2016 Volume 30 Issue 2 Pages 187-192
Axillary lymph node metastases from non-small-cell lung cancer (NSCLC) are categorized as distant metastases. The involvement of these nodes may spread through the chest wall. We report two patients with resected NSCLC thought to have ipsilateral axillary lymph node metastases on pre-operative positron emission tomography-computed tomography (PET-CT). The first patient was a 70-year-old woman. An abnormal lesion was noted on a screening chest radiograph, and she was referred to our department. Transbronchial aspiration cytology was performed, and she was diagnosed with adenocarcinoma of the right upper lobe of the lung. PET-CT revealed the accumulation of fluorodeoxyglucose in an ipsilateral axillary lymph node. A right upper lobectomy with lymph node dissection and surgical removal of the axillary lymph node were performed. The post-operative histologic diagnosis of the axillary lymph node specimen was hyperplasia with rheumatoid arthritis. The second patient was a 46-year-old woman. She complained of pain extending from the right axilla to the right upper arm. The primary tumor was located in the right upper lobe of the lung, and directly invaded the chest wall. She was diagnosed with adenocarcinoma of the right upper lobe of the lung. Fuorodeoxyglucose uptake was observed in the right axillary lymph nodes on PET-CT. A right upper lobectomy combined with chest wall resection was performed, and the ipsilateral hilar, mediastinal, and axillary lymph nodes were dissected. The post-operative pathologic findings confirmed metastases to the axillary lymph nodes. In this report, we also describe surgical indications for patients suspected to have ipsilateral axillary lymph node metastases.
