Hashimoto Kohei, Ohtsuka Takashi, Kohno Mitsutomo, Izumi Yotaro, Horinouchi Hirohisa, Hayashi Yuichiro, Nakahara Tadaki, Nomori Hiroaki
Division of General Thoracic Surgery, Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
Gen Thorac Cardiovasc Surg. 2012 Apr;60(4):240-3. doi: 10.1007/s11748-011-0917-7. Epub 2012 Mar 28.
A 47-year-old woman with a lung adenocarcinoma of 1.3 cm located in the left S9+10 was treated by S9+10 segmentectomy with sentinel node (SN) identification using radioisotopes. During segmentectomy, frozen section of the segmental nodes at S9+10 and S6, identified as SNs, did not show metastasis; however, postoperative immunohistochemical staining with cytokeratin revealed isolated tumor cells in the segmental node at S6. None of the other dissected nodes, including the hilar, interlobar, and mediastinal nodes, showed metastasis, even with immunohistochemical staining. Completion lobectomy was conducted 6 days after segmentectomy, and the resected specimens did not show further metastasis. The final pathological diagnosis was adenocarcinoma with pT1aN0(i+)M0 stage A. The present case was indicative of the importance of dissecting the segmental lymph node located not only at the tumor-bearing segment but also at the neighboring segment, especially the one located between the primary tumor and the lobar bronchi.
一名47岁女性，左肺S9+10区有一个1.3厘米的肺腺癌，接受了S9+10段切除术，并使用放射性同位素识别前哨淋巴结（SN）。在段切除术中，被确定为SN的S9+10和S6段的节段性淋巴结冰冻切片未显示转移；然而，术后细胞角蛋白免疫组化染色显示S6段的节段性淋巴结中有孤立肿瘤细胞。包括肺门、叶间和纵隔淋巴结在内的其他切除淋巴结，即使进行免疫组化染色也未显示转移。段切除术后6天进行了全肺叶切除术，切除标本未显示进一步转移。最终病理诊断为pT1aN0(i+)M0 A期腺癌。本病例表明，不仅要切除肿瘤所在节段的节段性淋巴结，还要切除相邻节段，特别是位于原发肿瘤和叶支气管之间节段的节段性淋巴结，这一点很重要。
