第8巻 2012年4月　第2号

■症例から学ぶ

頸部リンパ節転移，縦隔リンパ節転移を初発症状とし，原発巣の同定が困難であったneuroendocrine carcinomaの1例
三浦　由記子^1,2, 峯岸　裕司², 齋藤　好信², 寺崎　美佳³, 福田　悠³, 弦間　昭彦^2
1日本医科大学大学院医学研究科呼吸器感染腫瘍内科学
²日本医科大学内科学（呼吸器・感染・腫瘍部門）
³日本医科大学病理学（解析人体病理学）

A Neuroendocrine Carcinoma from a Difficult-to-detect Primary Site Presenting as Neck and Mediastinal Lymphadenopathy
Yukiko Miura^1,2, Yuji Minegishi², Yoshinobu Saito², Mika Terasaki³, Yu Fukuda³ and Akihiko Gemma^2
1)Division of Pulmonary Medicine, Infection Deseases and Oncology, Graduate School of Medicine, Nippon Medical School
²⁾Department of Internal Medicine, Division of Pulmonary Medicine, Infection, and Oncology, Nippon Medical School
³⁾Department of Pathology, Nippon Medical School

An 83-year-old man presented with supraclavicular and mediastinal lymph nodes swelling and elevated serum levels of neuron-specific enolase (NSE), pro-gastrin-releasing peptide (pro-GRP), and cytokeratin fragment (CYFRA). He underwent supraclavicular lymph node dissection. The pathological diagnosis was metastatic lymph node neuroendocrine carcinoma. The initial diagnosis was small cell lung carcinoma c-TxN3M0 III B with an unknown primary site, because fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) had revealed increased uptake in the neck and mediastinal lymphadenopathy, but no significant intrapulmonary uptake. However, computed tomography (CT) of the chest had detected a lesion, which was assumed to be a vessel, in the right lower lung. The patient underwent radiotherapy, and CT of the chest 1 month later revealed a partial response of the lymph nodes. However, at the same time, disease recurred in the skin adjacent to the site of supraclavicular lymph node dissection, and the lesion in the right lower lung enlarged. We suspected that this intrapulmonary lesion was the primary site. Metastasis to cervical and mediastinal lymph nodes from an unknown primary carcinoma is rare, and the primary site should be determined so that appropriate treatment can be performed. If the primary site cannot be determined with the initial examination, regular follow-up examinations with CT, magnetic resonance imaging, and FDG-PET should be performed.

日医大医会誌 2012; 8(2), 162-167

Key words
unknown primary tumor, metastatic cervical cancer, metastatic mediastinal cancer, fluorine-18-fluorodeoxyglucose positron emission tomography

Correspondence to
Yukiko Miura, Department of Internal Medicine, Division of Pulmonary Medicine, Infection, and Oncology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku Tokyo 113-8603, Japan
E-mail：s7081@nms.ac.jp

受付：2011年11月14日　受理：2012年1月6日