Hilar and Mediastinal Lymph Node Metastases of Adenocarcinoma from an Unknown Primary Site.

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A 52-year-old man was admitted with fever and left back pain. A chest X-ray filmdisclosed a 3cm round shadow in the left hilum, an infiltrative shadow in the left lower lung field and left pleural effusion. CT also demonstrated an enlarged paraaortic lymph node. The laboratory data revealed plasma CEA elevation. However, no primary lesion was detected despite a thorough systemic examination. We planned biopsy of the left thoracic lesions by thoracoscopy. Intraoperative diagnosis was none-small cell lung cancer of left S<SUP>3</SUP> and metastasis to the paraaortic lymph node. We performed left upper lobectomy and mediastinal lymphadenectomy. The pathological diagnosis was a metastatic lesion of the adenocarcinoma in hilar and mediastinal lymph nodes but there was no primary lesion in the resected lung. After the operation the plasma CEA level normalized immediately and there was no re-elevation. We have followed the patient for about 10 months after the operation and there is no evidence of a new lesion or tumor recurrence. We consider this is a very rare case of TON2M0 lung cancer.
特定非営利活動法人日本肺癌学会の論文