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Related Experiment Videos

Incidental malignancy in internal thoracic artery lymph nodes.

L R Guo1, M L Myers, M E Kirk

  • 1Department of Pathology, London Health Sciences Centre, Ontario, Canada.

The Annals of Thoracic Surgery
|August 23, 2001
PubMed
Summary

Malignant internal thoracic lymph nodes, found incidentally during coronary bypass surgery, were diagnosed as breast cancer or lymphoma in three male patients. All patients remain disease-free years after treatment, highlighting the importance of examining enlarged nodes during surgery.

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Area of Science:

  • Cardiothoracic Surgery
  • Surgical Oncology
  • Pathology

Background:

  • Coronary artery bypass grafting (CABG) frequently involves mobilizing the internal thoracic artery (ITA).
  • The ITA pedicle may harbor lymph nodes, the pathological significance of which is often overlooked.
  • Incidental findings during surgery can lead to unexpected diagnoses and altered patient management.

Observation:

  • Three male patients undergoing CABG between 1990 and 1993 had malignant lymph nodes discovered within the ITA pedicle.
  • These lymph nodes were incidentally found during the mobilization of the internal thoracic artery.
  • The malignant nodes were identified as metastatic breast carcinoma in one patient and previously undiagnosed lymphomas in the other two.

Findings:

  • Malignant internal thoracic lymph nodes can be an incidental finding during internal thoracic artery mobilization for coronary bypass grafting.

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  • Diagnoses included metastatic breast carcinoma and lymphoma, highlighting diverse potential malignancies.
  • All three patients received appropriate further investigation and treatment, achieving long-term disease-free survival (6.8–9.8 years post-surgery).

    • Implications:

    • Surgeons should consider the possibility of primary or metastatic malignancy in enlarged internal thoracic lymph nodes encountered during ITA harvesting.
    • Pathological examination of abnormally enlarged lymph nodes from the ITA pedicle is crucial for accurate diagnosis and timely management.
    • This highlights the importance of vigilance for unexpected oncological findings in cardiovascular surgical procedures.