OBJECTIVE: To review the latest research advancements in surgical techniques for the treatment of limb lymphedema. METHODS: The relevant literature at home and abroad in recent years was extensively reviewed, and the research on the treatment of limb lymphedema by surgical techniques were summarized and analyzed. RESULTS: Lymphovenous anastomosis has demonstrated good effectiveness for early to mid-stage limb lymphedema, however its long-term effectiveness and applicability for late-stage limb lymphedema still require further validation. Autologous lymphatic/venous grafting has shown clinical feasibility in the treatment of secondary limb lymphedema. Research on tissue-engineered lymphatic scaffolds remains insufficient, primarily due to the complexity of lymphatic anatomical structures and the technical challenges involved. Nevertheless, its potential application is promising. Vascularized lymph node flap transplantation has shown significant effectiveness in treating limb lymphedema, particularly yielding good outcomes in upper limb cases. However, it can not guarantee a complete cure for the condition. Charles' operation is the most effective treatment option for patients with late-stage limb lymphedema, but its extensive incision and severe postoperative complications limit its application. Liposuction has the advantages such as minimal invasiveness, high safety, and repeatability. It is suitable for patients with late-stage limb lymphedema who have failed conservative treatment or developed adiposity. However, its effectiveness is limited in patients with significant limb fibrosis. CONCLUSION Current treatments for limb lymphedema require further improvement, and there is considerable debate regarding treatment strategies for different stages of the condition. Future high-quality, multi-system combined treatment approaches are anticipated to guide clinical practice.
Humans ; Lymphedema/surgery* ; Surgical Flaps/blood supply* ; Lymphatic Vessels/surgery* ; Anastomosis, Surgical/methods* ; Lymph Nodes/transplantation* ; Lipectomy/methods* ; Extremities/surgery* ; Treatment Outcome ; Tissue Engineering ; Tissue Scaffolds ; Veins/transplantation*

OBJECTIVE: To compare the effectiveness of single-stage vascularized lymph node transfer (VLNT) combined with lymphaticovenular anastomosis (LVA) and liposuction (LS) (3L) versus LVA combined with LS (2L) for the treatment of moderate-to-late stage upper limb lymphedema following breast cancer surgery. METHODS: A retrospective analysis was conducted on the clinical data of 16 patients with moderate-to-late stage upper limb lymphedema after breast cancer surgery, treated between June 2022 and June 2024, who met the selection criteria. Patients were divided into 3L group (n=7) and 2L group (n=9) based on the surgical approach. There was no significant difference (P>0.05) in baseline data between the groups, including age, body mass index, duration of edema, volume of liposuction, International Society of Lymphology (ISL) stage, preoperative affected limb volume, preoperative circumferences of the affected limb at 12 levels (from 4 cm distal to the wrist to 42 cm proximal to the wrist), preoperative Lymphoedema Quality of Life (LYMQoL) score, and frequency of cellulitis episodes. The 2L group underwent LS on the upper arm and proximal forearm and LVA on the middle and distal forearm. The 3L group received additional VLNT in the axilla, with the groin serving as the donor site. Outcomes were assessed included the change in affected limb volume at 12 months postoperatively, and comparisons of limb circumferences, LYMQoL score, and frequency of cellulitis episodes between preoperative and 12-month postoperative. Ultrasound evaluation was performed at 12 months in the 3L group to assess lymph node viability. RESULTS: Both groups were followed up 12-20 months, with an average of 15.13 months. There was no significant difference in the follow-up time between the groups (t=-1.115, P=0.284). All surgical incisions healed by first intention. No adverse events, such as flap infection or necrosis, occurred in the 3L group. At 12 months after operation, ultrasound confirmed good viability of the transferred lymph nodes in the 3L group. Palpation revealed significant improvement in skin fibrosis and improved skin softness in both groups. Affected limb volume significantly decreased in both groups postoperatively (P<0.05). The reduction in limb volume significantly greater in the 3L group compared to the 2L group (P<0.05). Circumferences at all 12 measured levels significantly decreased in both groups compared to preoperative values (P<0.05). The reduction in circumference at all 12 levels was better in the 3L group than in the 2L group, with significant differences observed at 7 levels (8, 12, 16, 30, 34, 38, and 42 cm) proximal to the wrist (P<0.05). Both groups showed significant improvement in the frequency of cellulitis episodes and LYMQoL scores postoperatively (P<0.05). While the improvement in LYMQoL scores at 12 months did not differ significantly between groups (P>0.05), the reduction in cellulitis episodes was significantly greater in the 3L group compared to the 2L group (P<0.05). CONCLUSION The combination of VLNT+LVA+LS provides more durable and comprehensive outcomes for moderate-to-late stage upper limb lymphedema after breast cancer surgery compared to LVA+LS, offering an improved therapeutic solution for patients.
Humans ; Female ; Lipectomy/methods* ; Retrospective Studies ; Anastomosis, Surgical/methods* ; Lymphedema/etiology* ; Middle Aged ; Upper Extremity/surgery* ; Breast Neoplasms/surgery* ; Lymph Nodes/blood supply* ; Adult ; Lymphatic Vessels/surgery* ; Iliac Artery/surgery* ; Postoperative Complications/surgery* ; Perforator Flap/blood supply* ; Treatment Outcome ; Mastectomy/adverse effects* ; Quality of Life ; Aged

OBJECTIVE: To review the research progress of supraclavicular vascularized lymph node transfer (VLNT). METHODS: The research literature related to supraclavicular VLNT at home and abroad in recent years was extensively reviewed, and the anatomy of supraclavicular lymph nodes, clinical applications, and complications of supraclavicular VLNT were summarized. RESULTS: The supraclavicular lymph nodes are anatomically constant, located in the posterior cervical triangle zone, and the blood supply comes mainly from the transverse cervical artery. There are individual differences in the number of supraclavicular lymph nodes, and preoperative ultrasonography is helpful to clarify the number of lymph nodes. Clinical studies have shown that supraclavicular VLNT can relieve limb swelling, reduce the incidence of infection, and improve quality of life in patients with lymphedema. And the effectiveness of supraclavicular VLNT can be improved by combined with lymphovenous anastomosis, resection procedures, and liposuction. CONCLUSION There are a large number of supraclavicular lymph nodes, with abundant blood supply. It has been proven to be effective for any period of lymphedema, and the combined treatment is more effective. The more clinical studies are needed to clarify the effectiveness of supraclavicular VLNT alone or in combination, as well as the surgical approach and timing of the combined treatment.
Humans ; Quality of Life ; Lymphedema/surgery* ; Lymph Nodes/blood supply* ; Lymphatic Vessels/surgery* ; Extremities

INTRODUCTIONThe extent of lymph nodes (LNs) metastasis is a major determinant for the staging and the most reliable adverse prognostic factor. Primary tumours can induce lymphatics and vasculature reorganisations within sentinel LN before the arrival of cancer cells and these key blood vessels are identified as high endothelial venules (HEV). The alterations of HEV in the presence of cancer, coupled with the increased proliferation rate of the endothelial cells, results in a functional shift of HEV from immune response mediator to blood flow carrier. We aim to evaluate tumour-induced vascularisation in regional LN of cancer patients by studying the morphological and functional alterations of HEV and its correlation to clinico-pathological features.

MATERIALS AND METHODSThis multi-centre study with a prospective database identified 65 consecutive patients with tongue squamous cell carcinoma (SCC) who underwent primary surgical treatment from 2001 to 2005. Immunohistochemical staining for HEV and image analysis were performed and analysed with correlation to the patients' clinico-pathological features.

RESULTSThe total number of HEV is significantly associated to disease-free interval when controlling for the group (P = 0.022) as well as combining both groups as one cohort (P = 0.023). There is also a similar association comparing the HEV parameters to overall survival.

CONCLUSIONOur results suggest that HEV possibly plays a key role in the pathogenesis of lymphatic and subsequent distant metastases and may provide the missing link in cancer metastasis. Confirmation of this hypothesis would offer a novel therapeutic approach to preventing metastasis by blocking the remodeling processes of HEV in LN.

Awards and Prizes ; Biomarkers ; Databases, Factual ; Endothelial Cells ; physiology ; General Surgery ; Humans ; Lymph Nodes ; blood supply ; pathology ; Neoplasm Metastasis ; diagnosis ; Neovascularization, Pathologic ; pathology ; Prospective Studies ; Venules ; pathology

INTRODUCTIONLymphangiogenesis has been reported to be important in the prognosis of several tumours. The aim of this study was to assess the correlation between lymphangiogenesis and clinicopathological prognostic parameters in patients with clear cell renal cell carcinoma.

METHODS62 patients with renal cell carcinoma were included in the study. The D2-40 antibody, assessed immunohistochemically for each patient, was used as a marker. Light microscopy was used to determine the presence of intratumoral lymphatic vessels (ILVs) and the number of peritumoral lymph vessels (PLVs)/mm2 or PLV density (PLVD). Correlation between the numbers and the Fuhrman nuclear grade, tumour stage, distant metastasis status, presence of lymph node metastasis and lymphovascular invasion was assessed.

RESULTSA significant correlation was found between the presence of ILVs and distant metastasis (p = 0.033) and lymph node metastasis (p = 0.024). However, no significant correlation was found between the Fuhrman nuclear grade (p = 0.553), tumour stage (p = 0.464) and lymphovascular invasion (p = 0.242). Mean PLVD was 20.8, and no significant difference was found between the patients with PLVD below average and those with PLVD above average in terms of distant metastasis (p = 0.337), lymph node metastasis (p = 0.792), the Fuhrman nuclear grade (p = 0.566), tumour stage (p = 0.795) and lymphovascular invasion (p = 0.942).

CONCLUSIONWe found a significant correlation between ILVs and lymph node and distant metastases in patients with renal cell carcinoma.

Adult ; Aged ; Aged, 80 and over ; Antibodies, Monoclonal, Murine-Derived ; metabolism ; Biomarkers, Tumor ; metabolism ; Carcinoma, Renal Cell ; blood supply ; metabolism ; secondary ; Disease Progression ; Female ; Follow-Up Studies ; Humans ; Kidney Neoplasms ; blood supply ; metabolism ; pathology ; Lymph Nodes ; pathology ; Lymphangiogenesis ; Lymphatic Metastasis ; Lymphatic Vessels ; pathology ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Young Adult

A 29-yr-old man, presented with abdominal pain and fever, had an initial computed tomography (CT) scan revealing low attenuation of both adrenal glands. The initial concern was for tuberculous adrenalitis or autoimmune adrenalitis combined with adrenal hemorrhage. The patient started empirical anti-tuberculous medication, but there was no improvement. Enlargement of cervical lymph nodes were developed after that and excisional biopsy of cervical lymph nodes was performed. Pathological finding of excised lymph nodes was compatible to NK/T-cell lymphoma. The patient died due to the progression of the disease even after undergoing therapeutic trials including chemotherapy. Lymphoma mainly involving adrenal gland in the early stage of the disease is rare and the vast majority of cases that have been reported were of B-cell origin. From this case it is suggested that extra-nodal NK/T-cell lymphoma should be considered as a cause of bilateral adrenal masses although it is rare.
Adrenal Gland Neoplasms/*diagnosis/pathology ; Adrenal Glands/*blood supply ; Adult ; Diagnosis, Differential ; Hemorrhage/diagnosis ; Humans ; *Killer Cells, Natural ; Lymph Nodes/pathology ; Lymphoma, T-Cell/*diagnosis/pathology ; Male ; *T-Lymphocytes ; Tuberculosis, Endocrine/diagnosis

OBJECTIVETo study the histologic features and immunohistochemical findings of interfollicular stromal cells in hyaline-vascular Castleman's disease (HVCD), and to explore the role of these stromal cells in the pathogenesis of this disease.

METHODSThe clinical findings and microscopic features of 23 cases of HVCD cases were reviewed. Immunohistochemical study for CCL21, MSA, CD21, CD35, S-100 and CD34 was carried out.

RESULTSAccording to the criteria proposed by Danon et al., stroma-rich variant of HVCD contained prominent interfollicular zone which occupied at least 50% of the lymph node area. In the current study, there were 14 cases of stroma-rich HVCD and 9 cases of conventional HVCD. Eleven of the stroma-rich HVCD had paraneoplastic pemphigus and contrastly, no pemphigus lesion obtained in all the 9 cases of conventional HVCD. The association between stromal cell hyperplasia and paraneoplastic pemphigus was statistically significant (P < 0.01).In all the conventional HVCD cases studied, CCL21 and MSA were positive in the stromal cells.The stromal cells in 13 of the 14 cases of the stroma-rich HVCD were also positive for CCL21 and MSA, however, staining for CD21, CD35, S-100 and CD34 was negative in both groups. There was no statistical significance obtained (P > 0.05) between the differences of the staining results.

CONCLUSIONSStroma-rich HVCD and conventional HVCD represent two distinctive histologic variants and have a different association with paraneoplastic pemphigus. Most of the stromal cells locating in the interfollicular areas are fibroblastic reticular cells in origin, with the immunophenotype as CCL21(+)/MSA(+)/CD34⁻/CD21⁻/S-100⁻. The stromal cells proliferation correlate with the occurrence of paraneoplastic pemphigus, nevertheless, more cases are expected for a further study of the underlying pathogenesis.

Actins ; metabolism ; Adolescent ; Adult ; Blood Vessels ; pathology ; Castleman Disease ; complications ; metabolism ; pathology ; Chemokine CCL21 ; metabolism ; Female ; Follow-Up Studies ; Humans ; Hyalin ; cytology ; Lymph Nodes ; blood supply ; pathology ; Male ; Middle Aged ; Pemphigus ; complications ; metabolism ; pathology ; Stromal Cells ; pathology ; Young Adult

OBJECTIVE: To explore the value of flow imaging with contrast-enhanced ultrasound for residual neck lymph nodes in nasopharyngeal carcinoma after radiotherapy. METHODS: Blood flow imaging of 50 residual cervical lymph nodes in 36 patients with nasopharyngeal carcinoma after radiotherapy was observed and compared by color doppler ultrasound and contrast-enhanced ultrasonography. RESULTS: In the 50 remaining lymph nodes in the neck, 40 blood flow signals were increased, 10 did not significant change by contrast-enhanced ultrasonography. The blood flow in residual lymph nodes by contrast-enhanced ultrasonography was richer than that by color doppler ultrasound. There was a significant difference in the blood flow signals between contrast-enhanced ultrasonography and color doppler ultrasound (chi(2)=49.172, P<0.01). CONCLUSION Contrast-enhanced ultrasonography can help blood flow imaging of the residual lymph nodes in nasopharyngeal carcinoma after radiotherapy, which may provide the imaging basis for clinical diagnosis and treatment.
Adult ; Aged ; Contrast Media ; Female ; Humans ; Lymph Nodes ; blood supply ; Lymphatic Metastasis ; diagnostic imaging ; pathology ; radiotherapy ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; blood supply ; diagnostic imaging ; radiotherapy ; Neck ; Regional Blood Flow ; Ultrasonography, Doppler, Color

Adenocarcinoma, Papillary ; blood supply ; metabolism ; pathology ; Adult ; Aged ; Carcinoma, Pancreatic Ductal ; blood supply ; metabolism ; pathology ; Chemokine CXCL12 ; metabolism ; Female ; Gene Expression Regulation, Neoplastic ; Humans ; Lymph Nodes ; metabolism ; Lymphatic Metastasis ; Male ; Microvessels ; pathology ; Middle Aged ; Neoplasm Staging ; Neovascularization, Pathologic ; metabolism ; pathology ; Pancreas ; metabolism ; Pancreatic Neoplasms ; blood supply ; metabolism ; pathology ; Receptors, CXCR4 ; metabolism

OBJECTIVE: To investigate the correlation between intratumor microvessel density(IMVD) and lymph node micrometastases. METHOD: IMVD and lymph node micrometastases were stained with CD105 and CK19 antibody by immunohistochemical method of SABC respectively. RESULT: IMVD marked with CD105 antibody correlated with T stage and lymph node micrometastases (P < 0.01). CONCLUSION The result show that IMVD marked with CD105 antibody highly correlated with lymph node micrometastases. It could be a index to evaluate the prognosis of patients with pN0 supraglottic laryngeal squamous cell carcinoma.
Adult ; Aged ; Carcinoma, Squamous Cell ; blood supply ; pathology ; Female ; Humans ; Laryngeal Neoplasms ; blood supply ; pathology ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Microvessels ; Middle Aged ; Neoplasm Staging