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Mediastinal lymphatic efferents from the diaphragm
R Souilamas1, G Hidden, M Riquet
1Service de Chirurgie Thoracique, Hôpital Européen Georges Pompidou, 20 rue Leblanc, F-75015 Paris, France.
Surgical and Radiologic Anatomy : SRA
|August 9, 2001
Summary
Diaphragmatic lymphatic drainage connects to mediastinal lymph centers, sharing pathways with lung segments. This common drainage may explain the poor prognosis of non-small cell lung cancer invading the diaphragm.
Area of Science:
- Anatomy
- Surgical Oncology
- Thoracic Surgery
Background:
- The prognosis of non-small cell lung cancer (NSCLC) invading the diaphragm is often poor.
- The rich lymphatic drainage of the diaphragm is a suspected reason for this poor prognosis.
Purpose of the Study:
- To determine the mediastinal lymphatic efferents from the diaphragm.
- To elucidate the lymphatic pathways of the diaphragm for a better understanding of NSCLC metastasis.
Main Methods:
- The diaphragms of 20 adult cadavers (aged 77-104 years) were injected with a dye (modified Gerota's medium).
- Lymph vessels were catheterized and dissected, with each stage photographed.
- Injections were performed 23 times on the right and 25 times on the left diaphragm.
Main Results:
- Diaphragmatic lymph vessels were found to drain into three main lymph centers: posterior (paraaortic nodes), anterior (juxtasternal nodes), and mediastinal (visceral nodes).
- Ascending lymph pathways from these centers lead to the thoracic duct, internal thoracic vessels, and peritracheobronchial nodes.
- Abundant diaphragmatic lymphatics connect to mediastinal nodes and the bloodstream via the thoracic duct, sharing common pathways with pulmonary segments.
Conclusions:
- Diaphragmatic lymphatic drainage is extensive and converges in mediastinal lymph node centers.
- Common lymphatic pathways between the diaphragm and lung segments likely contribute to the poor prognosis observed in non-small cell lung cancer that invades the diaphragm.