Mediastinal signet-ring cell carcinoma of unknown primary site; report of a case

The question whether the tumor is primary or metastatic sometimes arises in patients with intrathoracic tumor. Especially, adenocarcinoma presents more difficulties in distinguishing primary tumors from secondary or deciding its origin. We reported a case of mediastinal signet-ring cell carcinoma. A 51-year-old female was admitted because of an abnormal shadow during mass screening. Chest X-ray showed a semicircular, well-demarcated shadow on right cardiophrenic angle. Chest computed tomography (CT) revealed a homogeneous mass, approximately 4 cm in diameter. The investigations of whole body failed to reveal any other tumor. At operation, the tumor was adherent to the esophagus but easily resected. Histologically, the tumor was mainly composed of signet-ring cells. Immunohistochemically, surfactant apoprotein (SPA) was strongly demonstrated in tumor cells. SPA is specific to the lung and the tumor was diagnosed as the metastasis in mediastinal lymph nodes. The primary site was considered to exist in lung. But the primary site was not found over 46 months in spite of repeated further examinations.     

Mediastinal lymph node carcinoma of an unknown primary site: clinicopathological examination

Purpose  We examined the clinicopathological features of four mediastinal lymph node carcinomas from an unknown primary site. Methods  Four patients with mediastinal lymph node carcinoma from an unknown primary site were treated at our hospital during the past 6 years. Results  All of the patients were men, with an average age of 74.0 years (range 70–78 years). Histologically, one lesion was poorly differentiated adenocarcinoma, two were poorly differentiated squamous cell carcinoma, and one was undifferentiated carcinoma. Radical resection of the mediastinal tumor and radiotherapy were performed in two patients, both of whom were still alive with no evidence of recurrence at 44 and 82 months, respectively, after the operation. Thoracoscopic biopsy was performed in two patients, and both underwent chemoradiotherapy. These two patients were alive at 24 and 33 months, respectively, after the biopsies. Conclusion  Radical resection of mediastinal lymph node carcinoma with an unknown primary site has the possibility of a good prognosis. In nonradical cases, it is important to perform a biopsy to make an accurate diagnosis and then administer radiotherapy and/or chemotherapy postoperatively.     

Mediastinal lymph node carcinoma without apparent primary lesion: report of case]

A 62-year-old man with dyspnea had an enlarged lymph node, 6.5 cm in size in the left hilum, but no primary carcinoma could be found. The patient underwent lymph node dissection under video-assisted thoracoscopic surgery, and the histological diagnosis was undifferentiated carcinoma. No primary lesion has been identified even in postoperative survey. The postoperative course was uneventful with no evidence of recurrence eight months after the operation.     

Squamous cell carcinoma of the hilar lymph node with unknown primary tumor: a case report

We herein report a rare case of squamous cell carcinoma (SCC) located in the hilar nodes with unknown primary tumor. A 56-year-old man underwent a thoracotomy under the clinical diagnosis of lung cancer with hilar nodes involvement. The tumor was found at the hilus and resected without pulmonary resection. The pathological diagnosis of this tumor was metastatic SCC in hilar lymph nodes. Examinations of the whole body failed to detect a primary site of the SCC. The patient is doing well with no clinical sign of recurrence 32 months after surgery.     

Multimodal treatment for multistation mediastinal lymph node adenocarcinoma: a case report

We report on a 68-year-old male with a multistation mediastinal lymph node adenocarcinoma, who had no primary lesions occurring within 48 months. After diagnosis by lymph node biopsy via right-sided thoracoscopy, the bilateral mediastinal lymphadenopathy responded to platinum-based chemotherapy. At 30 months after completion of chemotherapy, left mediastinal lymphadenopathy recurred. Left anterior mediastinal dissection via left-sided thoracoscopy was successful. After surgery, the patient did well with no primary lesions for more than a year. The etiology of mediastinal lymph node carcinoma of unknown origin is discussed.     

Thymic carcinoid with lymph node metastases; report of a case

A 71-year-old man was admitted to our hospital because of the detection of an anterior mediastinal tumor. Fluorodeoxyglucose-positron emission tomography (FDG-PET) showed abnormal accumulations in the tumor and the hilar and the supra-clavicular lymph nodes. Preoperatively, percutaneous needle biopsy of the tumor revealed thymic carcinoid. Tumor resection and thymectomy with mediastinal and supra-clavicular lymph nodes dissection were performed because of suspecting metastasis to the lymph nodes from FDG-PET. Postoperative pathological diagnosis revealed atypical carcinoid and metastases to the mediastinal and supra-clavicular lymph nodes. In our case, FDG-PET was useful in detecting the thymic carcinoid and lymph node metastasis. It is desirable to perform clinical research by many facilities for the assessment of FDG-PET as a diagnostic tool and postoperative chemo-radiation therapy for thymic carcinoid.     

Mediastinal lymph node metastasis of thyroid cancer occurring 15 years after the initial operation; report of a case

A 71-year-old woman was found to have an abnormal shadow on a chest X-ray. Fifteen years earlier she had undergone a subtotal thyroidectomy for thyroid cancer without any lymph node metastasis. Chest computed tomography (CT) revealed a mediastinal tumor with full of blood stream. Since the positron emission tomography (PET) disclosed an increased uptake of fluoro-2-deoxy-D-glucose (FDG) in the tumor, a malignant lymphatic tumor was therefore suspected. An immunohistological examination of biopsy specimens taken by thoracoscopic procedure demonstrated tumor to be lymph node metastasis of the previous thyroid cancer. After a tumor resection by means of a thoracotomy and total thyroidectomy, the patient was scheduled to receive radioiodine therapy. The previously reported cases are also herein reviewed.     

Mediastinal lymph-node carcinoma with no apparent primary lesion; report of a case

A 57-year-old woman was admitted to our department because of a chest X-ray showing a mass shadow about 40 mm in diameter in the right side of the middle of the mediastinum. A chest computed tomography(CT) scan demonstrated a large tumor, adherent to the superior vena cava and right pulmonary artery. No other metastases and no primary tumor were found. The tumor was resected through median sternotomy. Intraoperative frozen section analysis showed that the mediastinal tumor was a metastatic lymph-node carcinoma. Postoperative examination, too, did not detect the primary lesion. Radiotherapy was given after the operation. This case was thought to be a very rare case of T0N2M0 lung cancer or primary mediastinal lymph-node carcinoma (yolk sac tumor).     

Lymph node metastasis from melanoma with an unknown primary site

Twenty-six patients, treated surgically between 1961 and 1986 because of lymph node metastasis from melanoma with an unknown primary, were analysed. Six patients had a history of spontaneous regression of a skin lesion. Following node dissection, the overall actuarial disease-free survival rate was 49 per cent, after both 5 and 10 years. When considered as single factors, female (versus male), one lymph node involved (versus more than one node involved) and site of metastasis in the groin or axilla (versus the neck) were found to have significantly favourable effects on prognosis with 5-year survival rates of 82 per cent (25 per cent), 82 per cent (27 per cent) and 80 per cent (11 per cent) respectively. However, at multifactorial analysis only the site of cervical metastases maintained a significant influence on survival (P = 0.005). As survival in this series is comparable with, or even better than, that of adequately treated patients with lymph node metastasis from a known primary melanoma, a radical node dissection is essential also in these patients.     

Mediastinal lymph node metastasis of colon cancer: Report of a case

We herein describe a patient with mediastinal lymph node metastases which occurred after both a primary sigmoid colon cancer and metachronous ovarian metastasis had been resected. The most likely route of metastases to the mediastinum in this case is the paravertebral venous plexus probably connected to the ovarian metastasis, or so-called remetastasis. This case illustrates that the mediastinum is thus a possible metastatic site in patients with colon cancer. Surgeons should therefore pay attention to the mediastinum as well as the lung fields when checking chest X-ray films during a follow-up of patients after a resection of colon cancer.     

Mediastinal goiter; report of a case

A 76-year-old female was admitted to our hospital because of an abnormal shadow on chest computed tomography (CT) which showed the tumor extending from left lower end of the thyroid to the aortic window along the left side of the trachea, indicating the retrosternal goiter. Serum thyroid stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4) were within normal ranges. The tumor was resected through cervical collar incision and median sternotomy. The pathological diagnosis was an adenomatous goiter. The patient was discharged without complications.     

Castleman's disease of left interloblar lymph node; report of a case

A 21-year-old man developed an abnormal shadow of left hilum of the lung, discovered in an annual X-ray examination. The tumor grew 3 times in size as large as it had been 1 year before. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a homogenous mass lesion at the left interloblar portion of the left lung. CT revealed that the left pulmonary artery was markedly compressed by the tumor of left hilum. Surgical operation was performed under usual thoracotomy. The ligation of the branches of the left bronchial artery before tumor resection was very helpful to control bleeding from the tumor. We showed that a tumor of Castleman's disease may be resected without lobectomy of the lung or further procedures.     

Surgical treatment of lymph nodes with metastatic melanoma from unknown primary site

To determine the prognosis of patients with lymph node metastases from an unknown primary melanoma, we retrospectively reviewed the clinicopathologic features of 188 such patients treated from 1971 through 1986 and compared their records with those of patients with clinical stage II melanoma with known primary lesions. Patients with lymph node metastases from an unknown primary melanoma represented 4.6% of all patients with melanoma treated during that period. The five- and ten-year survival rates were 42% and 40%, respectively (median, 37 months). When stratified by number of tumor-containing lymph nodes, there was no significant difference in survival between patients with an unknown primary melanoma and lymph node metastases and those with clinical stage II melanoma and known primary sites. The prognosis of the former patients is no worse than that of patients with lymph node metastases from a known primary site and should be treated in a comparable manner.     

Dermatofibrosarcoma protuberans with regional lymph node metastasis: a case report

The case of a 21-year-old man with dermatofibrosarcoma protuberans of the scalp that spread to deep cervical lymph nodes is presented. Available literature is reviewed, and the infrequency of metastasis is discussed. Since cases of metastases almost always involve recurrent lesions, the importance of wide and deep resection in the initial operation cannot be overemphasized.     

Early gastric cancer with widespread lymph node metastases; A case report

The resected stomach from a 58-year old male patient showed a 4.3×3.2 cm, depressed (II c) lesion in the body, histology of which revealed moderately differentiated tubular adenocarcinoma with invasion reaching the submucosa. Widespread metastases of lymph nodes including superior mesenteric and para-aortic ones were noted. The patient once worked in a mustard gas (Yperite) factory, and had chronic bronchitis. The exposure to this toxic substance was discussed in relation to the diffuse metastases of cancer.     

Mediastinal cystic lymphangioma; report of a case

A cystic lymphangioma is a rare mediastinal benign tumor. A 38-year-old male was referred to our hospital because of an mediastinal mass incidentally detected on chest X-ray. The mass had enlarged rapidly during the course of 1 year. Computed tomography (CT) of the chest showed a 7 cm well defined cystic tumor in the left anterior mediastinum. Magnetic resonance imaging (MRI) demonstrated a mass with heterogeneous high signal intensity on enhanced T2-weighted images. The cystic tumor, localized in the mediastinal adipose tissue, was completely resected by a thoracoscopic procedure. A pathological examination confirmed the diagnosis of a cystic lymphangioma.