Kajiura Koichiro, Taniguchi Haruki, Ishimine Tomonari, Nakamura Kei, Ishigaki Masanobu, Fukumoto Taizo
Department of Thoracic Center, Urasoe General Hospital.
Department of Digestive Surgery, Urasoe General Hospital.
J Med Invest. 2018;65(3.4):283-285. doi: 10.2152/jmi.65.283.
Solitary abdominal paraaortic lymph node recurrence after radical lung cancer surgery is very rare. Here, we report a case of a solitary abdominal paraaortic lymph node recurrence of lung squamous cell carcinoma (SCC). A 63-year-old man was diagnosed with lung SCC (cT1cN0M0 stage IA3), underwent a video-assisted right lower lobectomy (ND2a-1), and the pathological findings showed SCC (pT1cN0M0 stage IA3). The EGFR mutation and ALK translocation statuses of SCC were negative, and adjuvant therapy was not performed. Follow-up positron emission tomography - computed tomography (PET/CT) showed a solitary fluorodeoxyglucose (FDG)-concentrated region in the swollen paraaortic lymph node. A paraaortic lymph node biopsy was performed by open laparotomy, to determine the precise diagnosis and identify the genetic status. Pathological findings revealed that the paraaortic lymph node contained poorly differentiated SCC, which was thought to metastasize from the lung cancer. The genetic status of the lymph node recurrence revealed a lack of EGFR mutations, ALK translocations, and ROS1 mutations, while the tumor proportion score (TPS) of PD-L1 was 55%, and we therefore administered pembrolizumab, an immune checkpoint inhibitor. Biopsies are very important for achieving precise diagnoses and determining the genetic statuses of tumors, since molecular-targeting drugs and immune checkpoint inhibitors are available. J. Med. Invest. 65:283-285, August, 2018.
肺癌根治术后孤立性腹主动脉旁淋巴结复发非常罕见。在此，我们报告一例肺鳞状细胞癌（SCC）孤立性腹主动脉旁淋巴结复发的病例。一名63岁男性被诊断为肺SCC（cT1cN0M0，IA3期），接受了电视辅助右下叶切除术（ND2a-1），病理结果显示为SCC（pT1cN0M0，IA3期）。SCC的表皮生长因子受体（EGFR）突变和间变性淋巴瘤激酶（ALK）易位状态均为阴性，未进行辅助治疗。随访的正电子发射断层扫描-计算机断层扫描（PET/CT）显示腹主动脉旁肿大淋巴结中有一个孤立的氟脱氧葡萄糖（FDG）浓聚区。通过开放剖腹术进行腹主动脉旁淋巴结活检，以明确诊断并确定基因状态。病理结果显示腹主动脉旁淋巴结含有低分化SCC，考虑为肺癌转移所致。淋巴结复发的基因状态显示不存在EGFR突变、ALK易位和ROS1突变，而程序性死亡受体配体1（PD-L1）的肿瘤比例评分（TPS）为55%，因此我们给予了免疫检查点抑制剂派姆单抗。活检对于实现精确诊断和确定肿瘤的基因状态非常重要，因为有分子靶向药物和免疫检查点抑制剂可供使用。《医学调查杂志》65:283 - 285，2018年8月。
