Search Results (13)

Lymphedema is a chronic and debilitating disease that affects up to 250 million patients worldwide. Recent advances in understanding its pathophysiology, along with improved diagnosis and microsurgical techniques, have enhanced our ability to cope with the challenging task of treating this disease. This review provides an overview of the disease from a surgeon’s point of view, including existing imaging modalities used for preoperative assessment, as well as surgical procedures used in its treatment. The advantages and drawbacks of various existing modalities used for the pre- or intraoperative assessment of lymphatic vessels are discussed. Lymphedema treatment has shifted from palliative debulking procedures (liposuction and direct excision) to those aimed at restoring lymphatic flow and countering the pathophysiology of the disease (lymphaticovenous anastomosis and vascularized lymph node transfer). A combination of both approaches can result in a synergistic benefit for patients and is discussed in this review. Despite recent advances, some controversies persist, and further studies are needed to better define surgical treatment algorithms. Full article

The diagnosis and treatment of lymphoid neoplasms have undergone a continuously progressive positive change in the last three decades, with accelerated progress in the previous decade due to the advent of genomics in cancer diagnosis. Significantly, there has been an increasing emphasis on integrating molecular genetics with clinical, morphologic, immunophenotypic, and cytogenetic evaluation for diagnosis. As we think of moving forward with further advances in the genomics era, it is first helpful to understand our current state of knowledge and how we achieved it in the challenging and complex field of lymphoid neoplasms, which comprise very heterogeneous neoplastic diseases in children and adults, including clinically acute lymphoblastic leukemias (ALLs) arising from precursor lymphoid cells and clinically indolent and aggressive lymphomas arising from mature lymphoid cells. This work aims to provide an overview of the historical evolution and the current state of knowledge to anyone interested in the field of lymphoid neoplasms, including students, physicians, and researchers. Therefore, I discuss this complex topic in three review manuscripts, designated Parts 1–3. In Part 1, I explain the basis of the diagnostic classification of lymphoid neoplasms and its evolution up to the current fifth edition of the World Health Organization classification of hematolymphoid neoplasms, and the crucial importance of diagnostic tumor classifications in achieving and advancing patient care and precision medicine. In the second and third manuscripts, I discuss current diagnostic considerations for B-ALL and T-ALL (Part 2) and common indolent and aggressive mature leukemias/lymphomas (Part 3), including significant updates in the WHO 2022 classification, newly described entities, and concepts, including genetic predisposition to ALLs and lymphomas, and throughout emphasizing the essential integration of molecular genetics with clinical, morphologic (pathologic), immunophenotypic, and cytogenetic evaluation, as is required for precise diagnosis of the type of lymphoma/leukemia in any patient. Full article

The diagnosis and treatment of lymphoid neoplasms have undergone a continuously progressive positive change in the last three decades, with accelerated progress in the previous decade due to the advent of genomics in cancer diagnosis. Significantly, there has been an increasing emphasis on integrating molecular genetics with clinical, morphological, immunophenotypic, and cytogenetic evaluation for diagnosis. As we think of moving forward with further advances in the genomics era, it will be first helpful to understand our current state of knowledge and how we achieved it in the challenging and complex field of lymphoid neoplasms, which comprise very heterogeneous neoplastic diseases in children and adults, including clinically acute lymphoblastic leukemias (ALLs) arising from precursor lymphoid cells and clinically indolent and aggressive lymphomas arising from mature lymphoid cells. This work aims to provide an overview of the historical evolution and the current state of knowledge to anyone interested in the field of lymphoid neoplasms, including students, physicians, and researchers. Therefore, I have discussed this complex topic in three review manuscripts, designated Parts 1–3. In Part 1, I explain the basis of the diagnostic classification of lymphoid neoplasms and its evolution up to the current fifth edition of the World Health Organization classification of hematolymphoid neoplasms and the crucial importance of diagnostic tumor classifications in achieving and advancing patient care and precision medicine. In the second and third manuscripts, I discuss current diagnostic considerations for B-ALL and T-ALL (Part 2) and common indolent and aggressive mature leukemias/lymphomas (Part 3), including significant updates in the WHO 2022 classification, newly described entities, and concepts, including genetic predisposition to ALLs and lymphomas, and emphasizing throughout the essential integration of molecular genetics with clinical, morphologic, immunophenotypic, and cytogenetic evaluation, as required for the precise diagnosis of the type of lymphoma/leukemia in any patient. Full article

MYC deregulation, a cardinal event in Burkitt lymphoma (BL) pathogenesis, necessitates the elucidation of the molecular mechanisms governing MYC activation to devise innovative and effective therapeutic strategies. The t(8;14)(q24;q32) chromosomal translocation commonly observed in hematological malignancies results in MYC deregulation, endowing cancer cells with a competitive edge through heightened cell proliferation, cell cycle progression, apoptosis evasion, and metabolic reprogramming. Recent discoveries of recurrent MYC mutations in BL underscore the potential of precision medicine, employing tailored therapeutics to specifically inhibit MYC activity. However, the intricate genetic landscape of BL, featuring additional alterations, such as mutations in TP53, TCF3, and ID3, may necessitate a combinatorial approach targeting multiple oncogenic pathways for effective intervention. Despite significant strides in hematological malignancy treatment, a comprehensive understanding of the molecular mechanisms underpinning MYC’s oncogenic properties remains crucial for the potential development of highly potent and selective MYC-directed cancer therapies. This review offers an in-depth analysis of MYC translocation and its implications in Burkitt lymphoma, with a spotlight on cutting-edge advances in research and emerging therapeutic paradigms. Full article

Proposed fundamental laws of biology and a model of health and disease underscore the importance of the lymphatic system. The lymphatics are responsible for two of the laws of biology and the fulcrum of health and disease balancing regeneration with degeneration through the immune system. It is responsible for protection from the environment and repair of senile and damaged tissue. Life is constantly bombarded by forces that increase entropy. Lymphatics provide negative entropy to maintain health. Lymphatics help maintain cellular homeostasis removing products of metabolism. Using these principles, the role of lymphatics is investigated in salt sensitivity hypertension, cardio-renal system, the new pillar of heart failure and kidney disease—Sodium-Glucose Transport Protein 2 (SGLT2) Inhibitors, and brain diseases. The realization of organ lymphatics in maintenance of health and disease opens the avenue to new therapeutics. This is the unrealized potential of lymphatic study. Full article

Lymph node (LN) metastasis is recognized to be an important prognostic factor for esophageal cancer (EC). However, there is no worldwide uniform classification system, and no consensus exists on the extent of the lymphadenectomy. Recently, an international observational cohort study was conducted to evaluate the distribution of LN metastasis in EC patients. Moreover, this could be a milestone to establish a standard classification system and provide new insights to determine the extent of LNs that should be target for treatment. With regard to surgical procedures, three-field lymphadenectomy seems to be promising to improve the prognosis with EC patients. However, extended lymphadenectomy could lead to postoperative complications. The development of minimally invasive esophagectomy (MIE) has allowed us to retrieve cervical paraesophageal nodes without cervical incision and reduce the incidence of postoperative complications. Therefore, it may be possible that the era of MIE could propose the modern extent of LN dissection in the future. Additionally, one of the key components in lymphadenectomy for EC was thoracic duct and surrounding tissues. Although there is some evidence of LN metastasis surrounding the TD, the survival benefit of TD resection is still debatable. With regard to esophagogastiric junction cancer, the extent of LN dissection could be determined by the length of esophageal involvement. We believe further understanding of LN metastasis of EC patients will contribute to establish a global standard of treatment and improve their prognosis. Full article

The diagnosis and treatment of lymphoid neoplasms have undergone a progressively positive change in the last three decades, with accelerated progress in the previous decade due to the advent of genomics in cancer diagnosis. Significantly, there has been an increasing emphasis on integrating molecular genetics with clinical, morphologic, immunophenotypic, and cytogenetic evaluation for diagnosis. As we consider moving forward with further advances in the genomics era, it is first helpful to understand our current state of knowledge and how we achieved it in the challenging and complex field of lymphoid neoplasms, which comprise very heterogeneous neoplastic diseases in children and adults, including clinically acute lymphoblastic leukemias (ALLs) arising from precursor lymphoid cells and clinically indolent and aggressive lymphomas arising from mature lymphoid cells. This work aims to provide an overview of the historical evolution and the current state of knowledge to anyone interested in the field of lymphoid neoplasms, including students, physicians, and researchers. Therefore, I have discussed this complex topic in three review manuscripts, designated Parts 1–3. In Part 1, I explain the basis of the diagnostic classification of lymphoid neoplasms and its evolution up to the current fifth edition of the World Health Organization (WHO) classification of hematolymphoid neoplasms and the crucial importance of diagnostic tumor classifications in achieving and advancing patient care and precision medicine. In the second and third manuscripts, I discuss current diagnostic considerations for B-ALL and T-ALL (Part 2) and common indolent and aggressive mature leukemias/lymphomas (Part 3), including significant updates in the WHO 2022 classification, newly described entities and concepts, including genetic predisposition to ALLs and lymphomas, and throughout emphasizing the essential integration of molecular genetics with clinical, morphologic (pathologic), immunophenotypic, and cytogenetic evaluation, as is required for precise diagnosis of the type of lymphoma/leukemia in any patient. Full article

Bleomycin-induced pulmonary toxicity (BPT) is a serious and potentially fatal complication of bleomycin, a key component of Hodgkin lymphoma (HL) treatment. Before ours, only one published study evaluated the predictability of 18F-FDG-PET/CT for the early diagnosis of BPT. In this retrospective cohort study, 18F-FDG-PET/CT scans of adult HL patients treated with bleomycin at an urban academic center over five years were assessed by radiologists blinded to the clinical information, and scans were correlated with clinical BPT. We found 11 HL patients with 54 interim or end-of-treatment 18F-FDG-PET/CT scans who had received bleomycin. Five of the eleven (5/11, 45%) patients had radiographic changes in PET/CT and developed clinical BPT. Patients with clinical BPT had higher FDG uptake in lungs compared to those who did not (SUV_max mean 2.66 (CI 1.8–3.7) vs. 0.86 (CI 0.4–1.9), Mann–Whitney U test, p < 0.05). In a separate cohort analysis, we compared HL patients with clinical BPT (9/25, 36%) and without clinical BPT (16/25, 64%) to assess potential risk factors. Low hemoglobin (p = 0.037) and high ESR values (p = 0.0289) were associated with clinical BPT. Furthermore, gender, stage, histology, prior lung radiation, G-CSF, or steroids did not significantly confer a higher risk of BPT. 18F-FDG-PET/CT imaging, which is routinely used to assess treatment response in HL, is useful for early detection of BPT, which can have high mortality and morbidity. Full article

Cure rates now exceed 90% in many contemporary trials for children with B-cell acute lymphoblastic leukemia (B-ALL). However, treatment remains suboptimal, and therapy is toxic for all patients. New treatment options potentially offer the chance to reduce both treatment resistance and toxicity. Here, we review recent advances in ALL diagnostics, chemotherapy, and immunotherapy. In addition to describing recently published results, we also attempt to project the impact of these new developments into the future to imagine what B-ALL therapy may look like in the next few years. Full article

Early detection and treatment can slow the progression of lymphedema. To diagnose lymphedema in the subclinical phase, a sensitive imaging modality is required. Radioisotope-based lymphoscintigraphy (LSG) has been the “gold standard” for a century. Indocyanine green lymphography (ICGL) is being used at our institute for diagnosing and grading all lymphedema patients. In this study, ICGL disease detection rate was compared to that of LSG. Chart review of all patients who presented for lymphedema consult between February 2020 and April 2022 was conducted. Patients who underwent both LSG and ICG for extremity edema in symptomatic/asymptomatic limbs were included. A total of 50 limbs in 23 patients met the inclusion criteria. Of those, 37 were symptomatic and 13 were asymptomatic. LSG detected lymphatic dysfunction in 26/37(70%) of the symptomatic limbs while ICG detected the same in 37/37(100%) limbs (p < 0.01). In the asymptomatic group, LSG detected the disease in 1/13(8%) limbs while ICG detected lymphatic dysfunction in 8/13 (62%) limbs (p < 0.01). LSG missed symptomatic limbs 30% of the time, whereas ICG did not miss any symptomatic limbs (p < 0.01). LSG missed asymptomatic disease 54% of the time (p < 0.01) compared to ICG. In conclusion, ICG lymphography was determined to have a higher lymphatic dysfunction detection rate compared to LSG. Full article

Background: The detection of positive lymph nodes after a lymph node dissection changes the clinical prognosis; therefore, we evaluated what factors help us predict the presence of positive lymph nodes. Methods: A retrospective analysis of all radical prostatectomies and extended lymph node dissection performed from January 2010 to October 2018 in our centre was conducted. The variables included in the Briganti nomogram (preoperative PSA, Gleason biopsy, percentage of cores, and clinical stage) were considered, as well as perineural invasion and involvement of the seminal vesicles in the prostate biopsy; Results: A total of 110 lymph node dissections are obtained. Patient mean age is 64.18 years (46.55–75.91). Of the 110 lymphadenectomies performed, 16 patients (14.5%) presented positive nodes. Presenting infiltrated seminal vesicles, perineural invasion, higher PSA, higher clinical stage, higher Gleason biopsy and percentage of cores is more likely to have statistically significant lymph node involvement (p < 0.05). In the multivariate analysis, the percentage of positive core, together with the involvement of the seminal vesicles and Gleason ≥ 4 in the majority are predictor factors for positive nodes (p < 0.01); Conclusions: The percentage of positive cores, the involvement of the seminal vesicles, and the majority Gleason ≥ 4 are independent predictors of lymph node involvement in prostate cancer. Full article

Lymph node status is an important prognostic factor in multiple oncologic conditions in humans and companion animals. In addition, the resection of the affected nodes can have a substantial therapeutic effect on various cancer subtypes in both species. Given the impact on prognosis and management, it is paramount to identify and remove affected nodes. While this can be achieved by removing predefined patterns of nodes (regional lymphadenectomy/resection of defined lymphatic stations), modern approaches increasingly utilize sentinel node mapping to identify the draining nodes to decrease the mortality of lymphadenectomies. Recent studies have shown that dogs have more comparable anatomy of the lymphatic system to humans than other animal models such as rodents or pigs. Given the fact that dogs develop spontaneous cancer types that share several similarities to their human counterparts, they represent a valuable translational model. The management of the lymphatic basin and sentinel node mapping have gained increased attention in veterinary surgical oncology in recent years. The present review aims at summarizing the resulting findings and their impact on patient management. Full article