Primary Tumor Detected 11 Years After the Appearance of Mediastinal Lymph Node Cancer of Unknown Primary

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  • Sogabe Masaya
    Department of Chest Surgery, International University of Health and Welfare Hospital Department of Chest Surgery, JCHO Utsunomiya Hospital
  • Myobatake Ryota
    Department of Chest Surgery, International University of Health and Welfare Hospital
  • Saito Itsuki
    Department of Chest Surgery, International University of Health and Welfare Hospital
  • Okada Shinya
    Department of Pathology, International University of Health and Welfare Hospital
  • Tsubochi Hiroyoshi
    Department of Thoracic Surgery, Jichi Medical University
  • Nakano Tomoyuki
    Department of Chest Surgery, International University of Health and Welfare Hospital

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  • 11年の経過で原発巣が明らかになった原発不明縦隔リンパ節癌の1例

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Abstract

<p>Background. Hilar and/or mediastinal lymph node (LN) cancer without a primary tumor is rare. Case. A 50-year-old man underwent distal gastrectomy for gastric cancer in year X. Although preoperative fluorodeoxyglucose (FDG)-positron emission tomography (PET) showed an LN of 11 mm in diameter with the abnormal uptake of FDG in the subaortic region (LN#5), a biopsy was not requested. In year X+1, LN#5 shrank to 3 mm, and the carcinoembryonic antigen (CEA) concentration decreased from 56.6 ng/ml to 8.6 ng/ml after gastric cancer surgery. However, the mediastinal LN slowly enlarged from year X+2, increasing to 24 mm at year X+11; the CEA concentration increased to 1760.4 ng/ml and a nodule appeared in the S1+2 segment of the left lung. Surgery was performed. Thoracoscopic resection of LN#5 and left upper division segmentectomy was performed. The postoperative pathological diagnosis was adenocarcinoma in both the pulmonary nodule and LN#5, and immunostaining was positive for thyroid transcription factor-1 and napsin A. Eleven years later, the primary lesion appeared in the lung and was diagnosed as lung cancer and mediastinal LN metastasis, pT1bN2M0 stage IIIA. Conclusion. Patients with lymph node carcinoma of unknown origin may develop a primary lesion after a long period of time. This case is instructive in suggesting the importance of long-term follow-up in such cases.</p>

Journal

  • Haigan

    Haigan 62 (5), 382-388, 2022-10-20

    The Japan Lung Cancer Society

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