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Vol.41 No.1 contents | Japanese/English |
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- Case Report -
A Case Report of Adenocarcinoma of Unknown Origin Metastatic to the Mediastinal Lymph Nodes with a Review of 21 Cases Reported in Japan
Atsushi Morio, Hideaki Miyamoto, Hiroshi Izumi, Ohu Tsumin, Akio Yamazaki and Yasuyuki HosodaDepartment of Thoracic Surgery, Juntendo University School of Medicine
Background: Metastasis of cancer of unknown origin to mediastinal lymph nodes is rare, and only 20 cases have been reported previously in the Japanese medical literature. Case: A 35-year-old man was admitted with cough and fever. An abnormal shadow was found on his chest X-ray film. Chest CT demonstrated a large tumor, 7 cm in diameter, on the right side of the middle of the mediastinum, severely adherent to the trachea and superior vena cava. The tumor was resected through median stertonomy. Intraoperative frozen section analysis showed that the mediastinal tumor was the metastatic lymph nodes #2, #3, #4 (poorly differentiated adenocarcinoma), and ND3 α lymph node dissection was performed. Postoperative examination did not detect the primary lesion. On the 18th postoperative day, right neck lymph node dissection was performed because of early recurrence of adenocarcinoma in the lymph node in the right side of the neck. Radiotherapy was given after the operation. The patient is disease free 27 months after the operation, but the primary site has still not been identified. This case was thought to be a very rare case of T0N2M0 lung cancer. Conclusion: In general, the prognosis is poor for patients with metastatic cancer from an unknown primary site. However, patients with T0 lung cancer, as in this case, might enjoy a better prognosis if complete resection of metastatic lymph nodes is performed.
key words: Adenocarcinoma of unknown origin, Mediastinal lymph nodes metastasis, T0 lung cancer
Received: October 17, 2000
Accepted: November 20, 2000
JJLC 41 (1): 73-78, 2001
