Shiota Yutaro, Imai Shigeo, Sasaki Naomi, Tahara Koo, Noma Bunjiro, Horita Naokatsu, Taniguchi Akihiko, Ono Tetsuya
Department of Internal Medicine, Kure Kyosai Hospital, Kure, Hiroshima 737-8505, Japan.
Acta Med Okayama. 2011 Dec;65(6):407-11. doi: 10.18926/AMO/47267.
Mediastinal lymph node carcinoma of unknown primary site is rare and may have a better prognosis if extensive treatment is performed. Case, A 69-year-old-male presented with a persistent cough. Chest computed tomography (CT) demonstrated a large tumor 9.5 × 8.2 cm, in the mediastinum, compressing the right main bronchus, the right pulmonary artery, and the superior vena cava. Because fiberoptic bronchoscopy was insufficient for diagnosis, mediastinoscopic tumor biopsy under general anesthesia was undertaken. Histological examination revealed adenocarcinoma. Extensive examinations revealed no other neoplastic lesion except in the mediastinum. Mediastinal lymph node carcinoma of unknown primary site was diagnosed. The patient was treated with docetaxel and cisplatin with concurrent thoracic radiation therapy. A month after the start of chemoradiotherapy, the mediastinal tumor regressed markedly. The patient remained free of symptoms without regrowth of the primary site. Exploration of the body showed no further abnormalities 20 months after disease onset.
原发部位不明的纵隔淋巴结癌较为罕见，如果进行广泛治疗，预后可能较好。病例：一名69岁男性，持续咳嗽。胸部计算机断层扫描（CT）显示纵隔有一个9.5×8.2 cm的大肿瘤，压迫右主支气管、右肺动脉和上腔静脉。由于纤维支气管镜检查不足以明确诊断，遂在全身麻醉下进行纵隔镜肿瘤活检。组织学检查显示为腺癌。广泛检查发现除纵隔外无其他肿瘤性病变。诊断为原发部位不明的纵隔淋巴结癌。患者接受了多西他赛和顺铂联合胸部放射治疗。放化疗开始一个月后，纵隔肿瘤明显缩小。患者无症状，原发部位未再生长。发病20个月后全身检查未发现进一步异常。
