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R. Ustaalioglu
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P1.06 - Poster Session with Presenters Present (ID 458)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.06-002 - Contralateral Axillary Lymph Node Metastasis of a Lung Cancer: A Case Report (ID 5382)
14:30 - 14:30 | Author(s): R. Ustaalioglu
- Abstract
Background:
Primary lung cancer metastasis to axillary lymph node is rare. Routine examination of the axilla is useful way to detect suspicious nodes.
Methods:
We evaluated retrospectively medical and pathological records of a male patient at our division who had a primary lung cancer with M1b axillary lymph node metastasis.
Results:
A 66-year-old male presented with shortness of breath. His chest x-ray showed a large opacity in the lower one-half of the right lung field. Computed tomography (CT) imaging revealed a solid mass in the right hemithorax measuring 50x50 mm. Positron emission tomography/Computed tomography (PET/CT) demonstrated increased fluorodeoxygucose uptake (Standard uptake value: 9,9) by the mass. Fiberoptic bronchoscopy was performed and transbronchial biopsy was consistent with squamous cell carcinoma. Mediastinoscopy was performed to evaluate the stage of the tumor and biopsies from 2R, 2L, 4R, 4L, 7. mediastinal lymph nodes had negative results. Right lower lobectomy was planned and due to invasion of the right middle lob vein and bronchus, right lower bilobectomy and mediastinal lymph node dissection were performed. Pathological evaluation of the tumor and lymph nodes showed that staging of the tumor was T2b N1 (11. lymph node had metastasis, although 2,4,7,9. lymph nodes were metastasis free). Patient was discharged on post-operative 7. days and received chemotherapy 12 cycles. During follow-up PET/CT revealed increased FDG uptake by mass in the residual right lung(SUV:9.3) and axillary subcentimetric nodule(SUV:11.1). Physical examination of the patient revealed a palpable nodule in the right axilla. Ultrasound guided needle biopsy was performed to this nodule but it had negative result. Before performing pulmonary resection, we decided to dissect this lymph node. 30 months after right lower bilobectomy, axillary lymph node dissection was performed and frozen section procedure demonstrated squamous cell lung carcinoma metastasis to axillary lymph node. Pulmonary resection was cancelled and patient was discharged post operatively 3.day and received chemotherapy again. After 6 month follow-up the patient was dead.
Conclusion:
Routine physical examination of axilla is recommended even if mediastinal lymph nodes are metastasis free either at initial presentation or at follow-up of patients. In this case metastatic axillary lymph node was subcentimetric, although according to Austin et al. 14 mm or larger axillary lymph nodes are suggestive of adenopathy. Fishman et al. considered 15mm or larger single axillary lymph node without fatty center as abnormal. Without mediastinal lymph nodes metastasis, contralateral axillary lymph node metastasis could be of systemic origin.
