A Triangular Intermuscular Space Sentinel Node in Melanoma: Association With Axillary Lymphatic Drainage

Hennessy, Sara; Dengel, Lynn T.; Hranjec, Tjasa; Slingluff, Craig L.

doi:10.1245/s10434-010-1018-z

Cited by 7 publications

(7 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There is a paucity of literature on lymphatic drainage of the right upper extremity and particularly of the deltoid [14] . The adjacent triangular intramuscular space has been described as a lymphatic station for upper back melanoma metastasis [15] . It is possible the inflammation we have described as centered in the quadrilateral space involves some of the adjacent spaces as definitive boundaries may be challenging by imaging.…”

Section: Discussionmentioning

confidence: 99%

Quadrilateral space region inflammation and other incidental findings on shoulder MRI following recent COVID-19 vaccination: Three case reports

Eisenberg

Tingey

Fulton

et al. 2021

Radiology Case Reports

View full text Add to dashboard Cite

We present 3 cases reporting the normal appearance of the post COVID-19 vaccination on shoulder MRI exams. All three patients were imaged 1-5 days post-vaccination for unrelated MSK shoulder symptoms, and none reported any symptoms besides mild shoulder discomfort for a day or two following vaccine administration. All three patients demonstrated characteristic deltoid edema, quadrilateral space region edema and axillary nodal prominence. Vessel prominence with T2 and T1 increased signal draining to the approximate location of the quadrilateral space and axilla was an associated feature. The normal appearance of the COVID-19 vaccine on shoulder MRI has not been previously described, and recognition by the radiologist will prevent erroneous differential diagnosis, unnecessary medical workups, and detract from the clinically relevant pathological imaging findings in patients with shoulder pain.

show abstract

Section: Discussionmentioning

confidence: 99%

Quadrilateral space region inflammation and other incidental findings on shoulder MRI following recent COVID-19 vaccination: Three case reports

Eisenberg

Tingey

Fulton

et al. 2021

Radiology Case Reports

View full text Add to dashboard Cite

show abstract

“…A hypothesis to explain this drainage is a lymphatic route through the triangular intermuscular space (TIS), through which passes the descending circumflex scapular artery, vein, and lymphatics ( Figure 7 ). This triangular space, located lateral to the scapula, is bounded by the teres major inferiorly, the infraspinatus, teres minor, and subscapularis superiorly, and the long head of the triceps laterally [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…This intermuscular space was first described by Uren [ 17 ] in 1996 as the gateway to the axilla, associated with an important site of recurrent melanoma [ 18 ]. Successively, Hennessey [ 16 ] improved the description of TIS and categorized three different lymphatic drain pathways of scapular and subscapular regions: Pattern 1: it separates lymphatic channels draining to the axilla directly, bypassing the TIS node. Pattern 2: lymphatic channels draining first to the TIS node, then to a homolateral axillary node.…”

Section: Discussionmentioning

confidence: 99%

Analysis of the Different Lymphatic Drainage Patterns during Sentinel Lymph Node Biopsy for Skin Melanoma

Cirocchi

Metaj

Cicoletti

et al. 2021

JCM

View full text Add to dashboard Cite

In the last two decades, studies of lymphoscintigraphy imaging in lymphatic mapping reported an extreme heterogeneity of skin lymphatic drainage of some skin area, in contrast with the previous scientific literature. The aim of this study was to investigate the presence of any correlations between the topographical location of cutaneous melanoma and the topographical location of sentinel lymph nodes. Data from 165 patients undergoing sentinel lymph node biopsy between January 2013 and May 2021 were analyzed, demonstrating that melanomas in the Lumbar region presented a significant more heterogeneous drainage by site than those in the Scapular region (p < 0.01) and that melanomas in the Subscapular region were significantly more heterogeneous by laterality (unilateral vs. bilateral) than those in the Scapular region (p < 0.05). Results of this study supported the evidence of multiple lymphatic drainage as regards the sentinel node biopsy performed in skin melanoma located on the dorsal subscapular region and lumbar region. For this reason, the association of preoperative lymphoscintigraphy with another imaging evaluation is needed in these critical cutaneous areas. Recent technical developments enabling fluorescence lymphography together with indocyanine green have significantly improved the visualization of lymphatic drainage patterns at a microscopic level. In the preoperative phase, any doubt can be resolved by associating the SPET-CT scan to lymphoscintigraphy, while during the intraoperative phase, an additional evaluation with indocyanine green can be performed in doubtful cases. The aim of the duplex lymphatic mapping (pre and/or intraoperative) is an accurate search of sentinel nodes, in order to reduce the rate of false negatives.

show abstract

“… 5 , 8 , 9 Those reports have helped to alert surgeons to the less typical locations, particularly the triangular intermuscular space nodes. 10 …”

Section: Introductionmentioning

confidence: 99%

“…5,8,9 Those reports have helped to alert surgeons to the less typical locations, particularly the triangular intermuscular space nodes. 10 Costal margin LN are another uncommon site of lymph node drainage, first identified in a series of 10 patients with periumbilical primary lesions. Two of these patients "had a lymph channel passing over the right costal margin."…”

Section: Introductionmentioning

confidence: 99%

Subcostal lymph nodes: An unusual sentinel lymph node basin in cutaneous melanoma

Marsh

Lattimore

Cramer

et al. 2022

Journal of Surgical Oncology

Self Cite

View full text Add to dashboard Cite

Background and Objectives Lymphatic drainage from subcostal nodes, along the costal groove, have not previously been characterized as sites for melanoma drainage and metastasis. This study reports a series of patients with subcostal nodes draining primary melanomas, with characterization of the sites of primary melanomas that drain to these nodes. Methods Patients who presented to our institution between 2005 and 2020 with documented cutaneous melanoma and sentinel lymph node biopsy of a subcostal node (sentinel = S), or metastases to subcostal nodes later in clinical management (recurrent = R) were included. Patient demographics, melanoma pathology, nodal features, imaging information, surgical approaches, and outcomes data were collected. Results Six patients had subcostal sentinel nodes (SNs). Primary sites included the posterior trunk and lateral chest wall. Subcostal nodes were found under ribs 10−12. Subcostal SNs had at least one dimension measuring 3 mm or less. There were no surgical complications related to removing the subcostal SN. Conclusions Melanoma can metastasize to subcostal lymph nodes and be found at the time of SN biopsy or identified at recurrence. These small nodes are fed by lymphatic channels that run in the neurovascular bundle under the ribs. When lymphatic mapping identifies a subcostal SN, it should be excised.

show abstract

A Triangular Intermuscular Space Sentinel Node in Melanoma: Association With Axillary Lymphatic Drainage

Cited by 7 publications

References 9 publications

Quadrilateral space region inflammation and other incidental findings on shoulder MRI following recent COVID-19 vaccination: Three case reports

Quadrilateral space region inflammation and other incidental findings on shoulder MRI following recent COVID-19 vaccination: Three case reports

Analysis of the Different Lymphatic Drainage Patterns during Sentinel Lymph Node Biopsy for Skin Melanoma

Subcostal lymph nodes: An unusual sentinel lymph node basin in cutaneous melanoma

Contact Info

Product

Resources

About