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Vol.63 No.1 contents | Japanese/English |
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- Case Report -
A Case of Lung Cancer with Multiple Swollen Lymph Nodes Combined with Suspicion of IgG4-related Disease
Satoshi Takamori1,2, Hiroyuki Oizumi2, Jun Suzuki1, Hikaru Watanabe1, Kaito Sato1, Satoshi Shiono11Department of Surgery II, Faculty of Medicine, Yamagata University, Japan, 2Department of General Thoracic Surgery, Higashiyamato Hospital, Japan
Background. Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) is an important examination for distinguishing lymph node metastasis in lung cancer. However, it is difficult to evaluate lymph node metastasis because of the underlying disease. Case. A 71-year-old man presented to the previous hospital with an abnormal shadow on chest X-ray. Chest CT revealed a lung tumor and enlarged mediastinal and right supraclavicular lymph nodes. He was clinically diagnosed with unresectable lung cancer (cT2aN3M0-IIIB) and referred to our chest physician for a further evaluation. At our hospital, transbronchial lung biopsy specimens obtained via bronchoscopy demonstrated squamous cell cancer. Enhanced CT showed segmental pancreatic enlargement and possible autoimmune pancreatitis, and blood tests revealed an elevated serum IgG4 level of 176 mg/dl. We suspected that the lymph nodes were not malignant and performed a supraclavicular lymph node biopsy; the pathological findings indicated reactive lymphadenopathy. We clinically reclassified the lung cancer as cT2aN0M0-IB and performed right upper lobectomy and lymphadenectomy (ND2a-2) via open thoracotomy. The postoperative pathological diagnosis was squamous cell carcinoma (pT2aN0M0-IB). Conclusion. FDG-PET/CT has been promoted as a useful tool for evaluating malignant diseases. As demonstrated by our patient's case, potentially fatal errors can be prevented by performing a biopsy whenever possible before declaring a lung cancer unresectable.
key words: Lung cancer, Supraclavicular lymph node biopsy
Received: June 2, 2022
Accepted: September 5, 2022
JJLC 63 (1): 40-44, 2023
