Sawada M, Ohdama S, Umino T, Tachibana S, Takano S, Miyake S, Yoshizawa Y, Aoki N, Matsubara O
First Department of Internal Medicine, Tokyo Medical and Dental University, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1994 Sep;32(9):867-72.
A 67-year-old woman was admitted to our hospital because of fever. Chest roentgenogram showed an enlargement of mediastinal lymph nodes. Despite thorough examination, no definite diagnosis could be made. The mediastinal lymph nodes got smaller over the next 3 weeks and a chest roentgenogram taken 4 months later showed no mediastinal lymphadenopathy. The mediastinal lymphadenopathy and fever recurred 5 months later. She underwent thoracotomy and the mediastinal lymph nodes were excised. Microscopic examination of pretracheal lymph node specimens showed invasion of poorly differentiated adenocarcinoma associated with abundant tumor-infiltrating lymphocytes. The other lymph nodes showed sarcoid reaction. Although she has been followed for one year and 11 months, no primary site of the cancer has been found. Metastasis of cancer of unknown origin to mediastinal lymph nodes is extremely rare. It is also interesting that the lymph node swelling diminished spontaneously. The tumor-infiltrating lymphocytes and sarcoid reactions may have been immunological responses to the cancer and may have caused the transient regression.
一名67岁女性因发热入院。胸部X线片显示纵隔淋巴结肿大。尽管进行了全面检查，但仍无法明确诊断。在接下来的3周内，纵隔淋巴结变小，4个月后拍摄的胸部X线片显示无纵隔淋巴结病。5个月后，纵隔淋巴结病和发热再次出现。她接受了开胸手术，切除了纵隔淋巴结。气管前淋巴结标本的显微镜检查显示为低分化腺癌浸润，伴有大量肿瘤浸润淋巴细胞。其他淋巴结显示为结节病反应。尽管对她进行了1年11个月的随访，但尚未发现癌症的原发部位。不明来源癌症转移至纵隔淋巴结极为罕见。同样有趣的是，淋巴结肿大自行消退。肿瘤浸润淋巴细胞和结节病反应可能是对癌症的免疫反应，可能导致了短暂的消退。
