Metastatic thoracic lymph node carcinoma of unknown origin

Objective. Metastatic thoracic lymph node carcinoma of unknown origin is rare. Some surgical cases which had better outcome than expected were reported in the literature. However, the reason for this unexpected outcome, the etiology, and preferable treatment are unclear. We present a review of our cases. Methods. In the past 20 years, we encountered 8 cases of thoracic lymph node carcinoma of unknown origin. Here we review the clinical course, treatment, and outcome. Results. Four out of 8 patients had single station lymph node carcinoma (SS). Three patients had multistation lesions (MS). One patient had single station lesion with malignant pleural effusion (SS + MPE). SS cases underwent complete excision of the focal lymph node without additional therapy. MS cases underwent chemotherapy or radiation therapy after biopsy. The SS + MPE case received excision of the focal lymph node with additional chemotherapy. All patients in the SS group had long day survival without carcinoma bearing (21-108 months). All patients in the MS group died due to cancer within 1 year (mean survival time: 9.3 months). The SS + MPE patient survived 17 months with carcinoma. Conclusion. A single hilar lesion and complete excision may lead to a good outcome. Thoracic lymph node lesions should be surgically excised if complete excision is possible.