title: Contralateral cervicomediastinal lymph node metastases from clinically occult adenocarcinoma of the lung.
abstract: A 69-year-old woman with a right cervical lymphadenopathy presented with an adenocarcinoma on excisional biopsy. Computed tomography (CT) scans and a positron emission tomography scan demonstrated that the tumor was localized in the right paratracheal and cervical region. A clinical diagnosis of lung cancer arising from an unknown primary site was made based on the radiologic and immunohistochemical findings. Serial CT scans showed a growing nodule in the left apex from pinpoint size to 1 cm in diameter after several months, which was defined as the primary site at autopsy. The finding of a clinically occult lung cancer directly spreading to the contralateral mediastinal and cervical nodes by skipping ipsilateral hilar and mediastinal nodes is rare.
authors.affiliation: Division of Respiratory Medicine, Tokyo Metropolitan Geriatric Hospital, Japan.
authors.forename: Mayumi
authors.initials: M
authors.lastname: Hoshikawa
authors.forename: Hideaki
authors.initials: H
authors.lastname: Mochizuki
authors.forename: Mio
authors.initials: M
authors.lastname: Saito
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Noguchi
authors.forename: Motoji
authors.initials: M
authors.lastname: Sawabe
authors.forename: Hideki
authors.initials: H
authors.lastname: Takahashi
mesh_terms: D000368:Aged; D018279:Carcinoma, Signet Ring Cell / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods