A Case of Mediastinal Lymph Node Metastasis from a Colorectal Liver Metastasis Successfully Treated by Surgical Resection

Abstract

The patient was a 59-year-old woman who visited our hospital with the chief complaint of thin stools. Colonoscopy revealed a tumor in the descending colon, and abdominal CT led to the identification of 4 liver metastases (S1,2,4). The patient was diagnosed as having descending colon cancer with multiple liver metastases, and we performed radical resection. XELOX chemotherapy was administered as adjuvant therapy; however, it had to be discontinued after 7 cycles due to the occurrence of liver damage. Chest CT performed 16 months after the surgery showed that the inferior mediastinal lymph nodes were enlarged, and PET-CT further showed excessive accumulation in a mediastinal lymph node. Since there were no other findings suggestive of recurrence, we performed surgical resection of the node. Postoperative histopathology showed lymph node metastasis from colorectal cancer. As there was no evidence of metastasis in the periaortic lymph nodes, it was likely a solitary metastasis originating from the liver metastases. Adjuvant therapy was not given at the request of the patient, and she has been recurrence-free for 8 years since the second surgery. Solitary metastasis from colorectal liver metastases to the mediastinal lymph nodes is rare, and treatment strategies for such cases are not yet well-defined. Our findings suggest that surgical resection may contribute to improved prognosis.