Transport function of lymph nodes in body antiorthostatic posture

The spontaneous contractile activity of isolated lymph nodes and the lymph flow from intestine lymphatic vessel in antiorthostatic posture of rats with an inclination angle of 30 degrees during 7-14 days, was decreased. Contractions of the rat lymph nodes in response to actions of adrenaline, acetylcholine and histamine were diminished. There are changes of biochemical components of lymph and blood plasma with simultaneous decrease of the blood plasma volume. It is concluded that the lymphatic system on antiorthostatic posture plays the compensatory role with the purpose of stabilization of homeostasis in the brain.     

Anatomy of the lymph vessels and nodes of the head and neck in green marmosets]

In 50 mature green monkeys, the lymphatic system of the skin on the hairy part of the skull (occipital, parietal, frontal) and on the face was studied. The lymphatic vessels of cranial and cervical organs flow into submental, submandibular (anterior, medial, posterior) lymph nodes and into profound cervical (cranial, medial, caudal) lymph nodes. Lymph nodes together with efferent lymphatic vessels form lymph collectors of the neck which follow the blood vessels branching: superficial jugular, profound jugular and paratracheal network.     

Anatomo-topographic features of the deep lymph nodes of the neck in adult humans]

Profounod cervical lymph nodes were studied on 35 corpses and 30 complexes of organs of the head and neck in adult man by method of dissection after a preliminary injecting the lymphatic vessels and nodes. Under study were the lymph nodes of the anterior part (prelaryngeal, prethyroid, pretracheal and paratracheal groups) which are disposed under the pretracheal lamina of the cervical fascia. The lymph nodes of the lateral area of the neck are concentrated along the internal jugular vein, accessory nerve and the transversal artery of the neck. The lymph nodes disposed along the internal jugular vein are divided into 3 groups: superior, medial and inferior. The lymph nodes disposed in the lateral area of the neck are of different types. The obtained data can be used for decoding data of lymphography.     

Anatomical variants of the lymphatic vessels connecting the inguinal lymph nodes]

The study of anatomical variants of lymphatic vessels connecting inguinal lymph nodes was carried out on 56 corpses of adult persons of both sex whose deaths were not connected with lesions in the lymphatic system of the pelvis and lower extremities. The inguinal lymph nodes and their afferent and efferent lymphatic vessels were detected by the method of intradermal injection and by the method of direct injection into the lymphatic vessels. It was stated that groups of the inguinal lymph nodes, as well as the nodes in every group determined, can serve as nodes of different stages for afferent lymphatic vessels running from different parts of the body and organs.     

Anatomy and topography of the common iliac lymph nodes in human beings in the 1st period of maturity

The investigation of common iliac lymph nodes has been performed in 20 corpses of the first mature age of both sex (5 male and 5 female corpses) of persons died from causes not connected with the lymphatic system diseases, the lower extremities and the pelvic organs. The common iliac lymph nodes with their afferent and efferent lymphatic vessels are revealed by means of interstitial injection into the lower extremities and the pelvic organs and with direct injection into the lymphatic vessels. The form, amount, size and topography of the common iliac lymphatic vessels have been studied. The lymphatic vessels, that go from certain body parts and organs to various subgroups of the common iliac lymph nodes, as well as the lymphatic vessels that connect the nodes both within the subgroup and also between the subgroups. The amount and size of the lymphatic nodes of the lateral subgroup predominate over the nodes of other subgroups of the common iliac lymph nodes; the amount of the common iliac lymph nodes predominates in men, and their size--in women. Amount of these nodes in the right and their size in the left predominate in both sex. Among the common iliac lymph nodes there are no teniform nodes, and efferent lymphatic vessels of the lateral and medial subgroup of the common iliac lymph nodes in 15% of cases run towards the lumbar nodes in the opposite side.     

Problems of ecological lymphology

Ecological influences, exercised on one the most important homeostatic systems - the lymphatic system - have been investigated extremely insufficiently. Nevertheless, in mechanisms of adaptogenesis interaction of the environmental effects with the lymphoid organs plays a rather essential role. Structural-functional response of the lymph nodes to the environmental effects possesses some features of stereotype, however, the stereotypic response is subjected to modulations in connection with the factor acting and functional specialization of the lymph node. Keeping this in mind, the lymph nodes (their morpho-functional status) can be considered as markers of the environmental pressing to the lymphatic system. When estimating the degree and stage of the phasic morpho-functional changes in the lymph nodes during their adaptation to the environmental influences, it is necessary to take into account the possibility of the environmental (in our case - cooling, chemicals) imprinting, in order to judge on the degree of individual stability of the organism to these effects. The morpho-functional rearrangements in the lymph nodes, under the environmental influences on the animal organism, reflect the dynamics of complex interorganic correlations both within the lymphatic system and at intersystemic level.     

Prevalence of additional positive lymph nodes in complete lymphadenectomy specimens after positive sentinel lymphadenectomy findings for early-stage melanoma of the head and neck

In this study, the prevalence of additional positive lymph nodes in subsequent complete lymphadenectomy specimens for patients with early-stage melanoma of the head and neck, after positive sentinel lymphadenectomy results, was retrospectively analyzed. In the past 5 years at the authors' institution, 23 consecutive patients with clinical stage I or stage II melanoma of the head and neck underwent complete lymphadenectomies after positive sentinel lymph node biopsies and wide local excisions of the primary lesions. Sentinel lymph nodes were identified with intraoperative lymphatic mapping techniques (radiolymphoscintigraphy and vital blue dye injection) and were examined with routine histological methods and immunohistochemical staining for S-100. All lymph nodes harvested in complete lymphadenectomies were examined with routine histological techniques. Twenty-one patients (91.3 percent) demonstrated no additional positive lymph nodes in subsequent complete lymphadenectomy specimens; two patients (8.7 percent) each demonstrated one additional positive lymph node in the complete lymphadenectomy specimens. Both patients had ulcerated primary lesions more than 5 mm in depth. No patient developed a regional nodal recurrence during a mean follow-up period of 23.7 months (range, 2 to 56 months). The low prevalence of additional positive lymph nodes in complete lymphadenectomy specimens suggests that when microscopic metastases exist in the regional nodal basin, most of the time they are confined to the sentinel lymph nodes of patients with early-stage melanoma of the head and neck. Nevertheless, the question of whether subsequent complete lymphadenectomy is still necessary for this subgroup of patients warrants further study.     

Sentinel lymph node biopsy in the management of cutaneous head and neck melanoma

Sentinel lymph node biopsy has revolutionized the surgical management of primary malignant melanoma. Most series on sentinel lymph node mapping have concentrated on extremity and truncal melanomas. The head and neck region has a rich and unpredictable lymphatic system. The use of sentinel lymph node mapping in the management of head and neck melanoma is evaluated. The authors conducted a retrospective review of patients treated for clinical stage I and stage II malignant melanoma of the head and neck with dynamic lymphoscintigraphy and gamma probe-guided sentinel lymph node biopsy. One hundred thirty-two patients (99 male patients and 33 female patients) were identified. The primary melanoma sites were the scalp (n = 54), ear (n = 14), face (n = 37), and neck (n = 27). Primary tumor staging was as follows: T1, 11; T2, 38; T3, 39; and T4, 44. Dynamic lymphoscintigraphy visualized sentinel lymph nodes in 128 patients (97 percent). In 71 cases (55 percent), a single draining nodal basin was identified, and in 57 cases there were multiple draining nodal basins (two basins, 55; three basins, two). Sentinel lymph nodes were successfully identified in 176 of 186 nodal basins (95 percent). Positive sentinel lymph nodes were identified in 22 patients (17.6 percent). Sentinel lymph node positivity by tumor staging was as follows: T2, 10.8 percent; T3, 19.4 percent; and T4, 26.8 percent. Completion lymphadenectomy revealed residual disease in seven patients (33.3 percent). Sentinel lymph node mapping for head and neck melanoma can be performed with results comparable to those of other anatomical sites.     

Senile changes in human lymph nodes

BACKGROUND: The degenerative process of lymph nodes is poorly documented. METHODS: 161 lymph nodes of seven fresh and one embalmed human cadavers in the head and neck were studied. We used 6% hydrogen peroxide, lead oxide injectant, and radiographs to demonstrate lymphatic vessels, and found both solidified and transparent lymph nodes. They were removed, fixed in 10% formalin and sent for histopathology cross section. RESULTS: Thirty-eight solidified and 123 transparent lymph nodes were found. A series of histopathological sections show the degenerative process is variable and continuous. Senile involution affects all elements of the lymph node including the cortex, the medulla, and the architecture. CONCLUSION: This study provides actual anatomical and histopathological images of lymph nodes in different degenerative stages in the head and neck region. It may help explain some clinical conditions in the elderly, especially their diminished immunological response to infection and cancer metastasis.     

Topography of lymphatic collectors and regional lymph nodes of the canine heart and their morphological characteristics

In 40 dogs lymphatic vessels and regional lymph nodes of the heart have been prepared. Morphology of the regional lymph nodes have been studied by means of various histological techniques. Lymph outflow from the canine ventricles is realized by three (less often), or by two (more often) collectors. In very rare cases one collector is formed. From the right atrium lymph flows out in two collectors (cranial and left). Lymphatic vessels of the left atrium get into the left collector of the ventricles, or into the tracheobronchial lymph nodes. Into the same nodes gets the lymphatic vessel, forming at the border of the left and right atrii. Cranial, medial, caudal mediastinal nodes (lymphatic mediastinal system) and right, middle and left tracheobronchial lymph nodes (tracheobronchial system) are regional lymph nodes of the canine heart. In the lymph nodes of the tracheobronchial system of puppies older than one month presence of exogenic pigment and signs of fibrous degeneration of parenchyma are noted.     

Anatomy and topography of external iliac lymph nodes in adults]

The investigation of the external iliac lymph nodes has been performed in 152 preparations of corpses of mature persons of both sex, who died from causes not connected with any disease of the lymphatic system, lower extremities and pelvic organs. The external iliac lymph nodes and their afferent and efferent lymphatic vessels have been revealed by means of interstitial injection of the lower extremities and pelvic organs, as well as by means of direct injection of Gerota mass into the lymphatic vessels. Form, amount, dimensions and topography of common iliac lymph nodes have been studied. Lymphatic vessels, running from certain parts and organs of the body to various subgroups of the external iliac lymph nodes have been described, as well as efferent lymph vessels of these nodes. The external iliac lymph nodes are constant formations; the largest of them--lymph nodes of the lacuna--are nodes of the I step for the lower extremity lymph vessels. In 54% of cases in persons of both sex positive (right-sided) asymmetry has been revealed. Total amount of the iliac lymph nodes prevails in men, while their size is greater in women. The size of these nodes in persons of both sex is greater to the left than to the right. There are connections (in 3% of cases) between the external iliac lymph nodes and aortal and lumbar nodes of the opposite side.     

Individual and sexual characteristics of the common iliac lymph nodes in elderly persons

The common iliac lymph nodes (CILN) have been investigated on 24 preparations from corpses of elderly persons (5 male and 7 female corpses), died from the causes not connected with the lymphatic system diseases, lower extremities and pelvic organs. The CILN with their afferent and deferent lymphatic vessels are revealed by means of interstitial injection into the lower extremities and pelvic organs, as well as by means of direct injection into lymphatic vessels. The form, amount, size and topography of CILN are studied. Lymphatic vessels, running from certain parts of the body and organs to various subgroups of CILN are described, as well as lymphatic vessels, connecting the nodes both within each subgroup and between the subgroups. There is a tendency in prevalence of amount and size of the lateral subgroup of the lymph nodes over the nodes of other subgroups of CILN; tendency in prevalence of amount of the lymph nodes in men, and their size--in women; prevalence of amount of right CILN and their size in the left--in persons of both sex; in 70% of the cases the amount of afferent lymphatic vessels to CILN prevails over that of the deferent lymph nodes.     

Dendritic-cell trafficking to lymph nodes through lymphatic vessels

Antigen-presenting dendritic cells often acquire foreign antigens in peripheral tissues such as the skin. Optimal encounter with naive T cells for the presentation of these antigens requires that the dendritic cells migrate to draining lymph nodes through lymphatic vessels. In this article, we review important aspects of what is known about dendritic-cell trafficking into and through lymphatic vessels to lymph nodes. We present these findings in the context of information about lymphatic-vessel biology. Gaining a better understanding of the crosstalk between dendritic cells and lymphatic vessels during the migration of dendritic cells to lymph nodes is essential for future advances in manipulating dendritic-cell migration as a means to fine-tune immune responses in clinical settings.     

Dynamic imaging of lymphatic vessels and lymph nodes using a bimodal nanoparticulate contrast agent

BACKGROUND: Evaluation of lymphedema and lymph node metastasis in humans has relied primarily on invasive or radioactive modalities. While noninvasive technologies such as magnetic resonance imaging (MRI) offer the potential for true three-dimensional imaging of lymphatic structures, invasive modalities, such as optical fluorescence microscopy, provide higher resolution and clearer delineation of both lymph nodes and lymphatic vessels. Thus, contrast agents that image lymphatic vessels and lymph nodes by both fluorescence and MRI may further enhance our understanding of the structure and function of the lymphatic system. Recent applications of bimodal (fluorescence and MR) contrast agents in mice have not achieved clear visualization of lymphatic vessels and nodes. Here the authors describe the development of a nanoparticulate contrast agent that is taken up by lymphatic vessels to draining lymph nodes and detected by both modalities. METHODS: A unique nanoparticulate contrast agent composed of a polyamidoamine dendrimer core conjugated to paramagnetic contrast agents and fluorescent probes was synthesized. Anesthetized mice were injected with the nanoparticulates in the hind footpads and imaged by MR and fluorescence microscopy. High resolution MR and fluorescence images were obtained and compared to traditional techniques for lymphatic visualization using Evans blue dye. RESULTS: Lymph nodes and lymphatic vessels were clearly observed by both MRI and fluorescence microscopy using the bimodal nanoparticulate contrast agent. Characteristic tail-lymphatics were also visualized by both modalities. Contrast imaging yielded a higher resolution than the traditional method employing Evans blue dye. MR data correlated with fluorescence and Evans blue dye imaging. CONCLUSION: A bimodal nanoparticulate contrast agent facilitates the visualization of lymphatic vessels and lymph nodes by both fluorescence microscopy and MRI with strong correlation between the two modalities. This agent may translate to applications such as the assessment of malignancy and lymphedema in humans and the evaluation of lymphatic vessel function and morphology in animal models.     

The utility of sentinel lymph node biopsy in head and neck melanoma in the pediatric population

Intraoperative lymph node mapping and sentinel lymph node biopsy have proven beneficial techniques in staging adult patients with melanoma of the head and neck, where there is great variability in lymphatic drainage. This technique has also been applied to pediatric patients with truncal cutaneous melanomas in an effort to determine nodal status without the morbidity associated with complete lymph node dissection. Nevertheless, the utility of sentinel lymph node biopsy in head and neck melanoma in the pediatric population has not been established. The objective of the authors' study was to determine the clinical utility of intraoperative lymph node mapping and sentinel lymph node biopsy of head and neck melanoma in the pediatric population. The authors reviewed the records of seven pediatric patients with head and neck melanoma or borderline melanocytic proliferations of unknown biologic potential who underwent intraoperative lymph node mapping and sentinel lymph node biopsy between 1998 and 2001. All sentinel lymph node specimens were examined by a melanoma dermatopathologist for the presence of metastatic melanoma. The mean operative time for each case was 3 hours, 8 minutes (range, 2 hours, 15 minutes to 3 hours, 50 minutes). All seven pediatric patients who underwent extirpation of a primary head and neck melanoma and preoperative lymphoscintigraphy had unique and identifiable basins of drainage to regional nodal groups. Four of seven patients had at least one positive sentinel lymph node. Overall, five of 19 sentinel nodes (26 percent) resected had evidence of metastatic melanoma. Of the patients with positive sentinel lymph nodes, two of the primary lesions were diagnosed as melanoma while two were initially considered atypical melanocytic proliferations of uncertain biologic potential with melanoma in the differential diagnosis. Sentinel lymph nodes in pediatric patients with melanoma of the head and neck can be successfully mapped and biopsied, as in adult patients. In addition, this procedure can provide critical diagnostic information for those pediatric patients with diagnostically challenging, controversial, or borderline melanocytic lesions.     

Obesity Impairs Lymphatic Fluid Transport and Dendritic Cell Migration to Lymph Nodes

Introduction

Obesity is a major cause of morbidity and mortality resulting in pathologic changes in virtually every organ system. Although the cardiovascular system has been a focus of intense study, the effects of obesity on the lymphatic system remain essentially unknown. The purpose of this study was to identify the pathologic consequences of diet induced obesity (DIO) on the lymphatic system.

Methods

Adult male wild-type or RAG C57B6-6J mice were fed a high fat (60%) or normal chow diet for 8–10 weeks followed by analysis of lymphatic transport capacity. In addition, we assessed migration of dendritic cells (DCs) to local lymph nodes, lymph node architecture, and lymph node cellular make up.

Results

High fat diet resulted in obesity in both wild-type and RAG mice and significantly impaired lymphatic fluid transport and lymph node uptake; interestingly, obese wild-type but not obese RAG mice had significantly impaired migration of DCs to the peripheral lymph nodes. Obesity also resulted in significant changes in the macro and microscopic anatomy of lymph nodes as reflected by a marked decrease in size of inguinal lymph nodes (3.4-fold), decreased number of lymph node lymphatics (1.6-fold), loss of follicular pattern of B cells, and dysregulation of CCL21 expression gradients. Finally, obesity resulted in a significant decrease in the number of lymph node T cells and increased number of B cells and macrophages.

Conclusions

Obesity has significant negative effects on lymphatic transport, DC cell migration, and lymph node architecture. Loss of T and B cell inflammatory reactions does not protect from impaired lymphatic fluid transport but preserves DC migration capacity. Future studies are needed to determine how the interplay between diet, obesity, and the lymphatic system modulate systemic complications of obesity.     

Sentinel lymph node imaging using quantum dots in mouse tumor models

We demonstrate that quantum dots injected into two model tumors rapidly migrate to sentinel lymph nodes. PEG-coated quantum dots having terminal carboxyl, amino, or methoxyl groups all migrated from the tumor to surrounding lymph nodes similarly. Passage from the tumor through lymphatics to adjacent nodes could be visualized dynamically through the skin; at least two nodes could usually be defined. Imaging during necropsy confirmed confinement of the quantum dots to the lymphatic system and demonstrated easy tagging of sentinel lymph nodes for pathology. Examination of the sentinel nodes identified by quantum dot localization showed that at least some contained metastatic tumor foci.     

Lymphatic Territories (Lymphosomes) in a Canine: An Animal Model for Investigation of Postoperative Lymphatic Alterations

Background

Lymph node dissection is often performed as a part of surgical treatment for breast cancer and malignant melanoma to prevent malignant cells from traveling via the lymphatic system. Currently little is known about postoperative lymphatic drainage pattern alterations. This knowledge may be useful for management of recurrent cancer and prevention of breast cancer related lymphedema. We mapped the complete superficial lymphatic system of a dog and used this canine model to perform preliminary studies of lymphatic architectural changes in postoperative condition.

Methods

Lymphatic territories (lymphosomes) were mapped with 4 female mongrel carcasses using an indocyanine green (ICG) fluorescent lymphography and a radiographic microinjection technique. Two live dogs were then subjected to unilateral lymph node dissection of lymph basins of the forelimb, and ICG lymphography and lymphangiogram were performed 6 months after the surgery to investigate lymphatic changes. Lymphatic patterns in the carcass were then compared with postoperative lymphatic patterns in the live dogs.

Results

Ten lymphosomes were identified, corresponding with ten lymphatic basins. Postoperative fluorescent lymphographic images and lymphangiograms in the live dogs revealed small caliber lymphatic network fulfilling gaps in the surgical area and collateral lymphatic vessels arising from the network connecting to lymph nodes in the contralateral and ipsilateral neck in one dog and the ipsilateral subclavicular vein in another dog.

Conclusion

Our canine lymphosome map allowed us to observe lymphatic collateral formations after lymph node dissection in live dogs. This canine model may help clarify our understanding of postoperative lymphatic changes in humans in future studies.     

Growth of the jugular lymph sacs and establishment of the topography of the cervical portion of the thoracic duct during early human ontogenesis

In 196 human embryos, prefetuses, fetuses and newborns, by means of a complex of morphological methods, development of the jugular lymphatic sacs and the process of settling of the thoracic duct cervical part topography have been studied. The jugular lymphatic sac anlages take place on the 6th week of the development. From the lymphatic cleft, situating in the mesenchyme near the anterior cardinal veins, multichambered cavities laid with endotheliocytes are forming,--the jugular lymphatic sacs. Connection of the initially close lymphatic sacs with the venous system takes place secondarily by the end of the embryonic period of development. In the area of the sac ostia a valve is formed, that makes morphological premises for unidirected lymph flow into the venous system. The lymph nodes developing at the place of the reducing jugular lymphatic sacs, ensure formation: from the left jugular lymphatic sac--the cervical part of the thoracic duct, from the right jugular lymphatic sac--the right lymphatic duct and the jugular and the subclavicular lymphatic trunks. Variability in the form and topography of these structures are determined both by the form and construction of the jugular lymphatic sacs and by developmental peculiarities of the lymph nodes at their place. The process of settling of the thoracic duct cervical part topography depends on age changes of its size and form, as well as on development of structures situating nearby, and by the time of birth it is not completed.     

Lymphatic mapping and sentinel lymph node biopsy in patients with melanoma of the lower extremity

Lymphatic mapping and sentinel lymph node biopsy is a new technique used in the surgical treatment of patients with malignant melanoma. The purpose of this study was to evaluate the results of this approach for patients with melanoma of the lower extremity. Between May of 1994 and June of 1997 at the H. Lee Moffitt Cancer Center and Research Institute, 85 consecutive patients with clinical stage I and II melanoma of the lower extremity underwent lymphatic mapping and sentinel lymph node biopsy. These nodes were identified in all 85 patients by intraoperative lymphatic mapping with both radiolymphoscintigraphy and a vital blue dye injection. Eleven patients (12.9 percent) had histologically positive sentinel lymph nodes, and 10 patients underwent inguinal complete lymph node dissections. All 10 patients had no further histologically positive lymph nodes confirmed by subsequent complete dissection. Among 74 patients with histologically negative sentinel lymph nodes, only 2 patients (2.7 percent) developed inguinal nodal metastases during a mean follow-up period of 21.8 months (range, 13.5 to 58.3 months). The sensitivity of lymphatic mapping and sentinel lymph node biopsy in this series was 100 percent and the specificity was 97.3 percent. Therefore, we conclude that the use of lymphatic mapping and sentinel lymph node biopsy can accurately stage patients with melanoma of the lower extremity and provide a rational surgical approach for these patients.