Watanabe Yoshifumi, Suzuki Rei, Kinoshita Mitsuru, Hirota Masashi
Department of Surgery, Hoshigaoka Medical Center, Hirakata, Osaka 573-8511, Japan.
Mol Clin Oncol. 2022 Jun 20;17(2):128. doi: 10.3892/mco.2022.2561. eCollection 2022 Aug.
Colorectal cancer commonly metastasizes to the regional lymph nodes, liver, lungs and peritoneum. At present, mediastinal lymph node metastasis from colorectal cancer is uncommon and poorly understood. The present study reported a case of solitary anterior mediastinal lymph node metastasis with pericardial invasion from transverse colon cancer. An 82-year-old woman had a history of colectomy with regional lymph node dissection for transverse colon cancer (T1N1bM0 stage IIIA in the UICC classification). The patient had no symptoms, but follow-up contrast-enhanced computed tomography revealed an anterior mediastinal tumor compressing the heart 18 months after colectomy. The tumor showed fluorodeoxyglucose uptake on positron emission tomography. Resection of the anterior mediastinal tumor with pericardiectomy was performed. The tumor was 35x25 mm in size and was histopathologically characterized to be adenocarcinoma. These cells expressed cytokeratin (CK)20 and caudal-type homeobox protein 2 but not CK7 and thyroid transcription factor 1 on immunohistochemical analysis, confirming a diagnosis of metachronous mediastinal metastasis originating from colon cancer. The tumor cells invaded the adjacent pericardium and diaphragm pathologically. The patient has lived without recurrence 8 months after the surgery for mediastinal metastasis. In conclusion, clinicians should consider metastasis to the mediastinum during follow-up in patients with colorectal cancer. Surgery may be the most reliable treatment for solitary anterior mediastinal lymph node metastasis, preventing carcinomatous pericarditis through direct pericardial invasion.
结直肠癌通常会转移至区域淋巴结、肝脏、肺和腹膜。目前，结直肠癌发生纵隔淋巴结转移的情况并不常见，且人们对此了解甚少。本研究报告了一例横结肠癌伴心包侵犯的孤立性前纵隔淋巴结转移病例。一名82岁女性有横结肠癌行结肠切除术及区域淋巴结清扫术的病史（根据国际抗癌联盟分类为IIIA期T1N1bM0）。患者无症状，但术后18个月的随访增强计算机断层扫描显示前纵隔肿瘤压迫心脏。该肿瘤在正电子发射断层扫描上显示氟脱氧葡萄糖摄取。进行了前纵隔肿瘤切除并心包切除术。肿瘤大小为35×25mm，组织病理学特征为腺癌。免疫组织化学分析显示这些细胞表达细胞角蛋白（CK）20和尾型同源盒蛋白2，但不表达CK7和甲状腺转录因子1，证实为源自结肠癌的异时性纵隔转移。肿瘤细胞在病理上侵犯了相邻的心包和膈肌。该患者在纵隔转移手术后8个月无复发存活。总之，临床医生在结直肠癌患者的随访过程中应考虑纵隔转移的可能性。手术可能是治疗孤立性前纵隔淋巴结转移最可靠的方法，可通过直接侵犯心包来预防癌性心包炎。
