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Vol.64 No.3 contents | Japanese/English |
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- Case Report -
A Case of Fallopian Tube Cancer Diagnosed After the Detection of Parasternal Lymph Node Metastasis
Junichi Takada1, Yuta Inoue11Department of Thoracic Surgery, Chigasaki Municipal Hospital, Japan
Background. Pleural effusion due to dissemination is the most frequently reported route of intrathoracic metastasis among fallopian tube, ovarian, and peritoneal cancers. Lymph node metastases are rarely documented. However, sporadic cases show metastasis to the parasternal regions and diaphragmatic areas. We present a rare case where a thoracoscopic biopsy of a parasternal nodule without pulmonary or pleural lesions led to the diagnosis of lymph node metastasis from fallopian tube cancer. Case. A 70-year-old woman was admitted to our department. Multiple peritoneal nodules and a 15 mm parasternal nodule were incidentally identified by computed tomography (CT). Measurement of tumor markers indicated elevated levels of sIL-2 receptor (1790/µl) and CA125 (346 U/ml). Positron emission tomography (PET)-CT revealed the increased uptake of fluorodeoxyglucose. The SUV max of the peritoneal and parasternal nodules was 8.2 and 6.0, respectively. No lung or pleural lesions were observed. Based on the suspicion of malignancies such as lymphoma, we performed a thoracoscopic biopsy. Atypical epithelial proliferation with positive ER and PAX8 immunostaining was identified, leading to the diagnosis of lymph node metastasis of high-grade serous adenocarcinoma. We suspected gynecological cancer as the primary lesion. Afterward, we performed bilateral salpingo-oophorectomy, omentectomy, and resection of the peritoneal nodules. The primary lesion was identified as the left fallopian tube lesion. Therefore, it was considered that primary fallopian tube adenocarcinoma probably spread lymphatically to the parasternal region through the diaphragm from peritoneal dissemination. At 10 months postoperatively, the patient continued outpatient chemotherapy. Conclusion. In the differential diagnosis of parasternal tumor-like lesions, lymph node metastasis of fallopian tube cancers should be considered as a rare but potential etiology.
key words: Parasternal lymph node metastasis, Fallopian tube cancer
Received: December 28, 2023
Accepted: February 22, 2024
JJLC 64 (3): 174-178, 2024
