A CASE OF SMALL ADENOCARCINOMA OF THE LUNG WITH DISTANT NODAL METASTASES SUGGESTED BY FDG-PET CT

Abstract

A 70-year-old man complaining of hoarseness diagnosed as having left recurrent nerve paralysis by anotolaryngologist was referred to our hospital for further examination and treatment.
There were no abnormal findings on physical examination of the head and neck region, cervical ultrasonography and gastrointestinal fiberscopy. Chest CT scan showed a 1.1×1.0cm nodular shadow in the left segment 4b of the lung, but enlarged hilar and mediastinal lymph nodes were absent. Cervical CT scan showed two small nodules 0.8cm in diameter which were adjacent to the trachea. Surgical extirpations were indicated for all lesions because of high accumulation on FDG-PET CT. A wedge resection of the middle lobe of lung was performed by VATS, and the pulmonary nodule was diagnosed as papillary adenocarcinoma by the frozen section. A middle lobectomy with systematic nodal dissection (ND2a) was done. Pathological examination revealed no hilar and mediastinal lymph node metastaseE of adenocarcinoma. The pathological diagnoses of two cervical nodules after the extirpation were metastatic lymph nodes of adenocarcinoma of the lung. FDG-PET CT was useful not only for making biological diagnosis of the pulmonary nodular shadow, but also for identifying distant nodal metastases of adenocarcinoma of lung in this patient.