A Case of Pulmonary Primary Squamous Cell Carcinoma with Peripheral Intrapulmonary Lymph Node Metastasis

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  • 原発巣より末梢側の胸膜直下肺内リンパ節転移を伴う肺扁平上皮癌の1例

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<p>Background. Advances in diagnostic imaging techniques have increased the opportunities to detect small nodules in peripheral lung fields. Making a differential diagnosis is sometimes difficult. Case. A 65-year-old-man was admitted to hospital to undergo further examination for a reticular shadow in the bilateral lower lung field on a chest radiograph. Chest CT revealed a 12-mm nodule in the right S8, and another 10-mm nodule just beneath the pleura of the same segment. Even though a bronchoscopic examination revealed that it was not malignant, the proximal nodule showed the slight accumulation of FDG-PET. The proximal nodule grew to 23 mm in size, and the nodule beneath the pleura grew to 22 mm in size. We therefore diagnosed the proximal nodule as primary lung cancer, and the nodule beneath the pleura as an inflammatory lesion. The partial resection of both nodules was performed. The intraoperative pathological diagnosis of the nodule on the proximal side was squamous cell carcinoma. We performed right lower lobectomy. The distal nodule was a metastatic intrapulmonary lymph node, and the final diagnosis was invasive squamous cell carcinoma, pT2aN1M0, stage IIA. Conclusion. We should consider intrapulmonary lymph nodes as a differential diagnosis when small nodules are observed in peripheral lung fields. If lung cancer is also suspected, then the possibility of metastasis to the peripheral intrapulmonary lymph nodes should be carefully taken into account, and a partial resection should be considered to enable an early diagnosis.</p>

Journal

  • Haigan

    Haigan 56 (7), 1051-1056, 2016

    The Japan Lung Cancer Society

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