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Zhang C, Ye G, Wang X, Huang Y, Huang Q, Liao Y. Primary lung adenocarcinoma harboring upper mediastinal lymphatic skip metastasis of cervical squamous cell carcinoma: A case report and literature review. Oncol Lett 2024; 28:481. [PMID: 39161330 PMCID: PMC11332576 DOI: 10.3892/ol.2024.14614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 06/25/2024] [Indexed: 08/21/2024] Open
Abstract
The upper mediastinal lymph nodes are a rare site of metastasis in early-stage cervical cancer, but they are a common site of metastasis in lung cancer. Notably, standard approaches for identifying the source of metastasis and subsequent treatment are currently lacking. The present study describes the case of a patient with primary lung adenocarcinoma harboring upper mediastinal lymphatic skip metastasis from cervical squamous cell carcinoma 2 years after a radical hysterectomy. During video-assisted thoracoscopic surgery, it was indicated that the patient had a tendency for metastasis to the upper mediastinal lymph nodes from the lung tumor. Pathological examination confirmed the presence of metastasis; however, it was confirmed to originate from cervical carcinoma, rather than lung adenocarcinoma. In conclusion, for patients with lung cancer and concurrent malignancies, metastatic lymph nodes discovered during surgery may originate from the previous malignancy. Surgical management of oligometastatic lymph nodes in the mediastinum can be a potential treatment option, albeit one that may necessitate the integration of adjuvant treatment modalities as warranted by the individual case.
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Affiliation(s)
- Chi Zhang
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Guanchao Ye
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Xiaojun Wang
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Yu Huang
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Quanfu Huang
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Yongde Liao
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
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Abstract
Lymph node (LN) removal during pulmonary metastasectomy is a prerequisite to achieve complete resection or at least collect prognostic information, but is not yet generally accepted. On average, the rate of unexpected lymph node involvement (LNI) is less than 10% in sarcoma, 20% in colorectal cancer (CRC) and 30% in renal cell carcinoma (RCC) when radical LN dissection is performed. LNI is a negative prognostic factor and presence of preoperative mediastinal disease usually leads to exclusion of the patient from metastasis surgery. Nonetheless, some authors found excellent prognoses even with mediastinal LNI in colorectal and RCC metastases when radical LN dissection was performed (median survival of 37 and 36 months, respectively). Multiple metastases, central location of the lesion followed by anatomical resections are associated with a higher LNI rate. The real prognostic influence of systematic LN dissection remains unclear. Two positive effects were described after radical lymphadenectomy: a trend for improved survival in RCC patients and a reduction of mediastinal recurrences from 23% to 0% in CRC patients. Unfortunately, there is a great number of studies that do not demonstrate any positive effect of lymphadenectomy during pulmonary metastasectomy except a pseudo stage migration effect. Future studies should not only focus on survival, but also on local and LN recurrence.
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Affiliation(s)
- Stefan Welter
- Department of Thoracic Surgery, Lung Clinic Hemer, Theo-Funccius-Str. 1, 58675 Hemer, Germany
| | - Varun Gupta
- Department of Thoracic Surgery, Lung Clinic Hemer, Theo-Funccius-Str. 1, 58675 Hemer, Germany
| | - Ioannis Kyritsis
- Department of Thoracic Surgery, Lung Clinic Hemer, Theo-Funccius-Str. 1, 58675 Hemer, Germany
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Lin H, Zhang H, Cheng Y, Zhang C. Solitary Metastasis in the Mediastinal Lymph Node After Radical Nephrectomy for Clear Cell Renal Cell Carcinoma: A Case Report and Literature Review. Front Oncol 2020; 10:593142. [PMID: 33392088 PMCID: PMC7773822 DOI: 10.3389/fonc.2020.593142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 11/17/2020] [Indexed: 12/04/2022] Open
Abstract
Background Renal cell carcinoma can metastasize to virtually any anatomical site throughout the body, especially the lung, bone, lymph nodes, liver, and brain. However, it is extremely rare for renal cell carcinoma to metastasize solely to the mediastinal lymph node more than 15 years after radical nephrectomy. Case Presentation The case we present here is that of a 50-year-old Chinese male with an isolated posterior mediastinal lymph node metastasis of clear cell renal cell carcinoma 16 years after radical nephrectomy. However, based on imaging examination, the mass was clinically misdiagnosed as Castleman’s disease before operation. Following surgical excision of the mass, it was finally judged to be a metastasis from clear cell renal cell carcinoma according to the patient’s medical history and immunohistochemical findings. Currently, there is no clinical or radiological finding the recurrence of metastasis after 10 months of follow-up. Conclusion We report a case of solitary metastasis in the posterior mediastinal lymph node 16 years after radical nephrectomy for clear cell renal cell carcinoma. Given the long disease-free interval between primary renal cell carcinoma to isolated mediastinal lymph node metastasis, it is important to conduct a lifelong regular follow-up, including thoracic computed tomography. In addition, surgical resection remains the best method of treatment for mediastinal lymph node metastases from clear cell renal cell carcinoma if the metastatic lesion is limited.
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Affiliation(s)
- Hang Lin
- Department of Thoracic Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Heng Zhang
- Department of Thoracic Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Yuanda Cheng
- Department of Thoracic Surgery, Xiangya Hospital, Central South University, Changsha, China.,Human Engineering Research Center for Pulmonary Nodules Precise Diagnosis and Treatment, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha, China
| | - Chunfang Zhang
- Department of Thoracic Surgery, Xiangya Hospital, Central South University, Changsha, China.,Human Engineering Research Center for Pulmonary Nodules Precise Diagnosis and Treatment, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha, China
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Sponholz S, Schirren M, Oguzhan S, Mese M, Schirren J. Long-term Outcome After Resection of Isolated Thoracic Lymph Node Metastases of Renal Cell Cancer. Ann Thorac Surg 2019; 109:262-269. [PMID: 31499030 DOI: 10.1016/j.athoracsur.2019.07.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/16/2019] [Accepted: 07/19/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Isolated thoracic lymph node metastases (ITLNMs) without any lung metastases of renal cell cancer are rare. Other than a few case reports and one study, there is no further literature on ITLNMs. For this reason, the goal of this study was to analyze our experiences, the long-term survival outcomes, and recurrence-free survival outcomes after the resection of ITLNMs. METHODS We analyzed our database of 15 patients with ITLNMs who underwent metastasectomy by systematic lymph node dissection from 2003 to 2017. The long-term outcomes and survival curves were analyzed with the Kaplan-Meier method. RESULTS The median disease-free interval between primary cancer and ITLNM was 40 months (range, 0-171 months). The R0 resection rate was 93.3% (n = 14). There was one R2 resection, which was due to a tracheal and left main bronchial infiltration. The postoperative morbidity and 30-day mortality rates were 13.3% and 0%, respectively. Altogether, 14 patients were included in the long-term follow-up with a median follow-up time of 35.5 months (range, 2-108 months). The 1-, 3-, and 5-year survival rates were 93%, 73%, and 73%, respectively. The median overall progression-free survival after metastasectomy was 18 months (95% confidence interval, 8.6-27.4 months), and the 5-year local recurrence-free rate was 65%. CONCLUSIONS Because of the long disease-free interval between primary cancer and ITLNM, a long oncologic follow-up that includes chest images should be mandatory. Altogether, metastasectomy of ITLNMs is feasible with low morbidity and mortality rates and might be associated with promising survival rates. Early detection and resection of ITLNMs may avoid severe complications.
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Affiliation(s)
- Stefan Sponholz
- Department of Thoracic Surgery, Agaplesion Markus Krankenhaus, Frankfurt, Germany.
| | - Moritz Schirren
- Department of Thoracic Surgery, Agaplesion Markus Krankenhaus, Frankfurt, Germany
| | - Selma Oguzhan
- Department of Thoracic Surgery, Agaplesion Markus Krankenhaus, Frankfurt, Germany
| | - Mesut Mese
- Department of Thoracic Surgery, Agaplesion Markus Krankenhaus, Frankfurt, Germany
| | - Joachim Schirren
- Department of Thoracic Surgery, Agaplesion Markus Krankenhaus, Frankfurt, Germany
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Val-Bernal JF, Martino M, Romay F, Yllera E. Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of mediastinal metastases of clear cell renal cell carcinoma. Pathol Res Pract 2018; 214:949-956. [PMID: 29807776 DOI: 10.1016/j.prp.2018.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 05/19/2018] [Accepted: 05/20/2018] [Indexed: 12/20/2022]
Abstract
Evaluation of mediastinal lymphadenopathy in patients with a previous diagnosis of renal cell carcinoma (RCC) is critical for the determination of further treatment. A minimally invasive method of cytology sampling of mediastinal lymph nodes using endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as a useful tool in diagnosis. Between January 2010 and April 2018, we performed 1744 EBUS-TBNA studies of mediastinal and hilar lymph nodes for a variety of clinical indications including mediastinal malignancy. Sixteen patients (93.7% males, mean age 59.1 years, range 44-81 years) were diagnosed by cytological and cell block study to have metastatic clear cell RCC. Twelve patients had been diagnosed with clear cell RCC in the past (mean 39 months, range 4-89 months) while in four, the tumor was primarily diagnosed in the staging phase on the basis of EBUS-TBNA. The EBUS features of the mediastinal nodal masses included increase of size (mean 2.5 cm, range 1.6-3.8 cm), irregular, inhomogeneous, hypervascular, and hyperechoic echotexture. EBUS-TBNA is a procedure safe and effective for evaluating mediastinal lymphadenopathy in patients with clear cell RCC. Immunohistochemistry in the cell block is decisive for proper diagnosis. The cytologist plays a key role in the diagnosis of metastatic clear cell RCC due to the treatment implications that this neoplasm encompasses.
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Affiliation(s)
- José-Fernando Val-Bernal
- Pathology Unit, Medical and Surgical Sciences Department, University of Cantabria and IDIVAL Research Institute, Santander, Spain.
| | - María Martino
- Anatomical Pathology Service, Marqués de Valdecilla University Hospital, University of Cantabria and IDIVAL Research Institute, Santander, Spain
| | - Félix Romay
- Neumology Service, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Elena Yllera
- Radiodiagnostic Service, Marqués de Valdecilla University Hospital, Santander, Spain
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Liu B, Li Y, Wang Y, Wang W, Wang L, Hertzanu Y, Wang J, Zhang F. 125Iodine brachytherapy via a trans-superior vena cava approach in patients with metastases in middle mediastinal lymph nodes: a novel approach. Asia Pac J Clin Oncol 2016; 13:219-225. [PMID: 27682313 DOI: 10.1111/ajco.12604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Bin Liu
- Department of Interventional Medicine; The Second Hospital of Shandong University; Jinan Shandong Province China
- Interventional Oncology Institute of Shandong University; Jinan Shandong Province China
| | - Yuliang Li
- Department of Interventional Medicine; The Second Hospital of Shandong University; Jinan Shandong Province China
- Interventional Oncology Institute of Shandong University; Jinan Shandong Province China
| | - Yongzheng Wang
- Department of Interventional Medicine; The Second Hospital of Shandong University; Jinan Shandong Province China
- Interventional Oncology Institute of Shandong University; Jinan Shandong Province China
| | - Wujie Wang
- Department of Interventional Medicine; The Second Hospital of Shandong University; Jinan Shandong Province China
- Interventional Oncology Institute of Shandong University; Jinan Shandong Province China
| | - Lili Wang
- Department of Interventional Medicine; The Second Hospital of Shandong University; Jinan Shandong Province China
| | - Yancu Hertzanu
- Department of Interventional Medicine; The Second Hospital of Shandong University; Jinan Shandong Province China
- Ben-Gurion University; Negev Israel
| | - Junjie Wang
- Department of Radiation Oncology; Cancer Centre; Peking University Third Hospital; Beijing China
| | - Fujun Zhang
- Department of Medical Imaging & Interventional Radiology; Cancer Center and State Key Laboratory of Oncology in South China; Sun Yat-sen University; Guangzhou Guangdong China
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Garnon J, Koch G, Caudrelier J, Ramamurthy N, Rao P, Tsoumakidou G, Cazzato RL, Gangi A. Percutaneous Image-Guided Cryoablation of Challenging Mediastinal Lesions Using Large-Volume Hydrodissection: Technical Considerations and Outcomes. Cardiovasc Intervent Radiol 2016; 39:1636-1643. [DOI: 10.1007/s00270-016-1396-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 05/26/2016] [Indexed: 12/26/2022]
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Bex A. Integrating metastasectomy and stereotactic radiosurgery in the treatment of metastatic renal cell carcinoma. EJC Suppl 2015. [PMID: 26217128 PMCID: PMC4041303 DOI: 10.1016/j.ejcsup.2013.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Axel Bex
- The Netherlands Cancer Institute, Department of Urology, Amsterdam, The Netherlands
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Zhao M, Liu B, Li SY, Wang YZ, Li YL, Hertzanu Y. Experimental computed tomography-guided vena cava puncture in pigs for percutaneous brachytherapy of middle mediastinal lymph node metastases. Chin Med J (Engl) 2015; 128:1079-83. [PMID: 25881603 PMCID: PMC4832949 DOI: 10.4103/0366-6999.155097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Percutaneous brachytherapy is a valuable method for the treatment of lung cancer and mediastinal lymph nodes metastasis. However, in some of the metastatic lymph nodes in the middle mediastinum, the percutaneous approach cannot be used safely due to possible damage to surrounding anatomical structures. We established an animal model (group of 12 pigs) to assess the safety and feasibility of computed tomography (CT)-guided vena cava puncture. METHODS Under CT guidance, an 18G needle was used to puncture the anterior wall of the anterior vena cava (AVC) in 12 pigs. The 18G needle was chosen as it is similar in size to the needles employed for clinical application in brachytherapy. The incidence of complications and vital signs was monitored during the procedure. Thoracotomy was performed to remove AVC specimens, which were analyzed for histological evidence of vessel wall damage and repair. RESULTS Following postoperative enhanced CT, two animals were found to have a small pneumothorax (one being hemopneumothorax). The intraoperative oxygen saturation of both animals was not significantly decreased and was maintained at 93-100%. No animals developed mediastinal hematoma. Preoperative, intraoperative, and postoperative changes in blood pressure, heart rate, hemoglobin, and blood oxygen saturation were not significant. Histological evaluation of AVC specimens showed that by 7 days following the procedure, the endothelial layer was smooth with notable scar repair in the muscularis layer. CONCLUSIONS CT performed after the procedure and histological preparations confirmed the safety of the procedure. This indicates that percutaneous brachytherapy for metastatic middle mediastinal lymph nodes can be carried out via the superior vena cava.
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Affiliation(s)
- Min Zhao
- Physical Examination Centre, The Hospital of Shandong University, Shandong 250033, China
| | - Bin Liu
- Department of Interventional Medicine, The Second Hospital of Shandong University, Shandong 250033, China
| | - Sheng-Yong Li
- Department of Hepatobiliary Surgery, Weihai Municipal Hospital, Weihai, Shandong 264200, China
| | - Yong-Zheng Wang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Shandong 250033, China
| | - Yu-Liang Li
- Department of Interventional Medicine, The Second Hospital of Shandong University, Shandong 250033, China
| | - Yancu Hertzanu
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel
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Dabestani S, Bex A. Metastasectomy. KIDNEY CANCER 2015. [DOI: 10.1007/978-3-319-17903-2_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bex A. Metastasectomy. KIDNEY CANCER 2012. [DOI: 10.1007/978-3-642-21858-3_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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