title: Occult lung cancer incidentally found during surgery for esophageal and gastric cancer: a case report.
abstract: A 70-year-old male was admitted to our hospital because of advanced esophageal squamous cell carcinoma and early gastric adenocarcinoma. A esophagectomy and partial gastrectomy with three-field lymph node dissection (neck, mediastinum and abdomen) was performed. Both tumors had lymph node metastases. In addition, three mediastinal lymph nodes (two subcarinal lymph nodes and a middle thoracic paraesophageal lymph node) were involved with adenocarcinoma. To elucidate whether they were metastases from the gastric cancer, an immunohistochemical analysis was performed. The cancer cells in these lymph nodes were positive for cytokeratin (CK) 7 and negative for CK 20, thus suggesting metastasis from a nondigestive organ. Interestingly, they were positive for thyroid transcription factor 1 (TTF-1), indicating metastasis from a lung cancer. Since the preoperative computed tomographic scan showed no evidence of lung cancer, a diagnosis of metastases from an occult lung cancer was finally recorded. Ten months after surgery, the patient was alive without a recurrence or the appearance of a lung cancer.
authors.affiliation: Department of Surgery, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo 116-8567, Japan. nisohata2000@yahoo.co.jp
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Isohata
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Naritaka
authors.forename: Takeshi
authors.initials: T
authors.lastname: Shimakawa
authors.forename: Shinichi
authors.initials: S
authors.lastname: Asaka
authors.forename: Takao
authors.initials: T
authors.lastname: Katsube
authors.forename: Souichi
authors.initials: S
authors.lastname: Konno
authors.forename: Minoru
authors.initials: M
authors.lastname: Murayama
authors.forename: Shunichi
authors.initials: S
authors.lastname: Shiozawa
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Yoshimatsu
authors.forename: Motohiko
authors.initials: M
authors.lastname: Aiba
authors.forename: Hiroko
authors.initials: H
authors.lastname: Ide
authors.forename: Kenji
authors.initials: K
authors.lastname: Ogawa
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000601:surgery*; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D016609:Neoplasms, Second Primary / Q000175:diagnosis* / Q000473:pathology; D013274:Stomach Neoplasms / Q000601:surgery*