Morimoto Tomonori, Hisamori Shigeo, Kinoshita Hiromitsu, Yamada Yosuke, Teramoto Yuki, Sakamoto Takashi, Kasahara Keiko, Okumura Shintaro, Nishigori Tatsuto, Tsunoda Shigeru, Obama Kazutaka
Department of Gastrointestinal Surgery, Kyoto University Hospital, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan.
Department of Diagnostic Pathology, Kyoto University Hospital, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan.
Surg Case Rep. 2024 Apr 18;10(1):91. doi: 10.1186/s40792-024-01888-9.
Even in cancer of unknown primary (CUP), which is rare clinical condition, solitary anterosuperior lymph node (LN) along the common hepatic artery (No.8a LN) enlargement diagnosed as metastatic adenocarcinoma has never been reported.
A 68-year-old Japanese male, with a history of early gastric cancer that had been completely treated by endoscopic submucosal dissection 26 years ago, was detected a single enlarged nodule along the common hepatic artery, No.8a LN, incidentally by computed tomography performed for monitoring of interstitial pneumonia. Endoscopic ultra-sound-guided fine needle aspiration revealed that this nodule was adenocarcinoma suggestive of metastasis, but other imaging studies, including upper and lower gastrointestinal endoscopy, positron emission tomography, and ultrasonography did not detect any primary cancer. We have finally diagnosed as the LN metastasis of CUP and performed laparoscopic lymphadenectomy for this tumor. The tumor was approximately 5 cm in size, was in close proximity to the pancreas, and involved part of the right gastric artery and vein. LNs in the No.5 and No.8a areas, including this tumor, were dissected laparoscopically, and radical resection was achieved. The patient had no postoperative complication and was discharged on postoperative day 10. Immunohistopathological findings revealed that the tumor was poorly differentiated adenocarcinoma, and different from the histology of gastric cancer resected 26 years ago, although the tumor was suggestive of gastrointestinal origin. Imaging studies performed 2 and 6 months after discharge also did not reveal a primary site.
We reported a case of solitary No.8a LN adenocarcinoma of CUP. For diagnostic and therapeutic purposes, radical resection is recommended for single enlarged intra-abdominal LN of CUP.
即使在原发性不明的癌症（CUP）这种罕见的临床情况下，沿肝总动脉的孤立性前上淋巴结（LN，第8a组LN）肿大并诊断为转移性腺癌的情况此前从未有过报道。
一名68岁的日本男性，26年前曾因早期胃癌接受内镜下黏膜下剥离术并已完全治愈，此次因监测间质性肺炎进行计算机断层扫描时，偶然发现肝总动脉旁有一个肿大的结节，即第8a组LN。内镜超声引导下细针穿刺显示该结节为提示转移的腺癌，但包括上、下消化道内镜检查、正电子发射断层扫描和超声检查在内的其他影像学检查均未发现任何原发性癌症。我们最终诊断为CUP的LN转移，并对该肿瘤进行了腹腔镜淋巴结切除术。肿瘤大小约5厘米，紧邻胰腺，累及部分胃右动脉和静脉。包括该肿瘤在内的第5和第8a区域的LN通过腹腔镜进行了清扫，实现了根治性切除。患者术后无并发症，术后第10天出院。免疫组织病理学检查结果显示，该肿瘤为低分化腺癌，虽然提示为胃肠道起源，但与26年前切除的胃癌组织学不同。出院后2个月和6个月进行的影像学检查也未发现原发部位。
我们报告了一例CUP的孤立性第8a组LN腺癌病例。出于诊断和治疗目的，对于CUP的单个腹腔内肿大LN，建议进行根治性切除。
