Yajima Toshiki, Onozato Ryoichi, Shitara Yoshinori, Mogi Akira, Tanaka Shigebumi, Kuwano Hiroyuki
Department of General Surgical Science (Surgery I), Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, 371-8511, Maebashi-shi, Gunma, Japan.
BMC Res Notes. 2013 Dec 27;6:558. doi: 10.1186/1756-0500-6-558.
Cervicomediastinal lymph node carcinoma with an unknown primary site is quite rare, and useful treatment of these diseases has not been established. We report here the case of a patient successfully treated with TS-1 alone after the relapse of cervicomediastinal lymph node carcinoma with an unknown primary site.
A 62-year-old man was referred to our hospital because of cervicomediastinal lymph node swelling and high serum levels of carbohydrate antigen 19-9 and carcinoembryonic antigen. Fluorodeoxyglucose-positron emission tomography/computed tomography revealed an accumulation of fluorodeoxyglucose in the left supraclavicular lymph nodes, mediastinal lymph nodes, and the pelvic cavity. Colonoscopy revealed rectal cancer, which was diagnosed by biopsy as a tubular adenocarcinoma. Because metastases from rectal cancer to the cervicomediastinal lymph nodes are rare, the patient underwent thoracoscopic mediastinal lymphadenectomy. A biopsy specimen from the paraaortic lymph nodes demonstrated papillary adenocarcinoma that was pathologically different from the rectal cancer; therefore, a diagnosis of mediastinal carcinoma with an unknown primary site was established. The patient underwent low anterior resection of the rectum for the rectal cancer, and no abdominal lymph node metastasis (pMP, N0/stage I) was found. Although radiotherapy was performed for the cervicomediastinal lymph nodes, the mediastinal carcinoma relapsed after 6 months. Because the patient desired oral chemotherapy on an outpatient basis, TS-1 was administered at a dosage of 80 mg/day for 2 weeks, followed by a 1-week rest. TS-1 treatment resulted in a decrease in the size of the cervicomediastinal lymph nodes, and the serum tumor marker levels decreased to normal after the fourth course. The patient continued TS-1 treatment without adverse events and is currently alive without recurrence or identification of the primary site at the 32nd month after TS-1 treatment.
This is the first reported case of relapsed cervicomediastinal lymph node carcinoma with an unknown primary site treated by TS-1 alone. TS-1 treatment for the carcinoma with an unknown primary site may be useful in patients who are not candidates for systemic platinum-based chemotherapy.
原发部位不明的颈纵隔淋巴结癌十分罕见，且尚未确立针对这类疾病的有效治疗方法。在此，我们报告一例原发部位不明的颈纵隔淋巴结癌复发后仅接受替吉奥（TS-1）治疗而成功治愈的患者病例。
一名62岁男性因颈纵隔淋巴结肿大以及血清中糖类抗原19-9和癌胚抗原水平升高而转诊至我院。氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描显示左锁骨上淋巴结、纵隔淋巴结及盆腔内有氟脱氧葡萄糖聚集。结肠镜检查发现直肠癌，经活检诊断为管状腺癌。由于直肠癌转移至颈纵隔淋巴结较为罕见，该患者接受了胸腔镜纵隔淋巴结切除术。腹主动脉旁淋巴结活检标本显示为乳头状腺癌，其病理特征与直肠癌不同；因此，确诊为原发部位不明的纵隔癌。该患者因直肠癌接受了直肠低位前切除术，未发现腹部淋巴结转移（pMP，N0/Ⅰ期）。尽管对颈纵隔淋巴结进行了放射治疗，但纵隔癌在6个月后复发。由于患者希望在门诊接受口服化疗，遂给予替吉奥，剂量为80mg/天，连用2周，随后休息1周。替吉奥治疗使颈纵隔淋巴结缩小，血清肿瘤标志物水平在第4疗程后降至正常。患者继续接受替吉奥治疗且未出现不良事件，在替吉奥治疗后第32个月，目前仍存活，未复发且原发部位仍未明确。
这是首例关于原发部位不明的复发性颈纵隔淋巴结癌仅接受替吉奥治疗的报道病例。替吉奥治疗对于不适合接受全身性铂类化疗的原发部位不明的癌症患者可能有效。
