A Case of Multiple Mediastinal Lymph Node Metastases of Hepatocellular Carcinoma Successfully Treated by Surgical Resection

Abstract

A 68-year-old woman had undergone caudal lobectomy for hepatocellular carcinoma (HCC) 6 years ago (moderately differentiated, pT2N0M0, pStage II). She was followed-up in another hospital, and serum alpha-fetoprotein (AFP) level was found elevated, so she was referred back to our hospital. Computed tomography (CT) showed a recurrence of HCC and two mediastinal tumors. We diagnosed the HCC recurrence and lymph node metastases. Since the metastases were localized, we performed surgery (extended left lobectomy and two mediastinal tumors' resection with median sternotomy). A pathological examination demonstrated local recurrence of moderately differentiated HCC and mediastinal lymph node metastases. Three months after the surgery, CT showed an enlarged mediastinal lymph node, and we suspected a recurrence of mediastinal lymph node metastasis. We observed the progress, and no other metastatic lesions had occurred. Hence, we performed tumor resection with right thoracotomy 13 months after the surgery. A pathological examination demonstrated the recurrence of mediastinal lymph node metastasis. After surgery, the tumor marker normalized. She has been well without recurrence for four years after the last operation. Surgical resection for multiple mediastinal lymph node metastases of HCC is a potential treatment option if metastases are limited.