Marcantonio D R, Libshitz H I
University of Texas M.D. Anderson Cancer Center, Diagnostic Radiology Department, Houston 77030, USA.
Cancer. 1995 Sep 1;76(5):803-6. doi: 10.1002/1097-0142(19950901)76:5<803::aid-cncr2820760514>3.0.co;2-0.
Metastasis of bronchogenic carcinoma to axillary lymph nodes is rare. The pathways and possible significance of axillary lymph node metastasis from bronchogenic carcinoma were investigated.
Seventeen patients with probable axillary lymph node metastases from bronchogenic carcinoma were identified by computed tomography. There were 15 nonsmall cell lung cancers and 2 small cell lung cancers. Axillary lymph node metastasis was proven by biopsy in six cases. Metastases were presumed because of an increase in the size of axillary lymph nodes compared with prior studies in six patients and enlarged axillary lymph nodes associated with biopsy-proven ipsilateral supraclavicular lymph node metastasis in five patients.
Four of 10 right-sided lung cancers had ipsilateral and six had contralateral axillary lymph node metastases. Six of seven left-sided cancers had ipsilateral and one had contralateral axillary lymph node metastases. Patients with ipsilateral lymph node disease had chest wall involvement and/or supraclavicular and mediastinal lymph node metastases. All seven patients with contralateral axillary lymph node metastases had supraclavicular and/or mediastinal lymph node metastases.
Bronchogenic carcinoma may involve ipsilateral axillary lymph nodes via either chest wall invasion or retrograde spread from supraclavicular lymph nodes. Contralateral axillary lymph node involvement requires involvement of contralateral mediastinal and supraclavicular lymph nodes with retrograde spread to the axillary lymph nodes.
支气管源性癌转移至腋窝淋巴结较为罕见。本研究对支气管源性癌腋窝淋巴结转移的途径及可能意义进行了调查。
通过计算机断层扫描确定了17例可能存在支气管源性癌腋窝淋巴结转移的患者。其中非小细胞肺癌15例，小细胞肺癌2例。6例经活检证实有腋窝淋巴结转移。6例患者因腋窝淋巴结较之前检查增大而推测有转移，5例患者因腋窝淋巴结肿大且同侧锁骨上淋巴结活检证实有转移。
10例右侧肺癌中4例有同侧腋窝淋巴结转移，6例有对侧腋窝淋巴结转移。7例左侧肺癌中6例有同侧腋窝淋巴结转移，1例有对侧腋窝淋巴结转移。同侧淋巴结受累的患者有胸壁侵犯和/或锁骨上及纵隔淋巴结转移。所有7例有对侧腋窝淋巴结转移的患者均有锁骨上和/或纵隔淋巴结转移。
支气管源性癌可能通过胸壁侵犯或从锁骨上淋巴结逆行扩散累及同侧腋窝淋巴结。对侧腋窝淋巴结受累需要对侧纵隔和锁骨上淋巴结受累并逆行扩散至腋窝淋巴结。
