This report describes 2 cases of calcified cavernous transformation of portal vein of unknown etiology. In both cases the revealing symptom was jaundice due to extrinsic compression of the common bile duct by the cavernoma. Only 4 other cases have been previously described in the literature. The cause of the jaundice was discovered only during surgery and confirmed by arteriography. Endoscopic retrograde cholangiography allowed both the diagnosis and the palliative treatment of the stricture of the distal common bile duct. Surgical treatment could not be performed.
The lymphatic system is a complicated system consisting of the lymphatic vessels and lymph nodes draining the extracellular fluid containing cellular debris, excess water and toxins to the circulatory system. The lymph nodes serve as a filter, thus, when the lymph fluid returns to the heart, it is completely sterile. In addition, the lymphatic system includes the mucosa-associated lymphoid tissue, such as tonsils, adenoids, Peyers patches in the small bowel and even the appendix. Taking advantage of the drainage system of the lymphatics, cancer cells enter the lymphatic vessels and then the lymph nodes. In general, the lymph nodes may serve as a gateway in the majority of cases in early cancer. Occasionally, the cancer cells may enter the blood vessels. This review article emphasizes the structural integrity of the lymphatic system through which cancer cells may spread. Using melanoma and breast cancer sentinel lymph node model systems, the spread of early cancer through the lymphatic system is progressive in a majority of cases. The lymphatic systems of the internal organs are much more complicated and difficult to study. Knowledge from melanoma and breast cancer spread to the sentinel lymph node may establish the basic principles of cancer metastasis. The goal of this review article is to emphasize the complexity of the lymphatic system. To date, the molecular mechanisms of cancer spread from the cancer microenvironment to the sentinel lymph node and distant sites are still poorly understood and their elucidation should take major priority in cancer metastasis research.
This essay is based on the injection and dissection of 100 cadaver specimens (fetuses, new borns and infants), the study of 34 case reports of pancreatic carcinoma, the injection of the lymphatic system in 14 living dogs and the reconstruction of the dorsal mesentery of an embryo of 30 mm according to Born's method. The results are as follows: the anatomy of the pancreas and of the lymphatic channels show that there are two distinct portions, one is right-sided and corresponds to the primitive ventral bud, the other is situated on the left and corresponds to the primitive dorsal bud. The primitive dorsal mesentery is formed by a double contingent: one right, for the right pancreas, this is the retroportal process (RPP). The other left, for the left pancreas. This is a formation which up until now, has never been described in the literature, the left lateral portal process (LLPP). While the anterior lymphatic drainage of the pancreas does not seem to hold any surprises, the posterior lymphatic drainage, arising from the posterior and anterior surfaces of the pancreas, is very particular. In the right side (anterior and posterior aspects), the drainage runs to the RPP, while in the left side (anterior and posterior aspects) it courses to the LLPP and here, in an exclusive manner. Only a few borderline regions, those situated precisely in the area of inosculation of the two buds, escape this systematisation. The terminal network of the pancreatic lymphatic channels have a short distance to bridge in order to reach the thoracic duct. The study of the distribution of lymph node metastases in carcinoma of the pancreas seems to confirm the anatomical results in the cadaver, but our series is too short to be of statistical value. Very early spread via the thoracic duct probably greatly reduces the value of supra-enlarged operations whose justification is precisely more complete lymph node removal. It might be useful, however, if proof could be provided that tumor reduction in the case of carcinoma of the pancreas is a necessary prelude to complementary therapeutic measures. The anatomy of the pancreas and of the lymphatic channels in mammals seems to confirm the results found in man, i.e. the division of the pancreas into a right and a left pancreas. The precise knowledge of the anatomy of the lymphatic ducts of the pancreas might be the starting point for progress in the experimental studies concerning the modifications of the lymphatic circulation during acute pancreatitis.(ABSTRACT TRUNCATED AT 400 WORDS)
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