A case of small lung cancer with solitary skip metastasis of unilateral supraclavicular lymph node

Abstract

A 52-year-old male was pointed out as showing a small nodule (12×12×7 mm) on CT examination. Primary lung cancer was suspected. Lymph node swelling (8 mm) was also pointed out in the right supraclavicular region. It showed FDG accumulation on PET examination. Supraclavicular lymph nodal biopsy and partial resection of the upper lobe of the lung (VATS) were performed. Both lesions were diagnosed as adenocarcinoma. As standard surgical treatment with lobectomy could not be recommended because of the pStage IIIB disease, chemotherapy (CBDCA+PTX) was selected. Eight months after the initial treatment, recurrence appeared in the residual right upper lobe and interlobar lesion. Complete pneumonectomy and postoperative adjuvant chemotherapy (CBDCA+GEM) were performed. Recurrence in the supraclavicular lymph node appeared 1 year and 3 months after the last operation, and radiotherapy was performed. The patient was placed on oral S-1 therapy thereafter. As small lung carcinoma with solitary skip metastasis of a unilateral supraclavicular lymph node is a rare condition, a standard strategy has not been established. We selected multiple modality therapy in the present case, and the patient has survived without recurrence for 4 years and 6 months since the initial treatment.