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What's in a node? The clinical and radiologic significance of Virchow's node. Abdom Radiol (NY) 2022; 47:2244-2253. [PMID: 35316379 DOI: 10.1007/s00261-022-03487-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 11/01/2022]
Abstract
In 1848, Rudolf Ludwig Karl Virchow described an association of left supraclavicular lymphadenopathy with abdominal malignancy. The left supraclavicular lymph node later became commonly referred to as Virchow's node. Charles-Emile Troisier went on to describe the physical exam finding of an enlarged left supraclavicular lymph node, later termed Troisier's sign. Subsequent studies confirmed a predilection of abdominal and pelvic malignancies to preferentially metastasize to the left supraclavicular node. Identification of a pathologically enlarged left supraclavicular node raises the suspicion for abdominopelvic malignancy, particularly in the absence of right supraclavicular lymphadenopathy, and provides a safe and easy target for biopsy. Supraclavicular lymph nodes also represent a great target for diagnosis of metastatic thoracic malignancies, although thoracic malignancies can involve either right or left supraclavicular nodes and do not show a predilection for either. This article presents a review of the history, anatomy, pathophysiology, clinical significance, radiological appearance, and biopsy of Virchow's node. Key points are illustrated with relevant cases.
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Wang Y, Ye D, Kang M, Zhu L, Yang M, Jiang J, Xia W, Kang N, Chen X, Wang J, Wang F. Mapping of Cervical and Upper Mediastinal Lymph Node Recurrence for Guiding Clinical Target Delineation of Postoperative Radiotherapy in Thoracic Esophageal Squamous Cell Carcinoma. Front Oncol 2021; 11:663679. [PMID: 33981612 PMCID: PMC8107680 DOI: 10.3389/fonc.2021.663679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/06/2021] [Indexed: 11/24/2022] Open
Abstract
Background The lower neck and upper mediastinum are the major regions for postoperative radiotherapy (PORT) in thoracic esophageal squamous cell carcinoma (TESCC). However, there is no uniform standard regarding the delineation of nodal clinical target volume (CTVnd). This study aimed to map the recurrent lymph nodes in the cervical and upper mediastinal regions and explore a reasonable CTVnd for PORT in TESCC. Methods We retrospectively reviewed patients in our hospital with first cervical and/or upper mediastinal lymph node recurrence (LNR) after upfront esophagectomy. All of these recurrent lymph nodes were plotted on template computed tomography (CT) images with reference to surrounding structures. The recurrence frequency at different stations was investigated and the anatomic distribution of recurrent lymph nodes was analyzed. Results A total of 119 patients with 215 recurrent lymph nodes were identified. There were 47 (39.5%) patients with cervical LNR and 102 (85.7%) patients with upper mediastinal LNR. The high-risk regions were station 101L/R, station 104L/R, station 106recL/R, station 105 and station 106pre for upper TESCC and station 104L/R, station 106recL/R, station 105, station 106pre and station 106tbL for middle and lower TESCCs. LNR in the external group of station 104L/R was not common, and LNR was not found in the narrow spaces where the trachea was in close contact with the innominate artery, aortic arch and mediastinal pleura. LNR below the level of the cephalic margin of the superior vena cava was also not common for upper TESCC. Conclusions The CTVnd of PORT in the cervical and upper mediastinal regions should cover station 101L/R, station 104L/R, station 106recL/R, station 105 and station 106pre for upper TESCC and station 104L/R, station 106recL/R, station 105, station 106pre and station 106tbL for middle and lower TESCCs. Based on our results, we proposed a useful atlas for guiding the delineation of CTVnd in TESCC.
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Affiliation(s)
- Yichun Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Dongmei Ye
- Department of Thoracic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Mei Kang
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Liyang Zhu
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Mingwei Yang
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jun Jiang
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wanli Xia
- Department of Thoracic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ningning Kang
- Department of Thoracic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiangcun Chen
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jie Wang
- Department of Medical Imaging, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Fan Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Chen A, Chen M, Trepanier M, Siblini A, Mueller C, Cools-Lartigue J, Spicer J, Ferri L. Endoscopic Submucosal Dissection for Upper Gastrointestinal Neoplasia-a North American Perspective. J Gastrointest Surg 2020; 24:2456-2465. [PMID: 32939623 DOI: 10.1007/s11605-020-04791-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 09/06/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Organ-sparing endoscopic submucosal dissection (ESD) is an acceptable treatment strategy for superficial neoplastic lesions of the esophagus and stomach. The adoption of this technique has lagged in North America compared with Asia, and we sought to report on our experiences with ESD for upper GI neoplasia. METHODS A prospectively entered database of all patients undergoing endoscopic resection of esophageal and gastric neoplasia at McGill University from 2009 to 2019 was queried for those who received ESD. RESULTS A total of 103 consecutive ESDs were identified from 2009 to 2019. Seventy-one (69%) patients were male and the median age was 72 (range: 38-90). Sixty-one (59%) cases were esophageal and 42 (41%) gastric. Forty-nine (48%) were performed in the endoscopy suite under local sedation only. Perforation occurred in 9 patients (7 esophageal and 2 stomach), of which 3 required operative repair. Histology was principally invasive carcinoma (79, 77%), with 17 (16%) dysplastic lesions (e.g., HGD), 1 (1%) neuroendocrine tumor, and 7 (7%) benign lesions. En bloc resection was achieved in 90 (87%), and the complete resection rate was 74 (72%), with 51 (50%) of procedures fulfilling the criteria for curative resection. At medium of 23-month (2-199) follow-up of these 51 curative resections, one case of recurrent carcinoma was found at follow-up and was managed with repeat endoscopic resection. Non-curative ESDs were found 45 (R1 resection = 29: risk of lymph node metastasis = 16), 21 had active surveillance, and 24 were resected. CONCLUSION ESD is a viable, effective, and safe therapeutic and staging modality for superficial lesions of the stomach and esophagus.
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Affiliation(s)
- Alex Chen
- Department of Surgery, Division of Thoracic Surgery, Montreal General Hospital, McGill University Health Centre, Room L8-505, 1650 Cedar Avenue, Montreal, Quebec, H3G 1A4, Canada
| | - Michael Chen
- Department of Surgery, Division of Thoracic Surgery, Montreal General Hospital, McGill University Health Centre, Room L8-505, 1650 Cedar Avenue, Montreal, Quebec, H3G 1A4, Canada
| | - Maude Trepanier
- Department of Surgery, Division of Thoracic Surgery, Montreal General Hospital, McGill University Health Centre, Room L8-505, 1650 Cedar Avenue, Montreal, Quebec, H3G 1A4, Canada
| | - Aya Siblini
- Department of Surgery, Division of Thoracic Surgery, Montreal General Hospital, McGill University Health Centre, Room L8-505, 1650 Cedar Avenue, Montreal, Quebec, H3G 1A4, Canada
| | - Carmen Mueller
- Department of Surgery, Division of Thoracic Surgery, Montreal General Hospital, McGill University Health Centre, Room L8-505, 1650 Cedar Avenue, Montreal, Quebec, H3G 1A4, Canada
| | - Jonathan Cools-Lartigue
- Department of Surgery, Division of Thoracic Surgery, Montreal General Hospital, McGill University Health Centre, Room L8-505, 1650 Cedar Avenue, Montreal, Quebec, H3G 1A4, Canada
| | - Jonathan Spicer
- Department of Surgery, Division of Thoracic Surgery, Montreal General Hospital, McGill University Health Centre, Room L8-505, 1650 Cedar Avenue, Montreal, Quebec, H3G 1A4, Canada
| | - Lorenzo Ferri
- Department of Surgery, Division of Thoracic Surgery, Montreal General Hospital, McGill University Health Centre, Room L8-505, 1650 Cedar Avenue, Montreal, Quebec, H3G 1A4, Canada.
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