Kwak Hyunjee V, Banks Kian C, Hsu Diana S, Debbaneh Peter M, Wang Kevin H, Velotta Jeffrey B
Department of Surgery, University of California San Francisco-East Bay, Oakland, CA, USA.
Department of Otolaryngology, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA.
AME Case Rep. 2022 Jul 25;6:29. doi: 10.21037/acr-22-23. eCollection 2022.
Paratracheal lymph nodes can be sites of metastasis for a variety of malignancies, but these metastases are treated differently depending on the tissue of origin. We describe a patient who underwent combined thoracoscopic and cervical resection of a multinodular goiter who was found to have incidental lung adenocarcinoma in an adjacent paratracheal lymph node despite having no pulmonary nodules.
A 62-year-old male with longstanding substernal multinodular goiter presented to his primary care doctor with continued growth of his goiter. After repeatedly declining surgery, he became amenable to resection and underwent right video-assisted thoracoscopic and cervical approaches. An incidentally found separate large right paratracheal lymph node was also discovered and completely resected. Final pathology of the thyroid mass revealed hyperplastic thyroid nodules consistent with a benign goiter. However, the separate right paratracheal lymph node revealed a thyroid transcription factor 1-positive (TTF-1) specimen concerning for lung adenocarcinoma in the absence of pulmonary nodules on imaging.
Noteworthy to this case is the minimally invasive thoracoscopic approach preventing the need for median sternotomy and preventing any increased morbidity for the patient's incidentally found TxN3M0 lung adenocarcinoma. The patient could have been spared resection of the lymph node given its pulmonary origin as the standard of care for stage IIIB non-small cell lung cancer is definitive chemoradiation and adjuvant immunotherapy.
气管旁淋巴结可能是多种恶性肿瘤的转移部位，但这些转移灶的治疗方式会因原发组织不同而有所差异。我们描述了一名接受胸腔镜和颈部联合切除术治疗多结节性甲状腺肿的患者，该患者尽管肺部无结节，但在相邻的气管旁淋巴结中意外发现了肺腺癌。
一名62岁男性，患有长期胸骨后多结节性甲状腺肿，因甲状腺肿持续增大就诊于他的初级保健医生。在多次拒绝手术后，他同意接受手术，并采用了右侧电视辅助胸腔镜和颈部入路。术中还意外发现并完整切除了一个单独的右侧气管旁大淋巴结。甲状腺肿块的最终病理显示为增生性甲状腺结节，符合良性甲状腺肿。然而，单独的右侧气管旁淋巴结病理显示甲状腺转录因子1阳性（TTF-1），在影像学检查肺部无结节的情况下，考虑为肺腺癌。
该病例值得注意的是，微创胸腔镜手术避免了正中开胸的需要，并且对于患者意外发现的TxN3M0肺腺癌没有增加任何发病率。鉴于该淋巴结的肺源性，按照标准治疗，IIIB期非小细胞肺癌的标准治疗是确定性放化疗和辅助免疫治疗，该患者本可不必切除该淋巴结。
