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- Case Report -

A Case of Hilar Lymph Node Small Cell Carcinoma of Unknown Origin Found as a 2.5-mm Primary Lesion in a Right Upper Lobe by a Thorough Macroscopic Observation

Shu Tanizawa¹, Jun Miyagi¹, Yui Naha², Teruhito Uchihara², Morikazu Akamine², Masashi Ishikawa^3
1Department of Thoracic Surgery, ²Department of Respiratory Medicine, ³Department of Pathology, Okinawa Red Cross Hospital, Japan

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Background. Small cell carcinomas of unknown origin have been reported to occur in the hilum or mediastinal lymph nodes. Furthermore, there are a few reports describing the independent coexistence of pulmonary small cell cancer and pulmonary adenocarcinoma in a lung field. Case. A ground glass opacity (GGO) lesion was incidentally found in the right upper lobe on a chest CT image of a 67-year-old man. Positron emission tomography (PET) revealed accumulation in the hilar lymph nodes but distant metastasis was not seen, right upper lobectomy and lymph node dissection were performed. A pathological examination revealed that the GGO lesion of the right upper lobe was pulmonary adenocarcinoma, and small cell cancer was detected in the hilar lymph node. A thorough search of the whole range of the upper lobe was performed to detect macroscopic primary lesions. A primary small cell carcinoma of 2.5 mm in size was found in the upper lobe separate from the GGO lesion. The invasion of cancer cells into the lymphatic vessels was found around the small cell carcinoma. It was therefore diagnosed as a primary lesion of small cell carcinoma of the lung. Conclusion. When small cell carcinoma of unknown origin is detected in the hilum or mediastinal lymph nodes, a detailed examination may reveal primary cancer of the lung.
key words: Lymph node small cell carcinoma of unknown primary origin, Hilar lymph node metastasis, Micro-sized lung small cell carcinoma, Synchronous multiple primary lung cancer

Received: January 26, 2016
Accepted: April 12, 2016

JJLC 56 (4): 257-262, 2016