1998 Volume 38 Issue 1 Pages 57-62
A 49-year-old women was referred to our hospital because of an abnormal shadow in the upper right lung field and swelling of the mediastinal lymph nodes on chest X-rays. Lung cancer was diagnosed because adenocarcinoma cells were detected by brushing cytology with a bronchofiberscope. A diagnosis of stage IIIA (T1N2M0) lung cancer was made based on these findings and on CT images of the swollen mediastinal lymph nodes. An upper right lobectomy was undertaken. Pathologically metastasis was not revealed in the swollen lymph nodes, and epitheloid granuloma without necrosis replaced the follicular structure of the lymph node. A pathological diagnosis of stage I (p-T1N0M0) of well-differentiated adenocarcinoma and sarcoid-like reaction in the mediastinal lymph nodes was made, although she had no clinical sign of sarcoidosis. In summary, our case shows that the N factor is important in judging the operability of the lung cancer staging, although swelling of the mediastinal or hilar lymph nodes do not always indicate metastasis. Size criteria is not sufficient for the correct diagnosis of lymph node metastasis.
