis was found in 20 patients. Pathologic findings showed that well, moderately and lower differentiated squamous cell carcinomas were 18, 24, 6 cases, respectively. The overall 3 and 5 year survival rates were 52.1% (25/48) and 27.3% (12/44), respectively. The 3 and 5 year survival rates in functionally preserved group were 65.2% (15/23) and 33.3% (7/21), while in non functionally preserved group were 40.0% (10/25) and 21.7% (5/23), respectively. Fifteen patients laryngeal functions (voice, respiration and deglutition) were completely restored and 8 patients partially restored (voice and deglutition). The decannulation rate was 65% (15/23). The complication included pharyngeal fistulas in 10 cases and splitting of chest wall in 1 cases.

CONCLUSIONSCombined therapy was the best choice for hypopharyngeal cancer with cervical esophageal invasion. The laryngeal function is preserved as far as possible. The continuity of the pharyngoesophagus was restored by pectoralis major musculocutaneous flap, laryngotracheal flap, or combined with the split graft. Stomach transposition or colon interposition was used while the defect of the esophagus was greater.

Adult ; Aged ; Carcinoma, Squamous Cell ; mortality ; pathology ; surgery ; Esophageal Neoplasms ; mortality ; secondary ; surgery ; Esophagus ; pathology ; Female ; Humans ; Hypopharyngeal Neoplasms ; mortality ; pathology ; surgery ; Lymphatic Metastasis ; Male ; Middle Aged ; Retrospective Studies ; Survival Rate

OBJECTIVETo evaluate the clinical value of prophylactic radiotherapy for esophageal carcinoma after curative operation.

METHODS495 esophageal squamous cell cancer patients who had undergone radical resection were randomized by the envelope method into a surgery alone group (S, 275) and a surgery plus radiotherapy group (S + R, 220). Radiation treatment was started 3 - 4 weeks after operation. The portals encompassed the whole mediastinum and bilateral supraclavicular areas. A mid-plane dose of 50 approximately 60 Gy in 20 approximately 30 fractions over 5 approximately 6 weeks was delivered.

RESULTS1. Survival rate: the overall 5-year survival rate was 39.4%. Those of S alone and S + R groups were 37.1% and 41.3% (P = 0.447 4). The 5-year survival rate for Stage III patients were 13.1% in S alone group and 35.1% in R + S group (P = 0.002 7), 2. Pattern of failure: The incidence of local recurrence intra-thoracic lymph node metastasis, anastomotic recurrence and extra-thoracic lymph node metastasis in S + R group (16.2%, 0.5% and 3.1%) were lower than those (25.9%, 5.8% and 13.2%) (P < 0.05) in S alone group and 3.

COMPLICATIONSthe anastomotic stricture frequencies were similar in the two groups (S 1.8%; S + R 4.1%).

CONCLUSION1. Prophylactic radiotherapy is able to improve the survival rate of stage III patients treated by radical resection, 2. Postoperative radiotherapy is able to reduce the incidence of failure by recurrence in the intra-thoracic lymph nodes and anastomotic recurrence to where radiation therapy had been given, 3. Postoperative radiotherapy does not increase the incidence of anastomotic stricture.

Adult ; Aged ; Carcinoma, Squamous Cell ; mortality ; radiotherapy ; secondary ; surgery ; Combined Modality Therapy ; Esophageal Neoplasms ; mortality ; pathology ; radiotherapy ; surgery ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Postoperative Care ; Survival Rate

OBJECTIVETo improve the accuracy of preoperative evaluation of cervical lymph node metastasis in thoracic esophageal squamous carcinoma.

METHODSForty-two patients with thoracic esophageal squamous carcinoma underwent neck ultrasonography. Enlarged lymph nodes with their long axis greater than 10 mm and a short-to-long axis ratio greater than 0.5 were considered as metastatic.

RESULTSPreoperative neck ultrasonography revealed the enlarged lymph nodes in 16 patients, but only in 5 (31%) cases the nodes were palpable. Among them 9 were classified as metastatic (cM(1-LN)), including 4 patients with palpable nodes. In 5 cM(1-LN) patients surgical intervention was canceled and the remaining 37 patients underwent trans-thoracic esophagectomy. Cervical node metastasis (pM(1-LN)) was confirmed pathologically in 6 surgical patients, 4 with tumors invading the adventitia (pT3) and the other 2 into the surrounding structure (pT(4)) (pT(1), pT(2) vs. pT(3), pT(4), P = 0.020). All 6 pM(1-LN) patients had concomitant mediastinal node metastasis and 4 of them had upper abdominal node metastasis. Statistically significant relationship was detected between cervical and abdominal nodal status (r = 0.536, P = 0.007). In comparison with the results of pathological examination and treatment response, the accuracy and sensitivity were 81% and 95% (P = 0.043), 36% and 82% (P = 0.081), respectively, for palpation and ultrasonography. Five out of 39 (13%) patients had their therapy changed due to ultrasonographic findings.

CONCLUSIONSNeck ultrasonography for cervical lymphadenopathy is of high sensitivity and accuracy, which plays an important role in the preoperative evaluation and therapeutic decision-making.

Adult ; Aged ; Carcinoma, Squamous Cell ; diagnostic imaging ; secondary ; surgery ; Esophageal Neoplasms ; pathology ; surgery ; Female ; Head and Neck Neoplasms ; diagnostic imaging ; secondary ; surgery ; Humans ; Lymph Node Excision ; methods ; Lymph Nodes ; diagnostic imaging ; Lymphatic Metastasis ; diagnosis ; Male ; Middle Aged ; Neck ; diagnostic imaging ; Sensitivity and Specificity ; Ultrasonography

PURPOSE: Although guidelines indicate that routine dissection of the central lymph nodes in patients with thyroid carcinoma should include the right para-oesophageal lymph nodes (RPELNs), located between the right recurrent laryngeal nerve and the cervical oesophagus and posterior to the former, RPELN dissection is often omitted due to high risk of injuries to the recurrent laryngeal nerve and the right inferior parathyroid gland. MATERIALS AND METHODS: We retrospectively identified all patients diagnosed with papillary thyroid carcinoma who underwent total thyroidectomy with central lymph node dissection, including the RPELNs, between January 1, 2009 and December 31, 2013 at the Thyroid Cancer Center of Yonsei University College of Medicine, Seoul, Korea. RESULTS: Of 5556 patients, 148 were positive for RPELN metastasis; of the latter, 91 had primary tumours greater than 1 cm (p<0.001). Extrathyroidal extension by the primary tumour (81.8%; p<0.001), bilaterality, and multifocality were more common in patients with than without RPELN metastasis; however, there were no significant differences in age and sex between groups. A total of 95.9% of patients with RPELN metastasis had central node (except right para-oesophageal lymph node) metastasis, and the incidence of lateral neck node metastasis was significantly higher in patients with than without RPELN metastasis (63.5% vs. 14.3%, p<0.001). Forty-one patients underwent mediastinal dissection, with 11 patients confirmed as having mediastinal lymph node metastasis with RPELN metastasis on pathological examination. CONCLUSION: RPELN metastasis is significantly associated with lateral neck and mediastinal lymph node metastasis.
Adult ; Aged ; Carcinoma/pathology/*surgery ; Carcinoma, Papillary/pathology/*surgery ; Esophageal Neoplasms/*secondary/surgery ; Female ; Humans ; Incidence ; *Lymph Node Excision ; Lymph Nodes/pathology/*surgery ; Lymphatic Metastasis/pathology ; Male ; Middle Aged ; Recurrent Laryngeal Nerve/pathology ; Republic of Korea/epidemiology ; Retrospective Studies ; Thyroid Neoplasms/pathology/*surgery ; *Thyroidectomy ; Treatment Outcome ; Young Adult

OBJECTIVETo investigate the histopathological features of basaloid squamous cell carcinoma of the esophagus, and to explore the ways of its diagnosis, differential diagnosis and treatment.

METHODSThe clinical data and pathological features of 23 cases of esophageal basaloid squamous cell carcinoma were reviewed and analyzed retrospectively.

RESULTSThe tumors were mainly located at the middle third segment of the esophagus. The 1-,2- and 3-year survival rates were 60.9%, 21.7% and 0, respectively.

CONCLUSIONThe basaloid squamous cell carcinoma of the esophagus is highly malignant with poor prognosis. Radical resection combined with radiotherapy and chemotherapy is required.

Adult ; Aged ; Antineoplastic Agents ; therapeutic use ; Carcinoma, Basosquamous ; diagnosis ; therapy ; Carcinoma, Squamous Cell ; diagnosis ; Cisplatin ; administration & dosage ; Combined Modality Therapy ; Diagnosis, Differential ; Esophageal Neoplasms ; diagnosis ; therapy ; Esophagectomy ; methods ; Esophagus ; pathology ; surgery ; Female ; Fluorouracil ; administration & dosage ; Follow-Up Studies ; Humans ; Liver Neoplasms ; secondary ; Lung Neoplasms ; secondary ; Male ; Middle Aged ; Radiotherapy, High-Energy ; Retrospective Studies ; Survival Rate

OBJECTIVEThe extrapulmonary small cell carcinoma (EPSCC), a uncommon malignant tumor, has seldom been reported. The aim of this study was to analyze the clinical characteristics, treatment and prognosis of EPSCC.

METHODSThe clinical data of 243 patients admitted in our hospital from 1977 to 2007 were reviewed. The survival rate was calculated by the Kaplan-Meier method and log-rank test.

RESULTSThe median age of the patients was 58 years and the male-to-female ratio was 2.47:1. According to VALSG criteria, 209 patients had limited disease (LD) and 34 had extensive disease (ED). 170 patients received chemotherapy-based multimodal therapy, 73 received surgery, and/or radiotherapy. The 6, 12, 24, 36 and 60-month survival rates of these patients were 88.9%, 67.2%, 36.8%, 27.3% and 18.3%, respectively. The clinical stage, vessel involvement and regional lymph node metastases were independent prognostic factors of EPSCC. Patients with LD had a median overall survival of 18.6 months compared with 14.0 months in patients with ED (P = 0.030). The median survival was 19.2 months for the patients without vessel involvement and 14.4 months with vessel involvement (P = 0.026). The median survival of the patients with regional lymph node metastases was 13.9 months, while 39.5 months without regional lymph node metastases (P = 0.000). Among different primary sites, patients with gynecologic small cell cancer had a median survival of 28.0 months, head and neck 20.1 months and gastrointestinal tract 14.3 months. Brain metastasis was observed in a lower number of patients with EPSCC compared with that in patients with SCLC. There were no statistically significant differences in overall survival between patients with pure and mixed EPSCC (P = 0.396).

CONCLUSIONEPSCC is an uncommon malignant tumor with early metastasis and poor prognosis. The clinical characteristics of EPSCC and SCLC were similar in some aspects, however, there are some differences in etiology, clinic course, survival and frequency of brain metastases. These differences may influence the choice of therapeutic strategy. Multimodal therapy, combination of chemo- and radio-therapy after surgical resection may improve the outcome of EPSCC.

Adult ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoma, Small Cell ; pathology ; surgery ; therapy ; Cisplatin ; therapeutic use ; Combined Modality Therapy ; Disease-Free Survival ; Esophageal Neoplasms ; pathology ; surgery ; therapy ; Etoposide ; therapeutic use ; Female ; Follow-Up Studies ; Gastrointestinal Neoplasms ; pathology ; surgery ; therapy ; Head and Neck Neoplasms ; pathology ; surgery ; therapy ; Humans ; Lung Neoplasms ; secondary ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Radiotherapy, High-Energy ; Survival Rate ; Urogenital Neoplasms ; pathology ; surgery ; therapy ; Young Adult

OBJECTIVETo evaluate the efficacy and prognostic factors of transarterial interventional therapy (TAIT) in patient with liver metastasis from malignancy of the alimentary tract.

METHODS266 patients with unresectable liver metastases from malignancy of the alimentary tract received totally 754 sessions of transarterial interventional therapy. Cox regression was used in the proportional hazard analysis.

RESULTSThe overall response rate of TAIT was 45.4%, The median survival time (MS) was 14.3 months in this series. The 0.5-, 1-, 2-, 3-, 5-year cumulative survival rate (CSR) was 83.1%, 56.8%, 17.7%, 9.3% and 1.5% , respectively. No severe adverse reaction was observed except nausea, vomiting and mild fever as well as pain in the hepatic area. It was found that portal vein tumor thrombosis (PVTT), the blood supply of tumor, metastasis from esophageal carcinoma, the number of metastasis, multi-lobe involvement, resection nature of primary tumor were independent factors affecting survival.

CONCLUSIONTransarterial interventional therapy is effective for treatment of liver metastasis from malignancy of the alimentary tract. Portal vein tumor thrombosis, metastasis from esophageal carcinoma, multiple metastatic lesions, multi-lobe involvement are poor prognostic factors, while complete resection of the primary tumor and rich blood supply of metastatic lesion are good independent prognostic factors.

Adult ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Chemoembolization, Therapeutic ; Cisplatin ; administration & dosage ; Colorectal Neoplasms ; pathology ; surgery ; Doxorubicin ; administration & dosage ; Esophageal Neoplasms ; pathology ; surgery ; Female ; Fluorouracil ; administration & dosage ; Follow-Up Studies ; Gastrointestinal Stromal Tumors ; pathology ; surgery ; Humans ; Infusions, Intra-Arterial ; Iodized Oil ; Liver Neoplasms ; secondary ; therapy ; Male ; Middle Aged ; Neoplastic Cells, Circulating ; Portal Vein ; pathology ; Remission Induction ; Retrospective Studies ; Stomach Neoplasms ; pathology ; surgery ; Survival Rate