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Metastatic thoracic lymph node carcinoma with unknown primary site.
Marc Riquet1, Cécile Badoual, Barthes Françoise le Pimpec
1Service de Chirurgie Thoracique, Hôpital Européen Georges Pompidou, Paris, France. marc.riquet@hop.egp.ap-hop-paris.fr
The Annals of Thoracic Surgery
|January 23, 2003
Summary
Metastatic cancer in thoracic lymph nodes without a known primary site is rare but treatable. Surgical resection can improve survival rates for this underestimated condition.
Area of Science:
- Oncology
- Thoracic Surgery
- Pathology
Background:
- Metastatic cancer in thoracic lymph nodes without a discernible primary tumor is an uncommon clinical presentation.
- This entity is likely underestimated due to diagnostic challenges and routine non-operative management.
Purpose of the Study:
- To highlight the existence of metastatic cancer in thoracic lymph nodes with an unknown primary site.
- To explore potential origins of these metastatic tumors.
- To propose treatment guidelines for this condition.
Main Methods:
- Retrospective review of eight heavy smokers diagnosed with malignant cells in intrathoracic lymph nodes (N1 or N2) during surgery, with no identified primary lung cancer.
- Analysis included surgical resection types, histopathology, immunohistochemistry, treatment regimens, and patient survival.
- Exploratory thoracotomy was the primary surgical approach, with one case of mucosa-associated lymphoid tissue lymphoma.
Main Results:
- Surgical resections included pneumonectomy, lobectomy, and bilobectomy, all with complete mediastinal lymph node dissection.
- Malignant cells, confirmed as epithelial by cytokeratin positivity, were found in intrapulmonary and/or mediastinal lymph nodes.
- A 5-year survival rate of 62.5% was observed, with three early deaths and the remaining patients disease-free.
Conclusions:
- Metastatic cancer to thoracic lymph nodes without a primary site is likely underdiagnosed, often being dismissed as unresectable metastatic disease.
- Determining the precise origin (pulmonary, endogenous, or extrathoracic) can be challenging.
- Surgical intervention, when feasible, can significantly improve patient survival, emphasizing the need for diagnosis and consideration of resectability.