ALT EKSTREMİTE MALIGN MELANOM OLGULARINDA NADİR GÖRÜLEN BİR DURUM;POPLİTEAL FOSSA METASTAZI VE DİSEKSİYONU;OLGU SUNUMU

Year 2008, Volume: 16 Issue: 3, 127 - 129, 01.12.2008

Ali Tufan Soydan Mahmet Ulvi Kayalı Gürsel Turgut Özay Özkaya Lütfü Baş

Abstract

Malign melanom'un prognozunu etkileyen en önemli faktör lokal lenf nodu metastazı varlığıdır.1 Son zamanlarda lenfosintigrafi ve sentinel lenf nodu biyopsisi gibi yöntemlerin kullanılması lokal lenf nodu metastazlarını taramada önemli bir etken olmuştur.2 Distal bacak ve ayak bölgesi malign melanomları klasik olarak ingüinal lenf nodlarına metastaz yaparlar.3 Bunun yanında üst ve alt ekstremitelerde sırasıyla epitroklear ve popliteal bölge gibi alışılmadık bölgelerin metastazlarına da rastlanmaktadır.4 Popliteal fossa metastazı ve diseksiyonu hakkında ise literatürde kısıtlı sayıda yayın bulunmaktadır.3,4,5,6 Biz bu çalışmamızda,nadiren yapılan bu cerrahi işlem ile ilgili deneyimimizi aktarmayı amaçladık.

Keywords

Popliteal lenf nodu diseksiyonu, malign melanom, alt ekstremite lenfatik drenaj

A RARELY SEEN METASTASIS IN LOWER EXTREMITY MALIGNANT MELANOMAS; POPLITEAL FOSSA METASTASIS AND LYMPH NODE DISSECTION CASE REPORT

Abstract

Metastatic disease of te regional lymph nodes is the most important predictor of outcome in malignant melanoma.1 The use of lymphoscintigraphy and sentinel node biopsy in the regional lymp nodes has made it possible to delineate lymphatic pathways in individual patients.2 Traditionally metastatic melanoma of the distal leg and foot metastasize to the lymph nodes of the groin.3 Sometimes,however ,metastasis exist outside these traditional nodal basinsincluding drainage to the epitrochlear and politeal nodes for distal upper and lower extremity respectively.4 Popliteal lypmh node metastasis and dissection is not clear from the literature.3,4,5,6 In this study,we aimed to share our experience wih this uncommon procedure.

Keywords

Popliteal lymph node dissection, malignant melanoma, lower extremity lymphatic drainage

References

• 1. McMasters KM, Chao C, Wong SL, Wrightson WR, Ross MI, Reintgen DS, Noyes RD, Cerrito PB, Edwards MJ.Interval sentinel lymph nodes in melanoma. Arch Surg. 2002 May;137(5):543-7; discussion 547-9.
• 2. Menes TS, Schachter J, Steinmetz AP, Hardoff R, Gutman H.Lymphatic drainage to the popliteal basin in distal lower extremity malignant melanoma. Arch Surg. 2004 Sep;139(9):1002-6.
• 3. Marone U, Caracò C, Chiofalo MG, Botti G, Mozzillo N.Resection in the popliteal fossa for metastatic melanoma. World J Surg Oncol. 2007 Jan 19;5:8.
• 4. Sholar A, Martin RC 2nd, McMasters KM. Popliteal lymph node dissection. Ann Surg Oncol. 2005 Feb;12(2):189-93. Epub 2005 Jan 25.
• 5. Thompson JF, Hunt JA, Culjak G, Uren RF, Howman-Giles R, Harman CR.Popliteal lymph node metastasis from primary cutaneous melanoma. Eur J Surg Oncol. 2000 Mar;26(2):172-6.
• 6. Georgeu G, El-Muttardi N, Mercer DMalignant melanoma metastasis to the sentinel node in the popliteal fossa. Br J Plast Surg. 2002 Jul;55(5):443-5.
• 7. Karakousis CP.The technique of popliteal lymph node dissection. Surg Gynecol Obstet. 1980 Sep;151(3):420-3.
• 8. Edward Arnold Normal lymphografic appearances: lower limb and pelvis.In:Kinmoth JB (ed) The Lymphatics.London:,1982:19-35.
• 9. Gabella G.Cardiovascular system.In:Bannister L(ed) Gray’s Anatomy (38 th edn) New York: Churchill Livingstone, 1995:1451-880.
• 10. Statius Muller MG, Hennipman FA, van Leeuwen PA, Pijpers R, Vuylsteke RJ, Meijer S.Unpredictability of lymphatic drainage patterns in melanoma patients. Eur J Nucl Med Mol Imaging. 2002 Feb;29(2):255-61.
• 11. Standiford SB, Kuvshinoff BW, Ota DM Surgical management of aberrant sentinel lymph node drainage in cutaneous melanoma. Surgery. 1998 Oct;124(4):757-61; Lieber KA.
• 12. Uren RF, Howman-Giles R, Thompson JF Patterns of lymphatic drainage from the skin in patients with melanoma. J Nucl Med. 2003 Apr;44(4):570-82.
• 13. Leong SP, Achtem TA, Habib FA, Steinmetz I, Morita E, Allen RE, Kashani-Sabet M, Sagebiel R.Discordancy between clinical predictions vs lymphoscintigraphic and intraoperative mapping of sentinel lymph node drainage of primary melanoma. Arch Dermatol. 1999 Dec;135(12):1472-6.
• 14. Morris KT, Stevens JS, Pommier RF, Fletcher WS, Vetto JT.Usefulness of preoperative lymphoscintigraphy for the identification of sentinel lymph nodes in melanoma. Am J Surg. 2001 May;181(5):423-6.
• 15. Sumner WE 3rd, Ross MI, Mansfield PF, Lee JE, Prieto VG, Schacherer CW, Gershenwald JE. Implications of lymphatic drainage to unusual sentinel lymph node sites in patients with primary cutaneous melanoma. Cancer. 2002 Jul 15;95(2):354-60.