DOCSLIB.ORG

Corpora Amylacea Act As Containers That Remove Waste Products from the Brain

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Corpora Amylacea Act As Containers That Remove Waste Products from the Brain Corpora amylacea act as containers that remove waste products from the brain Marta Ribaa,b,c,1, Elisabet Augéa,b,c,1, Joan Campo-Sabariza,d, David Moral-Antera,d, Laura Molina-Porcele, Teresa Ximelise, Ruth Ferrera,d, Raquel Martín-Venegasa,d, Carme Pelegría,b,c,2, and Jordi Vilaplanaa,b,c,2 aSecció de Fisiologia, Departament de Bioquímica i Fisiologia, Universitat de Barcelona, 08028 Barcelona, Spain; bInstitut de Neurociències, Universitat de Barcelona, 08035 Barcelona, Spain; cCentros de Biomedicina en Red de Enfermedades Neurodegenerativas (CIBERNED), 28031 Madrid, Spain; dInstitut de Recerca en Nutrició i Seguretat Alimentàries (INSA-UB), Universitat de Barcelona, 08291 Barcelona, Spain; and eNeurological Tissue Bank of the Biobanc- Hospital Clinic-Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain Edited by Lawrence Steinman, Stanford University School of Medicine, Stanford, CA, and approved November 5, 2019 (received for review August 8, 2019) Corpora amylacea (CA) in the human brain are granular bodies 6). Nonetheless, we observed that CA contain glycogen synthase formed by polyglucosan aggregates that amass waste products of (GS), an indispensable enzyme for polyglucosan formation, and different origins. They are generated by astrocytes, mainly during also ubiquitin and protein p62, both associated with processes of aging and neurodegenerative conditions, and are located predom- elimination of waste substances (5). The relationship between CA inantly in periventricular and subpial regions. This study shows that and waste substances is recurrent in the literature. Already in 1999, CA are released from these regions to the cerebrospinal fluid and after a detailed and complete review, Cavanagh indicated that “CA are present in the cervical lymph nodes, into which cerebrospinal functions seem to be directed towards trapping and sequestration fluid drains through the meningeal lymphatic system. We also show of potentially hazardous products of cellular metabolism, princi- that CA can be phagocytosed by macrophages. We conclude that CA pally derived from the aging process, but probably also from any can act as containers that remove waste products from the brain disease state resulting in excessive amounts of potentially harmful and may be involved in a mechanism that cleans the brain. Moreover, metabolic products” (3). Although some of these hazardous we postulate that CA may contribute in some autoimmune brain products were described after carrying out unreliable immunohis- diseases, exporting brain substances that interact with the immune tochemical procedures, the results obtained using other techniques system, and hypothesize that CA may contain brain markers that may have supported their presence. In this regard, ultrastructural aid in the diagnosis of certain brain diseases. studies by Sbarbati et al. (7) indicated that CA originate in astro- PHYSIOLOGY cytes and accumulate abnormal material, and the study by Augé corpora amylacea | meningeal lymphatic system | aging | phagocytosis | et al. (8) showed that CA are formed inside astrocytes by the ac- natural immune system cumulation of residual products, including degenerating mito- chondria and membranous fragments originating from degenerative n 1837 the anatomist and physiologist J. E. Purkinje described processes. Moreover, combining the results of human neuropath- Ithe presence of some particular granular bodies in the brain of ological surveys, cell culture techniques, and animal models, some elderly patients (1). Virchow, in 1854, described them in more authors have proposed that CA are homologous to “Gomori- detail and observed that these bodies (corpora in Latin) share positive” granules which accumulate in subcortical/periventricular some similarities with starch (amylum in Latin) (2). These bod- regions of the rodent brain and which are derived from damaged ies, named corpora amylacea (CA), were initially considered to have no pathological significance and for a long time were thought Significance to be irrelevant. In recent decades, however, this perception has changed. With the advances in technology, CA have been studied Aging and neurodegenerative processes induce the formation from different perspectives and a large number of theories re- of waste substances in the brain. Some of these substances garding their nature have been put forward. Unfortunately, none accumulate in corpora amylacea (CA). We reveal that CA are of these theories have been demonstrated conclusively and CA released from the brain into the cerebrospinal fluid and are remain intriguing and mysterious bodies. In the present study, present in the cervical lymph nodes, into which cerebrospinal several features of CA are described and a vision of their function fluid drains through the meningeal lymphatic system. We also is proposed which may have implications for clinical practice. show that CA can be phagocytosed by macrophages. We con- There is a consensus that the main components of CA are clude that CA can act as waste containers and hypothesize that polymerized hexoses (primarily glucose) (3) and it has been esti- CA are involved in a mechanism that cleans the brain. We also mated that hexoses constitute about 88% of their weight (4). postulate that CA may contain clinical markers of brain disor- Along with polymerized hexoses, other components originating in ders and may also play significant roles in some brain auto- neurons, astrocytes, or oligodendrocytes, from blood or of fungal immune diseases. These last points merit further study due to or viral origin, have also been described, although some of them their possible clinical implications. have generated controversy (5). In 2017 we reported that CA contain neoepitopes that are recognized by natural antibodies of Author contributions: M.R., E.A., R.M.-V., C.P., and J.V. designed research; M.R., E.A., J.C.-S., D.M.-A., L.M.-P., T.X., R.F., R.M.-V., C.P., and J.V. performed research; M.R., E.A., the immunoglobulin M (IgM) isotype (6). We also observed that C.P., and J.V. analyzed data; and M.R., E.A., C.P., and J.V. wrote the paper. these IgMs were present as contaminants in numerous commercial The authors declare no competing interest. antibodies used for immunohistochemistry procedures and, since This article is a PNAS Direct Submission. these contaminant IgMs are recognized by the majority of the This open access article is distributed under Creative Commons Attribution-NonCommercial- secondary antibodies, they frequently cause false positive immu- NoDerivatives License 4.0 (CC BY-NC-ND). nostaining in CA. These IgMs therefore account for some of the 1M.R. and E.A. contributed equally to this work. inconsistencies concerning CA composition and are the main 2To whom correspondence may be addressed. Email: [email protected] or vilaplana@ reason for the uncertainty surrounding their origin and functions. ub.edu. In subsequent work, we reviewed the presence of the components This article contains supporting information online at https://www.pnas.org/lookup/suppl/ previously described in CA and were able to rule out some of them, doi:10.1073/pnas.1913741116/-/DCSupplemental. at least at levels that can be detected by immunohistochemistry (5, www.pnas.org/cgi/doi/10.1073/pnas.1913741116 PNAS Latest Articles | 1of11 Downloaded by guest on September 28, 2021 mitochondria engaged in a complex macroautophagy process (9, occasionally, inside the CSF of the ventricular region. This evi- 10). For their part, using a combination of 2D electrophoresis dence (summarized in Fig. 1) seems to indicate a possible route of with matrix-assisted laser desorption/ionization time-of-flight escape for the CA into the CSF. mass spectrometry, Selmaj et al. (11) identified several proteins The CSF drains not only via arachnoid granulations, as clas- of suspected neuronal origin and others involved in the regulation sically believed, but also via the recently rediscovered meningeal of apoptosis and senescence, supporting the notion that the bio- lymphatic system (15). The presence of lymphatic vessels col- genesis of CA involves the degeneration and aggregation of sub- lecting CSF at the base of the skull was described for the first stances, some of them of neuronal origin. Moreover, Cissé et al. time by Földi et al. (16). Johnston et al. (17) reported connec- (12) already described the presence of ubiquitin in CA in high- tions between the CSF and nasal lymphatic vessels in humans performance liquid chromatography (HPLC) studies. Taken to- and other mammals. Later, lymphatic vessels collecting CSF gether, this evidence indicates a relationship between CA and waste were also described lining the dural sinuses by Louveau et al. (18, elements and reinforces the idea that CA are waste containers 19), and new techniques based on magnetic resonance imaging formed by a polyglucosan structure that amasses waste products (6). permit their in vivo visualization (20). From meningeal lymphatic It is well known that CA are located mainly in perivascular, vessels and subsequent lymphatic vessels, lymph crosses different periventricular, and subpial regions of the brain (4). Since the cervical lymph nodes (18, 21) before accessing the lymphatic glymphatic system drains the interstitial fluid (ISF) from the duct or right thoracic duct, which ultimately drain into the bra- perivascular regions to the cerebrospinal fluid (CSF) (13), and since both periventricular and subpial regions are close to the chiocephalic veins. The
Load more

Recommended publications
  • Adaptive Immune Systems
    Immunology 101 (for the Non-Immunologist) Abhinav Deol, MD Assistant Professor of Oncology Wayne State University/ Karmanos Cancer Institute, Detroit MI Presentation originally prepared and presented by Stephen Shiao MD, PhD Department of Radiation Oncology Cedars-Sinai Medical Center Disclosures Bristol-Myers Squibb – Contracted Research What is the immune system? A network of proteins, cells, tissues and organs all coordinated for one purpose: to defend one organism from another It is an infinitely adaptable system to combat the complex and endless variety of pathogens it must address Outline Structure of the immune system Anatomy of an immune response Role of the immune system in disease: infection, cancer and autoimmunity Organs of the Immune System Major organs of the immune system 1. Bone marrow – production of immune cells 2. Thymus – education of immune cells 3. Lymph Nodes – where an immune response is produced 4. Spleen – dual role for immune responses (especially antibody production) and cell recycling Origins of the Immune System B-Cell B-Cell Self-Renewing Common Progenitor Natural Killer Lymphoid Cell Progenitor Thymic T-Cell Selection Hematopoetic T-Cell Stem Cell Progenitor Dendritic Cell Myeloid Progenitor Granulocyte/M Macrophage onocyte Progenitor The Immune Response: The Art of War “Know your enemy and know yourself and you can fight a hundred battles without disaster.” -Sun Tzu, The Art of War Immunity: Two Systems and Their Key Players Adaptive Immunity Innate Immunity Dendritic cells (DC) B cells Phagocytes (Macrophages, Neutrophils) Natural Killer (NK) Cells T cells Dendritic Cells: “Commanders-in-Chief” • Function: Serve as the gateway between the innate and adaptive immune systems.
    [Show full text]
  • Human Anatomy As Related to Tumor Formation Book Four
    SEER Program Self Instructional Manual for Cancer Registrars Human Anatomy as Related to Tumor Formation Book Four Second Edition U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service National Institutesof Health SEER PROGRAM SELF-INSTRUCTIONAL MANUAL FOR CANCER REGISTRARS Book 4 - Human Anatomy as Related to Tumor Formation Second Edition Prepared by: SEER Program Cancer Statistics Branch National Cancer Institute Editor in Chief: Evelyn M. Shambaugh, M.A., CTR Cancer Statistics Branch National Cancer Institute Assisted by Self-Instructional Manual Committee: Dr. Robert F. Ryan, Emeritus Professor of Surgery Tulane University School of Medicine New Orleans, Louisiana Mildred A. Weiss Los Angeles, California Mary A. Kruse Bethesda, Maryland Jean Cicero, ART, CTR Health Data Systems Professional Services Riverdale, Maryland Pat Kenny Medical Illustrator for Division of Research Services National Institutes of Health CONTENTS BOOK 4: HUMAN ANATOMY AS RELATED TO TUMOR FORMATION Page Section A--Objectives and Content of Book 4 ............................... 1 Section B--Terms Used to Indicate Body Location and Position .................. 5 Section C--The Integumentary System ..................................... 19 Section D--The Lymphatic System ....................................... 51 Section E--The Cardiovascular System ..................................... 97 Section F--The Respiratory System ....................................... 129 Section G--The Digestive System ......................................... 163 Section
    [Show full text]
  • The Size of Lymph Nodes in the Neck on Sonograms As a Radiologic Criterion for Metastasis: How Reliable Is It?
    AJNR Am J Neuroradiol 19:695–700, April 1998 The Size of Lymph Nodes in the Neck on Sonograms as a Radiologic Criterion for Metastasis: How Reliable Is It? Michiel W. M. van den Brekel, Jonas A. Castelijns, and Gordon B. Snow PURPOSE: A definition of cut-off points for nodal size is essential to determine whether cervical lymph nodes are metastatic or not. Because the currently used size criteria are defined for random populations of patients with head and neck cancer, we set out to study whether these criteria are optimal for patients without palpable metastases in different levels of the neck. We defined optimal size criteria for sonography by calculating the sensitivity and specificity of different size cut-off points. METHODS: We compared the sensitivity and specificity of different size cut-off points as measured on sonograms for various levels in the neck in a series of 117 patients with and 131 patients without palpable neck metastases. RESULTS: A minimum axial diameter of 7 mm for level II and 6 mm for the rest of the neck revealed the optimal compromise between sensitivity and specificity in necks without palpable metastases. For all necks together (with and without palpable metastases), the criteria were 1 to 2 mm larger. CONCLUSION: Our findings indicate that the current sonographic size criteria used for random patient populations are not optimal for necks without palpable metastases, nor can the same cut-off points be used for all levels in the neck. The management of lymph node metastases in the cious lymph nodes may convert both selective neck neck in patients with squamous cell carcinoma of the treatment and a wait-and-see policy to more secure upper air and food passages is a continuing source of comprehensive treatment of all levels of the neck (6).
    [Show full text]
  • Brain-To-Cervical Lymph Node Signaling After Stroke
    ARTICLE https://doi.org/10.1038/s41467-019-13324-w OPEN Brain-to-cervical lymph node signaling after stroke Elga Esposito1, Bum Ju Ahn1, Jingfei Shi1,2, Yoshihiko Nakamura 1,3, Ji Hyun Park1, Emiri T. Mandeville 1, Zhanyang Yu1, Su Jing Chan 1,4, Rakhi Desai1, Ayumi Hayakawa1, Xunming Ji2, Eng H. Lo1,5*& Kazuhide Hayakawa1,5* After stroke, peripheral immune cells are activated and these systemic responses may amplify brain damage, but how the injured brain sends out signals to trigger systemic inflammation remains unclear. Here we show that a brain-to-cervical lymph node (CLN) 1234567890():,; pathway is involved. In rats subjected to focal cerebral ischemia, lymphatic endothelial cells proliferate and macrophages are rapidly activated in CLNs within 24 h, in part via VEGF-C/ VEGFR3 signalling. Microarray analyses of isolated lymphatic endothelium from CLNs of ischemic mice confirm the activation of transmembrane tyrosine kinase pathways. Blockade of VEGFR3 reduces lymphatic endothelial activation, decreases pro-inflammatory macro- phages, and reduces brain infarction. In vitro, VEGF-C/VEGFR3 signalling in lymphatic endothelial cells enhances inflammatory responses in co-cultured macrophages. Lastly, surgical removal of CLNs in mice significantly reduces infarction after focal cerebral ischemia. These findings suggest that modulating the brain-to-CLN pathway may offer therapeutic opportunities to ameliorate systemic inflammation and brain injury after stroke. 1 Neuroprotection Research Laboratory, Departments of Radiology and Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA. 2 China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China. 3 Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, Jonan, Fukuoka, Japan.
    [Show full text]
  • Magnetic Resonance Imaging Provides Evidence of Glymphatic Drainage
    www.nature.com/scientificreports OPEN Magnetic resonance imaging provides evidence of glymphatic drainage from human brain to Received: 25 October 2017 Accepted: 26 April 2018 cervical lymph nodes Published: xx xx xxxx Per Kristian Eide 1,2, Svein Are Sirirud Vatnehol 2,3, Kyrre Eeg Emblem3,4 & Geir Ringstad2,5 Pre-clinical research in rodents provides evidence that the central nervous system (CNS) has functional lymphatic vessels. In-vivo observations in humans, however, are not demonstrated. We here show data on CNS lymphatic drainage to cervical lymph nodes in-vivo by magnetic resonance imaging (MRI) enhanced with an intrathecal contrast agent as a cerebrospinal fuid (CSF) tracer. Standardized MRI of the intracranial compartment and the neck were acquired before and up to 24–48 hours following intrathecal contrast agent administration in 19 individuals. Contrast enhancement was radiologically confrmed by signal changes in CSF nearby inferior frontal gyrus, brain parenchyma of inferior frontal gyrus, parahippocampal gyrus, thalamus and pons, and parenchyma of cervical lymph node, and with sagittal sinus and neck muscle serving as reference tissue for cranial and neck MRI acquisitions, respectively. Time series of changes in signal intensity shows that contrast enhancement within CSF precedes glymphatic enhancement and peaks at 4–6 hours following intrathecal injection. Cervical lymph node enhancement coincides in time with peak glymphatic enhancement, with peak after 24 hours. Our fndings provide in-vivo evidence of CSF tracer drainage to cervical lymph nodes in humans. The time course of lymph node enhancement coincided with brain glymphatic enhancement rather than with CSF enhancement. In 2015, the traditional view of the brain having no lymphatic vessels was challenged by evidence showing func- tional lymphatic vessels lining the cranial dural sinuses in rodents1,2.
    [Show full text]
  • Multilingual Cancer Glossary French | Français A
    Multilingual Cancer Glossary French | Français www.petermac.org/multilingualglossary email: [email protected] www.petermac.org/cancersurvivorship The Multilingual Cancer Glossary has been developed Disclaimer to provide language professionals working in the The information contained within this booklet is given cancer field with access to accurate and culturally as a guide to help support patients, carers, families and and linguistically appropriate cancer terminology. The consumers understand their healthand support their glossary addresses the known risk of mistranslation of health decision making process. cancer specific terms in resources in languages other than English. The information given is not fully comprehensive, nor is it intended to be used to diagnose, treat, cure or prevent Acknowledgements any medical conditions. If you require medical assistance This project is a Cancer Australia Supporting people please contact your local doctor or call Peter Mac on with cancer Grant initiative, funded by the Australian 03 8559 5000. Government. To the maximum extent permitted by law, Peter The Australian Cancer Survivorship Centre, A Richard Pratt Mac and its employees, volunteers and agents legacy would like to thank and acknowledge all parties are not liable to any person in contract, tort who contributed to the development of the glossary. (including negligence or breach of statutory duty) or We particularly thank members of the project steering otherwise for any direct or indirect loss, damage, committee and working group, language professionals cost or expense arising out of or in connection with and community organisations for their insights and that person relying on or using any information or assistance. advice provided in this booklet or incorporated into it by reference.
    [Show full text]
  • Axillary Lymph Nodes and Breast Cancer
    AXILLARY LYMPH NODES Lymphatic system and axillary nodes The lymphatic system runs through the body. It carries lymph from tissues and organs to lymph nodes. Lymph nodes are small clumps of immune cells that act as filters for the lymphatic system. They also store white blood cells that help fight illness. The lymph nodes in the underarm are called axillary lymph nodes. If breast cancer spreads, this is the first place it’s likely to go. During breast surgery, some axillary nodes may be removed to see if they contain cancer. This helps determine breast cancer stage and guide treatment. Lymph node status is related to tumor size. The larger the tumor, the more likely it is the breast cancer has spread to the lymph nodes (lymph node-positive). Sentinel node biopsy To see if cancer has spread to the axillary lymph nodes, The lymphatic system runs through the body. most people have a sentinel node biopsy. Before or during the procedure, a radioactive substance (called a tracer) and/ or a blue dye is injected into the breast. The first lymph supraclavicular nodes nodes to absorb the tracer or dye are called the sentinel nodes. These are also the first lymph nodes where breast cancer is likely to spread. internal mammary The surgeon removes the sentinel nodes and sends them nodes to the lab. When the surgeon removes the sentinel nodes, it doesn’t mean there’s cancer in the nodes. It means a pathologist needs to check the nodes for cancer. If the nodes contain cancer, more lymph nodes may be removed.
    [Show full text]
  • Lymphatic Leukemia with Thymic Enlargement: a Brief Review of the Literature .With Case Reports
    LYMPHATIC LEUKEMIA WITH THYMIC ENLARGEMENT: A BRIEF REVIEW OF THE LITERATURE .WITH CASE REPORTS LLOYD F. CRAVER, M.D, AND WILLIAM S. MACCOMB, M.D. Memorial Hospital, New York Slight enlargement of the thymus may perhaps be present in lymphatic leukemia more frequently than is recorded in the litera- ture. This enlargement may be a true lymphosarcoma or thy- moma, or only a hyperplasia of lymphoid tissue. In a considerable series of cases a large sarcomatous tumor of the thymus with a leukemic blood picture has been the chief fea- ture, so that leukemia with involvement of the thymus came t.~be recognized as an atypical and malignant variety (1). These growt,hs have been designated by Orth as malignant leukemic lymphoma (2). As noted by Kaufmann (3), ('in leukemia, marked enlargement of the thymus gland is occasionally seen, especially in acute lym- phatic leukemia." The rapid growth of the thymus may be out of all proportion to the hyperplasia of other lymphatic structures and to the blood picture, thus giving rise to a mistaken diagnosis of thymoma as an entity. As stated by Heubner (4)) "with thymic tumors the other lesions of leukemia have not always been fully developed." Milne (5) in 1913 reported an unusual case of lymphatic leuke- mia which at autopsy revealed a mass of hyperplastic lymphoid tissue in the upper mediastinum, attached to the pericardium. This mass was ascribed to a hyperplasia of the anterior mediastinal lymph nodes and most probably the thymus, though no Hassall's corpuscles could be demonstrated. In 1925 Friedlander and Foote (6) reported a case of "malig- nant small-celled thymoma with acute lymphoid leukemia." Here the unripe lymph~blast~sof the blood stream so closely resembled the cells of the thymic tumor found at autopsy that the question arose-was the source of the abnormal cells of the blood an out- break of the tumor through the wall of some vein, or was the whole 277 278 LLOYD F.
    [Show full text]
  • NOTES: the Lymphatic / Immune System (Ch 12, Part 1) the Lymphatic System Is Closely Associated with the Cardiovascular System
    NOTES: The Lymphatic / Immune System (Ch 12, part 1) The lymphatic system is closely associated with the cardiovascular system. Functions of the Lymphatic System: ● transports excess fluid to the bloodstream ● absorbs fats ● helps defend the body against disease- causing agents LYMPHATIC PATHWAYS Lymphatic capillaries ● microscopic, closed-end tubes that extend into intercellular spaces ● receive LYMPH through their thin walls (LYMPH = the fluid of the lymphatic system … more later!) ● lymphatic capillary networks parallel blood capillary networks Lymphatic vessels: ● have walls similar to those of veins, but thinner, and have valves to prevent backflow of lymph ● become larger and lead to LYMPH NODES and then merge into LYMPHATIC TRUNKS Lymphatic Trunks and Collecting Ducts: ● lymphatic trunks lead to two collecting ducts: -THORACIC DUCT larger and longer duct ; receives lymph from the lower limbs, abdominal regions, left upper limb, left side of thorax, head, and neck -RIGHT LYMPHATIC DUCT receives lymph from the R side of the head & neck, R upper limb, R thorax ● collecting ducts join the SUBCLAVIAN VEINS Tissue Fluid & Lymph: ● LYMPH is essentially tissue fluid that has entered a lymphatic capillary ● tissue fluid originates from blood plasma and is composed of: -water -dissolved substances that leave blood capillaries (small molecules, nutrients, gases, hormones) **NOT present are larger plasma proteins (too large to pass through capillary walls) Functions of lymph: 1) returns to the bloodstream small proteins that leaked out
    [Show full text]
  • Chapter 21 the Lymphatic System
    Chapter 21 Lecture Outline See separate PowerPoint slides for all figures and tables pre- inserted into PowerPoint without notes. Copyright © McGraw-Hill Education. Permission required for reproduction or display. 1 Introduction • The body harbors at least 10 times as many bacterial cells as human cells – Some beneficial – Some potentially disease-causing • Immune system—not an organ system, but a cell population that inhabits all organs and defends the body from agents of disease – Especially concentrated in the true organ system: lymphatic system • Network of organs and vein-like vessels that recover fluid • Inspect it for disease agents • Activate immune responses • Return fluid to the bloodstream 21-2 The Lymphatic System • Expected Learning Outcomes – List the functions of the lymphatic system. – Explain how lymph forms and returns to the bloodstream. – Name the major cells of the lymphatic system and state their functions. – Name and describe the types of lymphatic tissue. – Describe the structure and function of the red bone marrow, thymus, lymph nodes, tonsils, and spleen. 21-3 The Lymphatic System • Fluid recovery – Fluid continually filters from the blood capillaries into the tissue spaces • Blood capillaries reabsorb 85% • 15% (2 to 4 L/day) of the water and about half of the plasma proteins enter the lymphatic system and then are returned to the blood 21-4 The Lymphatic System • Immunity – Excess filtered fluid picks up foreign cells and chemicals from the tissues • Passes through lymph nodes where immune cells stand guard against foreign matter • Activates a protective immune response • Lipid absorption – Lacteals in small intestine absorb dietary lipids that are not absorbed by the blood capillaries 21-5 The Lymphatic System Copyright © The McGraw-Hill Companies, Inc.
    [Show full text]
  • The First Report of Bilateral Retropharyngeal Lymph Node
    Acta Oto-Laryngologica, 2011; 131: 1341–1348 CASE REPORT The first report of bilateral retropharyngeal lymph node metastasis from papillary thyroid carcinoma and review of the literature KAZUYUKI KAINUMA, RYOSUKE KITOH, HIDEKANE YOSHIMURA & SHIN-ICHI USAMI Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Japan Abstract The sites of lymph node metastasis of papillary thyroid carcinomas are typically the paratracheal and jugular lymph nodes. On the other hand, metastasis to the retropharyngeal or parapharyngeal nodes from papillary thyroid carcinomas is very rare. During the last two decades, limited to cases with a histologically definite diagnosis by surgery, only 39 cases have been reported. All reported cases were unilateral retropharyngeal or parapharyngeal node metastasis except one metachronous bilateral case, and there were no reports of simultaneous bilateral cases within our literature review. We report three cases of retropharyngeal node metastasis from thyroid papillary carcinoma, including a case of bilateral nodal metastasis. Retro- pharyngeal node metastasis was successfully resected in all three patients by the transcervical approach. As pointed out in past reports, this report also suggests that prior neck dissection and/or metastasis to cervical lymph nodes might alter the direction of lymphatic drainage to the retrograde fashion, resulting in the unusual metastasis to the retropharyngeal lymph nodes, and there is a possibility of a bilateral pattern. Also, it is necessary to consider the possibility of metastasis from a papillary thyroid carcinoma in the differential diagnosis of lymph node swelling in the parapharyngeal space. Keywords: Thyroid cancer, papillary carcinoma, parapharyngeal metastasis, neck dissection Introduction through the superior thyroid pole by way of the poste- rior lymphatic trunks, which are reported to be present Thyroid papillary carcinomas comprise 70–80% of in 20% of the cases [16].
    [Show full text]
  • Renal Pelvis and Ureter Cases
    RP/Ureter Case 1 SURGICAL PATHOLOGY REPORT Surgical Pathology Report October 20, 2007 Specimen: A. Left ureter biopsy B. Uterus and bladder C. Right ureter Final Diagnosis: A. Left ureter biopsy - invasive high grade urothelial carcinoma. B. Uterus and bladder (radical cystohysterectomy) - invasive high grade urothelial carcinoma involving the left ureter. Neoplasm penetrates into but not through muscularis propria of the ureter. Extensive urothelial carcinoma in situ involving the bladder. No involvement of the urethra. Staging AJCC pathologic stage: pT2; pNX; pMX; No involvement of soft tissue margins; invasive carcinoma is present at the transected left ureteral margin. Cystic atrophy of the endometrium. Cervix, right fallopian tube and right ovary with no significant diagnostic abnormality. C. Right ureter - chronic ureteritis with reactive urothelial atypia; no dysplastic or neoplastic changes in sections examined. END RP/Ureter Case 1 1SEER MPH Rules Web Casts http://seer.cancer.gov/tools/mphrules/ RP/Ureter Case 2 SURGICAL PATHOLOGY REPORT Surgical Pathology Report September 10, 2007 Clinical History: Left renal pelvis mass, gross hematuria Specimen: Left kidney with ureter and bladder cuff Gross Description: The specimen is received in one formalin filled container labeled with the patient's name, sublabeled "left kidney with ureter and bladder cuff", and consists of a previously opened radical nephrectomy specimen which measures 13 x 8 x 8 cm. The adipose tissue is peeled away from the kidney. No adrenal grand is present. A ureter is present measuring 17 x 1 cm. The kidney measures 12 x 7 x 7 cm. Upon sectioning a fungating, friable gray-white mass lesion is located in the hilum measuring 6 x 6 x 5 cm.
    [Show full text]