[Mediastinal dissection of hepatocellular carcinoma with bilateral hilar and mediastinal lymph node metastasis]

A 54 year-old man, who had been operated for hepatocellular carcinoma 43 months before, complained of frequent cough. He had widening of mediastinal shadow on chest X-ray film and high level of alpha-fetoprotein (197 ng/ml). Under the diagnosis of metastasis to mediastinum of hepatocellular carcinoma, lymph node dissection was performed and disclosed large metastatic tumors in subcarinal, right tracheobronchial and left hilar lymph nodes. After operation, frequent cough disappeared and alpha-fetoprotein level fell to 38 ng/ml. Metastasis to the mediastinum without lung metastasis of hepatocellular carcinoma was recognized only 2.6% in non-operated cases in annual of pathological autopsy cases in Japan 1980 and 4 case reports were found in literature with large metastatic mass shadow in mediastinum of hepatocellular carcinoma.